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Esmolol

    Brands

    DEA Class;  Rx

    Common Brand Names; Brevibloc

    • Antidysrhythmics, II; 
    • Beta-Blockers, Beta-1 Selective

    Intravenous beta-blocker
    Used for short-term treatment of supraventricular tachycardia, including atrial fibrillation and atrial flutter, noncompensatory sinus tachycardia, and perioperative tachycardia and hypertension
    Rapid onset, short duration

    Indicated for the short-term treatment of noncompensatory sinus tachycardia or paroxysmal supraventricular tachycardia (PSVT), including atrial fibrillation and atrial flutter.

    For the short-term treatment of perioperative hypertension and/or tachycardia.
    For the short-term treatment of postoperative hypertension and/or tachycardia.
    For the treatment of ventricular tachycardia.
    For the treatment of hypertensive urgency or hypertensive emergency.
    For the treatment of thyrotoxicosis.

    Hypersensitivity

    Sinus bradycardia, 2°/3° heart block, cardiogenic shock, overt cardiac failure

    Asthma/COPD

    Sick sinus syndrome without permanent pacemaker

    • Hypotension, asymptomatic (25-38%)
    • Hypotension, symptomatic (12%)
    • Injection site pain (8%)
    • Nausea (7%)
    • Dizziness (3%)
    • Somnolence (3%)
    • Agitation (2%)
    • Confusion(2%)
    • Headache (2%)
    • Fatigue (1%)
    • Vomiting (1%)
    • Bradycardia
    • Chest pain
    • Anxiety
    • Anorexia
    • Depression
    • Abdominal discomfort
    • Constipation
    • Dry mouth
    • Dyspepsia
    • Taste perversion
    • Bronchospasm
    • Dyspnea
    • Nasal congestion
    • Wheezing

    Anesthesia/surgery (myocardial depression), bronchospastic disease, cerebrovascular insufficiency, CHF, DM, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions

    Sudden discontinuation can exacerbate angina and lead to myocardial infarction

    Increased risk of stroke after surgery

    Use in pheochromocytoma

    Avoid abrupt withdrawal

    Pregnancy Category: C; D in 2nd and 3rd trimesters (expert analysis)

    Lactation: excretion in milk unknown; use with caution

    Adults

    500 mcg/kg/dose IV load and 300 mcg/kg/minute continuous IV infusion.

    Geriatric

    500 mcg/kg/dose IV load and 300 mcg/kg/minute continuous IV infusion.

    Adolescents

    Safety and efficacy have not been established; however, 1,000 mcg/kg/dose IV load and 1,000 mcg/kg/minute continuous IV infusion have been used.

    Children

    Safety and efficacy have not been established; however, 1,000 mcg/kg/dose IV load and 1,000 mcg/kg/minute continuous IV infusion have been used.

    Infants

    Safety and efficacy have not been established; however, 1,000 mcg/kg/dose IV load and 1,000 mcg/kg/minute continuous IV infusion have been used.

    Neonates

    Safety and efficacy have not been established; however, 500 mcg/kg/dose IV load and 1,000 mcg/kg/minute continuous IV infusion have been used.

    Esmolol hydrochloride

    infusion bags

    • 2g/100mL
    • 2.5g/250mL

    injectable solution

    • 10mg/mL
    • 20mg/mL