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CARDIOVASCULAR SYSTEM › BETA BLOCKING AGENTS › BETA BLOCKING AGENTS › Beta blocking agents, selective
esmolol
C07AB09
Forms & Strengths
- Intravenous solution: 10 mg/mL (10 mL ampule)
- Premixed intravenous infusion: 200 mg/100 mL (2 mg/mL)
- Premixed intravenous infusion: 250 mg/250 mL (1 mg/mL)
- Concentrate for intravenous infusion: 250 mg/10 mL
Adult Dosing
- Supraventricular tachycardia (SVT) / Atrial fibrillation / Atrial flutter: Loading dose 500 mcg/kg/min over 1 minute, followed by maintenance infusion of 50 mcg/kg/min for 4 minutes. If inadequate response, repeat loading dose and titrate maintenance infusion up by 50 mcg/kg/min increments (max 200 mcg/kg/min).
- Perioperative hypertension / Tachycardia: Loading dose 80 mg (about 1 mg/kg) over 30 seconds, followed by infusion of 150 mcg/kg/min, titrated up to 300 mcg/kg/min; alternatively, loading dose 500 mcg/kg/min for 1 minute then 50 mcg/kg/min infusion.
Pediatric Dosing
- Hypertension / Tachycardia (off-label): Loading dose 100 to 500 mcg/kg administered intravenously over 1 minute.
- Maintenance infusion (off-label): Start at 25 to 100 mcg/kg/min, titrate up to 300 to 500 mcg/kg/min as needed.
Indications
- Rapid control of ventricular rate in atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances
- Short-term treatment of tachycardia and hypertension occurring perioperatively
- Non-interchangeable management of supraventricular tachycardia (off-label)
Mechanism of Action
- Class II antiarrhythmic and cardioselective beta-1 receptor antagonist
- Decreases heart rate, myocardial contractility, and atrioventricular nodal conduction
- Ultra-short duration of action due to rapid metabolism by red blood cell esterases (half-life approximately 9 minutes)
Contraindications
- Sinus bradycardia
- Second- or third-degree atrioventricular (AV) block without a pacemaker
- Decompensated heart failure
- Cardiogenic shock
- Hypersensitivity to esmolol or any component of the formulation
- Pre-existing pulmonary hypertension (relative)
Adverse Reactions
- Hypotension (frequently dose-dependent and rapidly reversible upon discontinuation)
- Asymptomatic or symptomatic bradycardia
- Injection site reactions (inflammation, induration, thrombophlebitis)
- Dizziness, somnolence, confusion, headache
- Nausea, vomiting
- Diaphoresis, asthenia
Drug Interactions
- Concomitant administration with calcium channel blockers (e.g., verapamil, diltiazem) may lead to severe depression of myocardium and AV conduction
- May increase serum concentration and toxicity of digoxin
- Concurrent use with anesthetics that depress myocardial function (e.g., ether, chloroform) can produce additive hypotensive effects
- Catecholamine-depleting drugs (e.g., reserpine) administered concurrently may produce additive reductions in sympathetic activity
- Anticoagulants or antithrombotics may increase bleeding risks when combined with injection site irritation
Curated Content: Needs Vetting Before Put to Clinical Use