Classifications: beta-adrenergic antagonist; antiarrhythmic; Therapeutic:antiarrhythmic
Pregnancy Category: C
10 mg/mL, 250 mg/mL injection
Ultrashort-acting beta1-adrenergic blocking agent with cardioselective properties. Hemodynamic effects are mild, with potency as a beta blocker about
1/100 that of propranolol. Inhibits the agonist effect of catecholamines by competitive binding at beta-adrenergic receptors.
Antiarrhythmic properties occur at the AV node.
Effective as an antiarrhythmic agent on the AV-nodal conduction system. Blocks sympathetically mediated increases in cardiac
rate and BP since it binds predominantly to beta1-receptors in cardiac tissue.
Supraventricular tachyarrhythmias (SVT) in perioperative and postoperative periods or in other critical situations. Also short-term
treatment of noncompensating sinus tachycardia and in the control of heart rate for patients with MI.
Moderate postoperative hypertension; treatment of intense transient adrenergic response to surgical stress in cardiac as well
as noncardiac surgery.
Hypersensitivity to esmolol; cardiac failure, heart block greater than first degree, sinus bradycardia, cardiogenic shock;
decompensated CHF; pulmonary disease such as bronchial asthma, acute bronchospasm, COPD, pulmonary edema; pregnancy (category
C). Safety in children is not established.
History of allergy; CHF; diabetes mellitus; kidney function impairment; lactation.
Route & Dosage
Adult: IV 500 mcg/kg loading dose followed by 50 mcg/kg/min, may increase dose q510min prn if response inadequate, may repeat
loading dose followed by 100 mcg/kg/min 4 x min; may continue repeating loading dose and increasing 4-min
dose by 50 mcg/kg/min prn (max: 200 mcg/kg/min)
Adult: IV 80 mg bolus followed by 150 mcg/kg/min; increase if needed (max: 300 mcg/kg/min)
- Note: Do not use the 2500 mg ampule for direct IV injection.
PREPARE: Direct: Use the 10 mg/mL vial undiluted for the loading dose. IV Infusion: Use the concentrate for injection (250 mg/mL). Prepare maintenance infusion by adding 2.5 g to 250 mL or 5 g to 500 mL of
IV solution to yield 10 mg/mL. Compatible diluents include D5W, D5/RL, D5/NS, D5/.45NS, RL.
ADMINISTER: Direct: Give loading dose over 1 min. IV Infusion: Give maintenance infusion over 4 min. If adequate response is noted, continue maintenance infusion with periodic adjustments
as needed. If an adequate response has not occurred, repeat loading dose and follow with an increased maintenance infusion
of 100 mcg/kg/min. May continue titration cycle with same loading dose while increasing maintenance infusion by 50 mcg/kg/min
until desired end point is near. Then omit loading dose and titrate maintenance dose up or down by 25 to 50 mcg/kg/min until
desired heart rate is reached.
INCOMPATIBILITIES Solution/Additive: Diazepam, procainamide, thiopental. Y-site: Amphotericin B cholesteryl, furosemide, warfarin.
- Diluted infusion solution is stable for at least 24 h at room temperature.
Adverse Effects (≥1%)CNS:
somnolence, confusion, agitation. CV: Hypotension
(dose related), cold hands and feet, bradyarrhythmias, flushing, myocardial depression
Nausea, vomiting. Respiratory: Dyspnea
, chest pain, rhonchi, bronchospasm
. Skin: Infusion site inflammation
(redness, swelling, induration).
May increase digoxin IV
levels 1020%; morphine IV
may increase esmolol levels by 45%; succinylcholine
may prolong neuromuscular blockade.
<5 min. Peak:
1020 min. Duration:
1030 min. Metabolism:
Hydrolyzed by RBC esterases. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Monitor BP, pulse, ECG, during esmolol infusion. Hypotension may have its onset during the initial titration phase; thereafter
the risk increases with increasing doses. Usually the hypotension experienced during esmolol infusion is resolved within 30
min after infusion is reduced or discontinued.
- Change injection site if local reaction occurs. IV site reactions (burning, erythema) or diaphoresis may develop during infusion.
Both reactions are temporary. Blood chemistry abnormalities have not been reported.
- Overdose symptoms: Discontinue administration if the following symptoms occur: bradycardia, severe dizziness or drowsiness,
dyspnea, bluish-colored fingernails or palms of hands, seizures.