Drug reference

Esmolol

Beta Blocker · Antiarrhythmic, Antihypertensive

Also known as Esmolol hydrochloride, Brevibloc

Beta BlockerAntiarrhythmic, AntihypertensiveATC C07AB09

CDSCO approvedATC C07AB09

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

—

not curated

Top interactionssee all 12 →

AdrenalineSevereTextbookKDT 7e · p133
AmilorideSevereTextbookKDT 7e
SofosbuvirSevereTextbookHarrison 22e · unknown
TriamtereneSevereTextbookKDT 7e

Mechanism

Esmolol, as a cardioselective beta-blocker, primarily blocks beta-1 adrenergic receptors in the heart. This action attenuates the effects of the sympathetic nervous system on cardiac automaticity and conductivity. By doing so, it reduces heart rate, myocardial contractility, and conduction velocity.

Indications

Short-term treatment of supraventricular arrhythmiasSinus tachycardiaHypertension, particularly in the peri-operative periodAcute myocardial infarction when sustained beta-blockade might be hazardousprevent or treat tachycardia (during surgery)supraventricular tachycardiasevere postoperative hypertensionRate control of rapidly conducted atrial fibrillation (IV)Situations requiring immediate β adrenergic blockadeAcute treatment of hypertensionEpisodic atrial fibrillation or flutterArrhythmia during anaesthesiaReduction of HR and BP during and after cardiac surgeryEarly treatment of myocardial infarctionEmergency control of ventricular rate in atrial fibrillation (AF)Emergency control of ventricular rate in atrial flutter (AFl)Termination of supraventricular tachycardiaArrhythmias associated with anaesthesia (when rapid β-adrenergic blockade is desired)Termination of Torsades de pointes (i.v.)Hypertensive emergenciesAortic dissection (to reduce cardiac contractility and work)Hypotensive and bradycardiac drug during and after anaesthesia

Dosing

Adult: By intravenous infusion: 50–200 micrograms/kg/minute; consult product literature for details of dose titration and doses during peri-operative period.

Pharmacokinetics

Onset

rapid onset (within 6-10 min for peak hemodynamic effects)

Duration

Very short duration of action

Half-life

about 8 min; carboxylic acid metabolite ~4 h

Protein binding

substantial diminution of β blockade within 20 min of stopping infusion

Metabolism

hydrolyzed rapidly by esterases in erythrocytes

Contraindications

Uncontrolled heart failure (general beta-blocker contraindication)
Hypotension (general beta-blocker contraindication)
Bradyarrhythmias (general beta-blocker contraindication)
Obstructive airways disease (general beta-blocker contraindication)
Concomitant use with verapamil in established ischaemic heart disease (risk of precipitating heart failure)
patients already on β blocker therapy
bradycardic patients
patients with decompensated heart failure
Asthma
Peripheral vascular disease
Hypoglycemia