On the first legs of the Painkiller tour in Canada, the song was performed with a drum solo from Scott Travis, however, for the rest of the tour, the song was made as part of a medley with "Riding on the Wind" from Screaming for Vengeance, with the guitar duel, leading into the drum intro to "Riding on the Wind", before the full song is played, then the drum solo. Finally the band returns with the riff of Metal Meltdown but Halford singing "Riding on the Wind" instead. A possible reason for the change to a medley, was that, when one listens to recordings of the full version of Metal Meltdown performed live in 1990, Rob seems have problems keeping up with the speed of some of the verses.
During the Jugulator tour and featured on '98 Live Meltdown, the song was performed without the guitar duel intro and without a drum solo. It was not performed after that tour.