Early treatment: 3 bolus IV inj of 5 mg given approx at 2-min interval. Shifting to oral therapy: Patients who tolerate full IV dose 50 mg metoprolol tartrate tab 6 hrly, initiated at 15 min after the last IV dose & continued for 48 hr. Patients who do not tolerate full IV dose 25 or 50 mg metoprolol tartrate tab 6 hrly, initiated at 15 min after the last IV dose as soon as clinical condition allows. Late treatment: Patients w/ contraindications to early phase treatment, cannot tolerate full early treatment or in whom physician wishes to delay therapy 100 mg metoprolol tartrate tab twice daily as soon as clinical condition allows & continued for at least 3 mth.
Discontinue treatment if heart failure occurs or persists. Monitor hemodynamic status of the patient during therapy. If bradycardia or heart block occurs, discontinue treatment & administer atropine IV. If atropine is not successful, administer isoproterenol or consider installation of a cardiac pacemaker. If hypotension occurs, discontinue treatment & assess hemodynamic status of the patient & the extent of myocardial damage. Patients w/ bronchospastic diseases. Impaired hepatic function. Pregnancy & lactation. Childn. Elderly.
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