Rate Control Medications
Medication
Classification
Indication
Dosage
Nursing
Implications
Patient Education
Diltiazem
Calcium
Channel Blocker
Acute
RVR in
AFib
IV: Initial
0.25 mg/kg
bolus over 2
minutes, may
repeat in 15
minutes.
Continuous
infusion: 5-15
mg/h. Oral:
120-360 mg
daily
Monitor BP and
HR before
administration.
Caution in
patients with
heart failure.
Watch for
hypotension and
bradycardia.
Avoid grapefruit
juice. Do not stop
abruptly. Report
dizziness, fainting,
or an irregular
heartbeat.
Metoprolol
Beta-Blocker
Acute
RVR in
AFib; Rate
control
IV: 2.5-5 mg
every 2-5
minutes for a
total of 15
mg. Oral: 25-
100 mg BID
Monitor BP and
HR before and
after
administration.
Caution in
patients with
asthma or
COPD. Watch
for hypotension
and bradycardia.
Take with food. Do
not stop abruptly.
Report difficulty
breathing, dizziness,
or unusual fatigue.
Digoxin
Cardiac
Glycoside
Rate
control in
AFib,
especially
with heart
failure
IV: 0.25 mg
every 2 hours
up to a total
dose of 1.5
mg. Oral:
0.125-0.25
mg daily
Monitor HR and
ECG for
arrhythmias.
Assess for signs
of digoxin
toxicity (nausea,
vomiting, visual
disturbances).
Monitor
potassium levels.
Take at the same
time each day.
Report symptoms of
toxicity, such as
blurred vision or
nausea. Maintain
consistent dietary
potassium intake.
Esmolol
Beta-Blocker
Acute
RVR in
AFib
IV: 500
mcg/kg bolus
over 1
minute,
followed by
50-200
mcg/kg/min
infusion
Monitor BP, HR,
and ECG during
administration.
Watch for
hypotension and
bradycardia.
Inform healthcare
provider of any
breathing difficulties
or dizziness. Report
any signs of a slow
or irregular
heartbeat.
