title: Safety of intravenous metoprolol use in unmonitored wards: a single-centre observational study.
abstract: OBJECTIVE
  This study aims to examine and quantify the risks associated with the use of intravenous metoprolol on unmonitored wards.
  
  
  METHODS
  This study was a retrospective single-centre observational study from 1 January 2009 to 31 December 2013. The study hospital was a 415-bed, private hospital in Melbourne, Victoria. The study population was all patients who received intravenous metoprolol on an unmonitored ward. The primary outcome measure was the rate of serious adverse events (SAE), defined as a complication of intravenous metoprolol resulting in transfer to a critical-care environment, a medical emergency team call or death.
  
  
  RESULTS
  Six hundred and nine patients received a total of 8260 doses of intravenous metoprolol. Seven cases were identified with a SAE deemed possibly related to beta-blocker use and there was one death. All SAE were hypotension, giving an overall rate of hypotension of 7/609 or 1.1% (95% confidence interval (CI), 0.5 to 2.4%) with a rate per dose delivered of 0.8/1000 doses (95% CI 0.3 to 1.7). The death occurred in a 94-year-old woman with abdominal sepsis. After case file review, consensus opinion deemed this to be unrelated to intravenous metoprolol.
  
  
  CONCLUSIONS
  The use of intravenous metoprolol on unmonitored wards appears to be safe. The complication rate was low, suggesting that this may be a sensible approach to the management of in-hospital populations at risk of beta-blocker withdrawal.
authors.affiliation: Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Kelly
authors.affiliation: Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Hawdon
authors.affiliation: Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Reeves
authors.affiliation: Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Morris
authors.affiliation: Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Cunningham
authors.affiliation: Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Barrett
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D004305:Dose-Response Relationship, Drug; D006339:Heart Rate / Q000187:drug effects*; D016304:Hospitals, Private; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D007275:Injections, Intravenous; D008790:Metoprolol / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol
keywords: beta-blocker; intravenous; metoprolol; risk; serious adverse event; unmonitored