Question: Should IV push Lopressor be given on medical/surgical units where there is no cardiac monitoring?

Complete Question: Should IV push Lopressor (metoprolol) be given on medical-surgical units where there is no cardiac monitoring?

Answer: Our review reveals that the best practice is to ensure the patient receiving metoprolol has a cardiac monitor in place.

The manufacturer recommends that patients who are receiving IV metoprolol have their heart rate, blood pressure and ECG monitored during administration. This allows the nurse to detect hypotension, bradycardia or atrioventricular block, which may occur rapidly. No recommendation is provided for ongoing monitoring (Physicians Digital Reference, 2019)

The American Heart Association recommends that cardiac monitoring be considered for patients who are undergoing initiation of medications which may lower heart rate when symptomatic bradycardia is a concern (Sandau, et al.2019). Metoprolol may decrease the heart rate (Physicians Digital Reference, 2019).

Some facilities may require additional training or competency validation for nurses who administer IV metoprolol.

Based on these recommendations, it would be appropriate to administer intravenous metoprolol on a medical-surgical unit, if cardiac monitoring is available.

We encourage you to review the information provided and work within your organization to further address your question.

References:

(Updated June 2019)
(Published March 2015)