Quick facts
| Fact | Metoprolol |
|---|---|
| Drug class[2] | Beta-1 selective (cardioselective) beta blocker |
| Used for (TOPROL-XL)[2] | High blood pressure, long-term treatment of angina, and heart failure |
| Main safety warning[2] | Stopping it abruptly can worsen angina and, in some cases, lead to a heart attack, so the prescriber reduces it gradually |
| Check before each dose[1] | Apical pulse and blood pressure; follow the order's hold parameters |
| Contraindications[2] | Sick sinus syndrome without a pacemaker, severe bradycardia, heart block beyond first degree, cardiogenic shock, decompensated heart failure |
| Tablet handling[2] | TOPROL-XL tablets have a score line and may be split, but never crushed or chewed |
| High-alert status[3] | IV metoprolol falls under ISMP's high-alert IV adrenergic antagonists |
Before giving metoprolol: apical pulse, blood pressure and the order's parameters
- Take the apical pulse and blood pressure before each dose. Hold parameters are often written in the order; Open RN's common example is holding a beta blocker for a heart rate under 60/min and calling the provider.[1]
- Check the medication list for digoxin, clonidine, diltiazem and verapamil, which also slow AV conduction and heart rate and raise the bradycardia risk with metoprolol.[2]
- Ask about asthma or other bronchospastic disease. Metoprolol's beta-1 selectivity isn't absolute: at higher plasma levels it also blocks beta-2 receptors in the airways.[2]
- In a patient with diabetes, check glucose more closely. Beta blockers can hide early signs of hypoglycemia, such as a fast heart rate, and fasting or vomiting raises the risk.[1][2]
Report a slow pulse, low blood pressure, breathing trouble, and weight gain in heart failure
- Severe slowing can happen: sinus pause, heart block and even cardiac arrest have been reported. Report bradycardia; for severe bradycardia, the label calls for reducing or stopping the drug.[2]
- Common reactions include tiredness, dizziness, depression, shortness of breath, bradycardia and hypotension.[2]
- Weight gain or increasing shortness of breath can mean worsening heart failure.[2]
- Wheezing, cold hands and feet, and worse symptoms of peripheral vascular disease have also been reported.[2]
Teach the patient not to stop it suddenly and to check pulse and blood pressure
- Take it regularly, preferably with or right after a meal. After a missed dose, take only the next scheduled one; don't double it.[2]
- Don't stop or interrupt it without talking to the prescriber.[2]
- Check pulse and blood pressure at home and report abnormal readings.[1]
- Avoid driving or other tasks that need alertness until the response to the drug is known.[2]
- Patients with heart failure call the provider about weight gain or more shortness of breath.[2]
- Tell the surgeon or dentist about it before any surgery.[2]
Drill metoprolol, lisinopril, and furosemide in the Cardiovascular and renal medicines flashcard deck.
Browse flashcardsHow it shows up on nursing exams
- Before giving metoprolol, check the apical pulse and blood pressure against the hold parameters in the order.[1]
- A beta blocker can hide the fast heart rate that warns of low blood sugar, so watch glucose in patients with diabetes.[2]
- Stopping it abruptly can worsen angina or lead to a heart attack, so any stop goes through the prescriber.[2]
- Every beta blocker NIDDK LiverTox names, from acebutolol to timolol, ends in -lol.[4]
Practice question
A 64-year-old patient with hypertension and stable angina takes metoprolol succinate extended-release each morning. At 0845, before the 0900 dose, respirations are 16/min, SpO2 is 97% on room air and the lungs are clear. Which finding should the nurse act on before giving the dose?
- A. Apical pulse 48/min at rest
- B. Blood pressure 134/82 mm Hg sitting
- C. Mild tiredness since last week
- D. Cool fingers this morning
Show the answer and why
Correct answer: A. Apical pulse 48/min at rest
- A. Correct. A heart rate under 60/min is the common beta-blocker hold parameter Open RN describes: withhold the dose and call the provider unless the order sets other parameters. The label also warns that severe bradycardia can occur.
- B. Incorrect. This blood pressure isn't low, so it gives no reason to hold the dose; lowering blood pressure is what the drug is for.
- C. Incorrect. Tiredness is one of the most common metoprolol reactions and doesn't on its own call for holding the dose.
- D. Incorrect. Cold extremities are a reported effect worth noting, but they don't outrank a heart rate of 48/min.
Sources for this question: [1][2]
Memory hook: The -lol drugs lower heart rate and blood pressure, so check both before every dose.