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Esmolol hydrochloride

Beta Blocker · Anti-arrhythmic, Antihypertensive

Also known as Esmolol, Brevibloc

Beta BlockerAnti-arrhythmic, Antihypertensive
CDSCO approvedSchedule H
Pharmacokineticsplasma · t hours
8minONSET8minPEAK8min20minDURATION
ONSET
8min · Rapid onset; peak hemodynamic effects occur within 6-10 minutes of administration of a loading dose
PEAK
8min · Peak hemodynamic effects occur within 6-10 minutes of administration of a loading dose
8min · Approximately 8 minutes (esmolol); approximately 4 hours (carboxylic acid metabolite)
DURATION
20min · Very short duration of action, substantial attenuation of beta blockade within 20 minutes of stopping an infusion
EXCRETION
not curated
INTERACTIONS
9 major
incl. contraindicated
PREGNANCY
not curated
Top interactionssee all 12
  • DiltiazemContraindicatedTextbookG&G 14e · p617
  • RitodrineContraindicatedTextbookKDT 7e · p333
  • AdrenalineSevereTextbookKDT 7e · p133
  • AmilorideSevereTextbookKDT 7e

Mechanism

Esmolol is a beta-1 selective adrenergic receptor antagonist with a rapid onset and very short duration of action. It works by blocking beta-1 receptors, primarily in the heart, leading to a reduction in heart rate and myocardial contractility. The drug has little to no intrinsic sympathomimetic activity and lacks membrane-stabilizing actions.

Indications

Short-term treatment of supraventricular arrhythmias (including atrial fibrillation, atrial flutter, sinus tachycardia)Tachycardia and hypertension in peri-operative periodPrevent or treat tachycardia during surgeryTreatment of supraventricular tachycardia

Dosing

Adult
BY INTRAVENOUS INFUSION: 50–200 micrograms/kg/minute, consult product literature for details of dose titration and doses during peri-operative period
Renal adjustment
Manufacturer advises caution

Pharmacokinetics

Onset
Rapid onset; peak hemodynamic effects occur within 6-10 minutes of administration of a loading dose
Peak effect
Peak hemodynamic effects occur within 6-10 minutes of administration of a loading dose
Duration
Very short duration of action, substantial attenuation of beta blockade within 20 minutes of stopping an infusion
Half-life
Approximately 8 minutes (esmolol); approximately 4 hours (carboxylic acid metabolite)
Metabolism
Hydrolyzed rapidly by esterases in erythrocytes
Excretion
Carboxylic acid metabolite excreted in the urine

Side effects

Common
AnxietyAppetite decreasedConcentration impairedDrowsinessHyperhidrosis
Serious
  • Arrhythmias
  • Chills
  • Constipation
  • Costochondritis
  • Dry mouth
  • Dyspepsia
  • Fever
  • Flushing
  • Nasal congestion
  • Oedema
  • Pain
  • Pallor
  • Pulmonary oedema
  • Respiratory disorders
  • Seizure
  • Skin reactions
  • Speech disorder
  • Taste altered
  • Thinking abnormal
  • Urinary retention
  • Cardiac arrest
  • Extravasation necrosis
  • Thrombophlebitis
  • Angioedema
  • Coronary vasospasm
  • Hyperkalaemia
  • Metabolic acidosis
  • Bradycardia
  • Hypotension
  • Heart failure

Pregnancy & lactation

Lactation

Manufacturer advises avoidance.

Drug interactions

Diltiazem
Contraindicated
Textbook

Increased propensity for AV block, severe bradycardia, and decreased left ventricular function.

Avoid concurrent administration. The concurrent administration of diltiazem with a beta blocker is contraindicated.

Source: G&G 14e · p617

Ritodrine
Contraindicated
Textbook

Reduced efficacy of ritodrine and potential for adverse cardiovascular effects.

Ritodrine should not be used if the mother is receiving beta blockers.

Source: KDT 7e · p333

Adrenaline
Severe
Textbook

Marked rise in BP.

Adrenaline should not be given to patients receiving β blockers.

Source: KDT 7e · p133

Amiloride
Severe
Textbook

Hyperkalaemia more likely.

Source: KDT 7e

Epinephrine
Severe
Textbook

Severe hypertension and cerebral hemorrhage.

The use of epinephrine generally is contraindicated in patients who are receiving nonselective β receptor antagonists.

Source: G&G 14e · p258

Methacholine
Severe
Textbook

Exaggerated or prolonged bronchoconstriction and reduction in vital capacity in response to methacholine.

Emergency resuscitation equipment, oxygen, and medications to treat severe bronchospasm (e.g., β2 adrenergic receptor agonists for inhalation) should be available during testing.

Source: G&G 14e · p212

Sofosbuvir
Severe
Textbook

Severe bradycardia.

Extreme caution advised if amiodarone is co-administered with sofosbuvir and a beta blocker.

Source: Harrison 22e · unknown

Triamterene
Severe
Textbook

Hyperkalaemia more likely.

Source: KDT 7e

Verapamil
Severe
Textbook

Life-threatening bradyarrhythmias.

Particular caution is indicated.

Source: G&G 14e · p275

Aceclofenac + Paracetamol
Moderate
Textbook

Reduced antihypertensive effect.

Monitor blood pressure and consider alternative antihypertensive agents or NSAIDs if necessary.

Source: G&G 14e · p275

Aceclofenac
Moderate
Textbook

Reduced antihypertensive effect.

Monitor blood pressure and consider alternative antihypertensive agents or NSAIDs if necessary.

Source: G&G 14e · p275

Alfuzosin
Moderate
Textbook

Increased antihypertensive effect.

This combination is often used to achieve better blood pressure control and manage reflex tachycardia from alpha-1 blockers.

Source: G&G 14e

Related guidelines

Other Beta Blocker drugs

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Sources: BNF·Verified: 2026-05-10 · House clinical team