Esmolol Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Atrial Fibrillation

Initial dose: Loading infusion of 500 mcg/kg/min (0.5 mg/kg/min) over one minute.
Maintenance dose: 50 mcg/kg/min (0.05 mg/kg/min) for 4 minutes.

Usual Adult Dose for Atrial Flutter

Initial dose: Loading infusion of 500 mcg/kg/min (0.5 mg/kg/min) over one minute.
Maintenance dose: 50 mcg/kg/min (0.05 mg/kg/min) for 4 minutes.

Usual Adult Dose for Supraventricular Tachycardia

Initial dose: Loading infusion of 500 mcg/kg/min (0.5 mg/kg/min) over one minute.
Maintenance dose: 50 mcg/kg/min (0.05 mg/kg/min) for 4 minutes.

Usual Adult Dose for Intra- or Post-op SVT or Hypertension

Immediate control: 80 mg (approximately 1 mg/kg) bolus dose over 30 seconds followed by a 150 mcg/kg/min infusion, if necessary. Adjust the infusion rate as required up to 300 mcg/kg/min to maintain desired heart rate and/or blood pressure.
Gradual control: The dosing schedule is the same as that used in supraventricular tachycardia.

NOTE: Higher dosages (250 to 300 mcg/kg/min) may be required for adequate control of blood pressure than those required for the treatment of atrial fibrillation, flutter and sinus tachycardia. One third of the postoperative hypertensive patients required these higher doses.

Usual Pediatric Dose for Hypertension

Greater than 1 year: 100 to 500 mcg/kg given over 1 minute followed by a continuous infusion for control of Supraventricular tachycardia (SVT).
Loading doses of 500 mcg/kg/minute over 1 minute followed by continuous infusion with doses of 50 to 250 mcg/kg/minute have been used in addition to nitroprusside to treat postop hypertension after coarctation of aorta repair.

Usual Pediatric Dose for Supraventricular Tachycardia

Greater than 1 year: 100 to 500 mcg/kg given over 1 minute followed by a continuous infusion for control of Supraventricular tachycardia (SVT).
Loading doses of 500 mcg/kg/minute over 1 minute followed by continuous infusion with doses of 50 to 250 mcg/kg/minute have been used in addition to nitroprusside to treat postop hypertension after coarctation of aorta repair.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

If an adequate therapeutic effect is observed over the 5 minutes of drug administration, maintain the maintenance infusion dosage with periodic adjustments up or down as needed. If an adequate therapeutic effect is not observed, the same loading dosage is repeated over one minute followed by an increased maintenance infusion rate of 100 mcg/kg/min (0.1 mg/kg/min).

Precautions

Esmolol is contraindicated in patients with sinus bradycardia, second- or third-degree AV heart block, cardiogenic shock, or overt heart failure.

As with other beta-adrenergic receptor antagonists, esmolol should be given cautiously, if at all, to patients with reactive airways disease, diabetes, congenital heart disease with right to left shunting, or peripheral vascular disease.

Infusion concentrations of 20 mg/mL have been associated with serious venous irritation compared to concentrations of 10 mg/mL. Extravasation reactions leading to possible necrosis can occur, particularly with greater infusion concentrations (e.g., 20 mg/mL).

Esmolol should not be used as the therapy for hypertension in patients in whom the increased blood pressure is primarily due to the vasoconstriction associated with hypothermia.

Esmolol should be administered with caution to patients with impaired renal function.

In clinical studies, patients treated with esmolol have experienced hypotension. Patients should be monitored closely, especially if pretreatment blood pressure is low. Decrease of dose or termination of infusion reverses hypotension, usually within 30 minutes.

Sympathetic stimulation is needed in supporting circulatory function in congestive heart failure, and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure. Continued depression of the myocardium with beta blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of impending cardiac failure, esmolol should be discontinued. Although withdrawal may be sufficient because of the short elimination half-life of esmolol, specific therapy may also be considered. The use of esmolol for control of ventricular response in patients with supraventricular arrhythmias should be done with caution when the patient is compromised hemodynamically or is taking other drugs that decrease any or all of the following: peripheral resistance, myocardial filling, myocardial contractility, or electrical impulse propagation in the myocardium. Despite the rapid onset and offset of the effects of esmolol, several cases of death have been observed in complex clinical states where esmolol was presumably being used to control ventricular rate.

Dialysis

Data not available

Other Comments

In the treatment of SVT, responses to esmolol usually occur within the range of 50 to 200 mcg/kg/min (0.05 to 0.2 mg/kg/min).
The average effective dosage is approximately 100 mcg/kg/min (0.1 mg/kg/min).
Dosages as low as 25 mcg/kg/min (0.025 mg/kg/min) have been adequate in some patients.
Dosages as high as 300 mcg/kg/min (0.3 mg/kg/min) have been used, but these provide little added effect and an increased rate of adverse effects, and are not recommended.

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