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Esmolol Dosage

Medically reviewed by Drugs.com. Last updated on Dec 12, 2023.

Applies to the following strengths: 10 mg/mL; 250 mg/mL; 20 mg/mL; 10 mg/mL-sterile water; 20 mg/mL-sterile water

Usual Adult Dose for Atrial Fibrillation

This drug is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response:

Recommended Dosing:
Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV


Comment:

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

Usual Adult Dose for Atrial Flutter

This drug is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response:

Recommended Dosing:
Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV


Comment:

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

Usual Adult Dose for Supraventricular Tachycardia

This drug is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response:

Recommended Dosing:
Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV


Comment:

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

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

For intraoperative and postoperative tachycardia and hypertension it is not always advisable to slowly titrate to a therapeutic effect; therefore 2 dosing options are presented (immediate control and gradual control):

IMMEDIATE CONTROL:


GRADUAL CONTROL:

MAXIMUM RECOMMENDED DOSES:

Use: For the short-term treatment of tachycardia and hypertension that occur during induction and tracheal intubation, during surgery, on emergence from anesthesia and in the postoperative period, when such specific intervention is considered indicated

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Use with caution.

Dose Adjustments

After patients achieve adequate control of the heart rate and a stable status, they may be transitioned to alternative antiarrhythmic drugs. When transitioning alternative drugs, the physician should carefully consider the labeling instructions of the alternative drug selected and reduce the dosage of this drug as follows:

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:


Storage requirements:


General:

Monitoring:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.