Esmolol

Esmolol is a prescription medication used to treat Intraoperative Tachycardia/Hypertension, Supraventricular Tachycardia, and Hypertensive Emergency. 

• Esmolol is available under the following different brand names: Brevibloc

Adult dosage

Infusion bags

• 2g/100mL
• 2.5g/250mL

Injectable solution

• 10mg/mL
• 20mg/mL

Intraoperative Tachycardia/Hypertension

Adult dosage

Immediate control

• Initial bolus: 80 mg (~1 mg/kg) IVP over 30 seconds, then
• 0.15-0.3 mg/kg/min IV infusion as needed

Postoperative/gradual control

• Load 0.5 mg/kg IV over 1 minute, then 
• 0.05 mg/kg/min IV for 4 minutes
• If inadequate response in 5 minutes:
• 2nd loading dose of 0.5 mg/kg/min for 1 minute, then
• 0.1 mg/kg/min IV

Supraventricular Tachycardia

Adult dosage

• Load: 0.5 mg/kg IV over 1 minute, then
• Maintenance: Start 0.05 mg/kg/min IV for 4 minutes, may increase by 0.05 mg/kg up to 0.2 mg/kg/min
• If HR/BP not controlled after 5 minutes, repeat bolus (i.e., 500 mcg/kg/min for 1 minute), then initiate infusion of 0.1 mg/kg/min IV
• May administer a 3rd bolus if needed, then a maintenance infusion of 0.15 mg/kg/min IV
• Higher maintenance doses may be required, up to 0.25-0.3 mg/kg/min

Hypertensive Emergency

Adult Dosage

• Load: 0.25-0.5 mg/kg IVP over 1 minute, then
• 0.05-0.1 mg/kg/min IV for 4 minutes
• May repeat loading dose or increase infusion up to 0.3 mg/kg/min if necessary

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Esmolol include:

• increased sweating, 
• nausea, 
• dizziness, 
• drowsiness, and
• low blood pressure

Serious side effects of Esmolol include:

• hives, 
• difficult breathing, 
• swelling in the face or throat, 
• lightheadedness, 
• very slow heartbeats, 
• swelling in the hands or feet, 
• wheezing, 
• chest tightness, 
• shortness of breath, 
• weak or shallow breathing, 
• pain, swelling, irritation, bruising, or skin changes around the injection site. 
• cold feeling in the hands and feet,
• nausea, 
• fast, slow or unusual heart rate, 
• weakness, 
• loss of movement, 
• headache, 
• hunger, 
• sweating, 
• irritability, 
• dizziness, 
• nausea, 
• anxiety, and
• shakiness

Rare side effects of Esmolol include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Esmolol has severe interactions with no other drugs.
• Esmolol has serious interactions with at least 22 other drugs. 
• Esmolol has moderate interactions with at least 172 other drugs.
• Esmolol has minor interactions with at least 32 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity 
• Sinus bradycardia, 2o/3o heart block, cardiogenic shock, overt cardiac failure
• Asthma/COPD
• Sick sinus syndrome without permanent pacemaker

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Esmolol?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Esmolol?”

Cautions

• 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 and Lactation

• Use with caution in benefits outweigh risk during pregnancy; use in LIFE-THREATENING emergencies when no safer drug is available in 2nd and 3rd trimesters (expert analysis). Positive evidence of human fetal risk.  
• Lactation: excretion in milk unknown; use with caution.