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Table 21. Pharmacological Agents for Rate Control in
Patients With Atrial Fibrillation
Intravenous
Administration
Oral
Maintenance
Dose
Elimination
Half-Life Notes
Beta blockers
Metoprolol
tartrate
2.5–5 mg bolus over
2 min; up to 3 doses
25–200 mg
twice daily
3–4 h
Metoprolol
succinate
N/A 50–400 mg
daily
3–7 h
Atenolol N/A 25–100 mg
daily
6–7 h Predominantly
renally
eliminated
Bisoprolol N/A 2.5–10 mg
daily
9–12 h
Carvedilol N/A 3.125–25 mg
twice daily
7–10 h
Esmolol 500 µg/kg bolus
over 1 min; then
50–300 µg/kg/min
N/A 9 min
Nadolol N/A 10–240 mg
daily
20–24 h
Propranolol 1 mg over 1 min;
repeat as needed
every 2 min; up to
3 doses
10–40 mg 3–4
times daily
IV: 2.4 h
Oral: 3–6 h
Extended
release (ER:)
8–20 h
Nondihydropyridine calcium channel blockers
Diltiazem 0.25 mg/kg (actual
body weight) IV
over 2 min
May repeat 0.35
mg/kg over 2 min;
then 5–15 mg/h
continuous infusion
120–360 mg
daily (ER)
IV: 3–5 h
Oral
immediate
release:
3–4.5 h
ER: 4–9.5 h
Avoid in
heart failure
with reduced
ejection
fraction
(HFrEF)
