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esmolol

Generic Name: esmolol (ES moe lol)
Brand Name: Brevibloc

What is esmolol?

Esmolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Esmolol is used to help keep the heart beating normally in people with certain heart rhythm disorders of the atrium (the upper chambers of the heart that allow blood to flow into the heart). Esmolol is used in people with atrial fibrillation or atrial flutter.

Esmolol is also used during surgery to help regulate blood pressure and heart rate.

Esmolol may also be used for purposes not listed in this medication guide.

What is the most important information I should know about esmolol?

You should not be treated with esmolol if you have a serious heart condition ("sick sinus syndrome" or "AV block"), very slow heartbeats, heart failure, pulmonary hypertension, or if you are receiving certain IV heart or blood pressure medications.

In an emergency situation it may not be possible to tell your caregivers about your health conditions. Make sure any doctor caring for you afterward knows you have received this medicine.

What should I discuss with my healthcare provider before receiving esmolol?

In an emergency situation it may not be possible to tell your caregivers about your health conditions. Make sure any doctor caring for you afterward knows you have received this medicine.

You should not be treated with esmolol if you are allergic to it, or if you have:

  • a serious heart condition such as "sick sinus syndrome" or "AV block" (second or third degree);

  • a history of slow heart beats that have caused you to faint;

  • heart failure;

  • pulmonary hypertension (increased pressure inside the blood vessels of the lungs and heart); or

  • a condition for which you are being treated with IV heart or blood pressure medication (such as diltiazem, nicardipine, or verapamil).

If possible before you receive esmolol, tell your doctor if you have:

  • a heart condition called Prinzmetal's angina;

  • asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;

  • diabetes;

  • pheochromocytoma (tumor of the adrenal gland);

  • overactive thyroid;

  • allergies;

  • kidney disease;

  • coronary artery disease (hardened arteries); or

  • peripheral vascular disease such as Raynaud's syndrome.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether esmolol passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.

How is esmolol given?

Esmolol is injected into a vein through an IV. A healthcare provider will give you this injection.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving esmolol.

What happens if I miss a dose?

Since the medication will be administered by a healthcare provider, missing a dose should not occur.

What happens if I overdose?

Since this medicine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid while receiving esmolol?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Esmolol side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

  • a light-headed feeling, like you might pass out;

  • very slow heartbeats;

  • swelling in your hands or feet;

  • wheezing, chest tightness, feeling short of breath;

  • weak or shallow breathing;

  • pain, swelling, irritation, bruising, or skin changes around the IV needle;

  • cold feeling in your hands and feet;

  • high potassium--nausea, slow or unusual heart rate, weakness, loss of movement; or

  • low blood sugar--headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, and feeling anxious or shaky.

Common side effects may include:

  • increased sweating;

  • nausea;

  • dizziness, drowsiness; or

  • low blood pressure.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Esmolol dosing information

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

-Maintenance dose: 25 to 200 mcg/kg/min IV
-Maximum dose: 200 mcg/kg/min IV
-Duration: Maintenance infusions may be continued for up to 48 hours

Comment:
-In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

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

-Maintenance dose: 25 to 200 mcg/kg/min IV
-Maximum dose: 200 mcg/kg/min IV
-Duration: Maintenance infusions may be continued for up to 48 hours

Comment:
-In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

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

-Maintenance dose: 25 to 200 mcg/kg/min IV
-Maximum dose: 200 mcg/kg/min IV
-Duration: Maintenance infusions may be continued for up to 48 hours

Comment:
-In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

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:
-Administer 1 mg/kg IV as a bolus dose over 30 seconds followed by 150 mcg/kg/min if needed
-Adjust the infusion rate as required to maintain desired heart rate and blood pressure (refer to maximum recommended doses)

GRADUAL CONTROL:
-Administer 500 mcg/kg IV as a bolus dose over 1 minute followed by a maintenance infusion of 50 mcg/kg/min IV for 4 minutes
-Infusion may be continued at 50 mcg/kg/min or, if the response is inadequate, titrated upward in 50 mcg/kg/min increments (increased no more frequently than every 4 minutes) to a maximum of 300 mcg/kg/min; may administer an optional loading dose equal to the initial bolus (500 mcg/kg over 1 minute) prior to each increase in infusion rate

MAXIMUM RECOMMENDED DOSES:
-For the treatment of tachycardia, maintenance infusion dosages greater than 200 mcg/kg/min IV are not recommended; dosages greater than 200 mcg/kg/min IV provide little additional heart rate-lowering effect, and the rate of adverse reactions increases.
-For the treatment of hypertension, higher maintenance infusion dosages (250 to 300 mcg/kg/min) may be required; the safety of doses above 300 mcg/kg/min has not been studied.

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

What other drugs will affect esmolol?

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • digoxin, digitalis;

  • blood pressure medication;

  • diet pills, stimulants, ADHD medication (Ritalin, Adderall, and others);

  • insulin or oral diabetes medicine; or

  • medicines to treat asthma, colds, or allergies.

This list is not complete. Other drugs may interact with esmolol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about esmolol.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.01.

Date modified: March 15, 2017
Last reviewed: August 09, 2016

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