TABLE 21.

Pharmacological Agents for Rate Control in Patients With AF

	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 or twice daily in divided doses	3-7 h
Atenolol	N/A	25-100 mg daily	6-7 h	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 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 HFrEF
Verapamil	5-10 mg over ≥2 min (may repeat twice); then 5 mg/h continuous infusion (max 20 mg/h)	180-480 mg daily (ER)	IV: 6-8 h Oral: 2-7 h ER: 12-17 h	Avoid in HFrEF
Digitalis glycoside
Digoxin	0.25-0.5 mg over several min; repeat doses of 0.25 mg every 6 h (maximum 1.5 mg/24 h)	0.0625-0.25 mg daily	1-2 d	Renally eliminated Increased mortality at plasma concentrations exceeding 1.2 ng/mL
Other
Amiodarone	150-300 mg IV over 1 h, then 10-50 mg/h over 24 h	100-200 mg daily (generally IV form used for rate control)	IV: 9-36 d Oral: 26-107 d	Loading dose 6-10 g administered over 2-4 wk; can combine IV and oral dosing to complete

AF indicates atrial fibrillation; ER, extended release; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; and N/A, not applicable.