Esmolol
BREVIBLOC
What it isUltra-short-acting IV beta-1 blocker cleared by red-cell esterases; acute tachyarrhythmia and perioperative control.
Why this oneA nine-minute half-life means a mistake wears off in minutes, which is why it suits unstable patients.
What limits itInfusion only, and large volumes at high doses. Bradycardia and hypotension; avoid in decompensated heart failure.
FDA-approved for
- acute tachyarrhythmias (IV) (1986)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Supraventricular tachycardia / noncompensatory sinus tachycardia | Adults | Optional load 500 mcg/kg over 1 min, then 50 mcg/kg/min infusion | 50-200 mcg/kg/min | 200 mcg/kg/min |
| Perioperative tachycardia / hypertension | Adults | Load 500 mcg/kg over 1 min (or 1 mg/kg over 30 s for immediate control), then 50 mcg/kg/min | 50-200 mcg/kg/min | 200 (tachycardia) / 300 (hypertension) mcg/kg/min |
Titration Titrate using ventricular rate or blood pressure at intervals of >=4 minutes
Renal Undefined
Hepatic Undefined
Maintenance doses >200 mcg/kg/min not recommended for ventricular rate control
Instructions
- Administer by continuous IV infusion
- Effective maintenance dose 50-200 mcg/kg/min
- Maintenance infusions may continue up to 48 hours
Contraindications
- Severe sinus bradycardia
- Heart block greater than first degree; sick sinus syndrome
- Decompensated heart failure
- Cardiogenic shock
- IV cardiodepressant calcium-channel antagonists (e.g., verapamil) in close proximity
- Pulmonary hypertension
Cautions
- Hypotension (dose-related)
- Bradycardia incl. sinus pause/cardiac arrest
- Cardiac failure
- Exacerbation of reactive airway disease
- Masks symptoms of hypoglycemia in diabetes
- Unopposed alpha-agonism/severe hypertension in untreated pheochromocytoma
- Myocardial ischemia on abrupt discontinuation in CAD
Adverse reactions
- Hypotension (symptomatic and asymptomatic)
- Infusion site reactions
- Nausea
- Dizziness
- Somnolence
Pregnancy Use only if benefit justifies risk; fetal bradycardia reported with use in last trimester/labor
Lactation Unknown whether excreted in human milk; weigh importance to mother
NO BOXED WARNINGS
Principal riskBradycardia; avoid in decompensated heart failure
Classes and tags
Clinical profile
Mechanism of action: Esmolol ballicule
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Memory aids: mascots and interaction avatars
