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Brevibloc Side Effects

Generic Name: esmolol

Note: This page contains information about the side effects of esmolol. Some of the dosage forms included on this document may not apply to the brand name Brevibloc.

In Summary

Common side effects of Brevibloc include: dizziness, hypotension, symptomatic hypotension, and diaphoresis. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to esmolol: intravenous solution

In addition to its needed effects, some unwanted effects may be caused by esmolol (the active ingredient contained in Brevibloc). In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking esmolol, check with your doctor or nurse immediately:

More common:
  • Blurred vision
  • confusion
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • increased sweating
  • unusual tiredness or weakness
Less common:
  • Itching of skin
  • numbness and tingling of face, fingers, or toes
  • pain in arms, legs, or lower back, especially pain in calves and/or heels upon exertion
  • pale, bluish-colored, or cold hands or feet
  • weak or absent pulses in legs
  • Blue lips and fingernails
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • changes in skin color
  • changes in vision
  • chest pain or discomfort
  • convulsions
  • coughing that sometimes produces a pink frothy sputum
  • decrease in frequency of urination
  • decrease in urine volume
  • delusions
  • dementia
  • difficult, fast, noisy breathing, sometimes with wheezing
  • difficulty in passing urine (dribbling)
  • difficulty with speaking
  • feeling of warmth
  • feeling unusually cold
  • lightheadedness, dizziness, or fainting
  • loss of bladder control
  • muscle spasm or jerking of all extremities
  • no heartbeat
  • pain, tenderness, or swelling of foot or leg
  • painful urination
  • paleness of skin
  • peeling of skin
  • redness of the face, neck, arms and occasionally, upper chest
  • shivering
  • shortness of breath
  • slow or irregular heartbeat
  • small clicking, bubbling, or rattling sounds in the lung when listening with a stethoscope
  • sudden loss of consciousness
  • swelling, redness, or burning of skin where the needle is placed
  • tightness in chest

If any of the following symptoms of overdose occur while taking esmolol, get emergency help immediately:

Symptoms of overdose:
  • Dilated neck veins
  • extreme fatigue
  • irregular breathing
  • no blood pressure or pulse
  • stopping of heart
  • swelling of face, fingers, feet, or lower legs
  • unconsciousness
  • weight gain

Minor Side Effects

Some of the side effects that can occur with esmolol may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Hardening or thickening of skin where the needle is placed
  • nausea
Less common:
  • Anxiety
  • dry mouth
  • headache
  • hyperventilation
  • irritability
  • nervousness
  • restlessness
  • shaking
  • sleepiness or unusual drowsiness
  • trouble sleeping
  • vomiting
  • Acid or sour stomach
  • belching
  • change in taste or bad, unusual, or unpleasant (after) taste
  • difficulty having a bowel movement (stool)
  • discouragement
  • feeling sad or empty
  • heartburn
  • indigestion
  • lack of appetite
  • lack or loss of strength
  • loss of interest or pleasure
  • shoulder pain
  • stomach soreness, discomfort, upset, or pain
  • stuffy nose
  • tiredness
  • trouble concentrating
  • weight loss

For Healthcare Professionals

Applies to esmolol: intravenous solution


Effects and side effects of esmolol (the active ingredient contained in Brevibloc) are usually brief and transient because of the relatively short half-life of esmolol (approximately 9 minutes).[Ref]


Significant reductions of left and right ventricular ejection fractions, increases in pulmonary capillary wedge pressure, and decreases in cardiac output have been reported in patients with a mean left ventricular (LV) ejection fraction of 0.27. None of these changes were clinically significant, but the investigators advise cautious monitoring of the hemodynamic status in patients with LV dysfunction, especially at dosages greater than 200 mcg per kg per min.[Ref]

Cardiovascular side effects are the most common. Symptomatic (diaphoresis or dizziness) and asymptomatic hypotension occur in up to 14% and 50% of patients, respectively. Hypotension is more likely with dosages greater than 200 mcg per kg per min. Peripheral ischemia, pallor, flushing, chest pain, syncope, bradycardia, pulmonary edema, and heart block have been reported in less than 1% of patients. Hemodynamic changes are reported in patients with left ventricular dysfunction.[Ref]

Nervous system

Nervous system side effects include dizziness, weakness, somnolence or headache in 3% to 7% of patients. Paresthesias, anorexia, asthenia, lightheadedness, agitation and general irritability occur in less than 1% of patients. One fatal seizure associated with esmolol (the active ingredient contained in Brevibloc) is reported.[Ref]


Gastrointestinal complaints are mainly limited to nausea in 6% of patients. Dyspepsia, general abdominal discomfort, dry mouth, and vomiting are reported in less than 1% of patients.[Ref]


Respiratory system side effects including bronchospasm, dyspnea, wheezing nasal congestion, rhonchi, and rales have been reported in less than 1% of patients. As with other beta-adrenergic receptor antagonists, esmolol (the active ingredient contained in Brevibloc) should be given cautiously, if at all, to patients with a reactive airways disease.[Ref]


Local intravenous site reactions including inflammation and induration have been reported (approximately 8%). Edema, erythema, skin discoloration, burning, thrombophlebitis, and local skin necrosis have been reported in less than 1% of patients.[Ref]


Psychiatric side effects including depression and abnormal thinking have been rarely reported (<1%).[Ref]


Genitourinary effects including urinary retention have been rarely reported (<1%).[Ref]


Other side effects including speech disorder, abnormal vision, midscapular pain, rigors, and fever have been reported rarely (<1%).[Ref]


1. Byrd RC, Sung RJ, Marks J, Parmley WW "Safety and efficacy of esmolol (ASL-8052: an ultrashort-acting beta- adrenergic blocking agent) for control of ventricular rate in supraventricular tachycardias." J Am Coll Cardiol 3 (1984): 394-9

2. Mooss AN, Hilleman DE, Mohiuddin SM, Hunter CB "Safety of esmolol in patients with acute myocardial infarction treated with thrombolytic therapy who had relative contraindications to beta-blocker therapy." Ann Pharmacother 28 (1994): 701-3

3. Herschman Z, Dimich I, Singh PP "Sudden death in a young postoperative patient given esmolol." Crit Care Med 21 (1993): 1975-6

4. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.

5. Deegan R, Wood AJJ "beta-receptor antagonism does not fully explain esmolol-induced hypotension." Clin Pharmacol Ther 56 (1994): 223-8

6. Abrams J, Allen J, Allin D, et al "Efficacy and safety of esmolol vs propranolol in the treatment of supraventricular tachyarrhythmias: a multicenter double-blind clinical trial." Am Heart J 110 (1985): 913-22

7. Anderson S, Blanski L, Byrd RC, Das G, Engler R, Laddu A, Lee R, Rajfer S, Schroeder J, Steck JD, et al "Comparison of the efficacy and safety of esmolol, a short-acting beta blocker, with placebo in the treatment of supraventricular tachyarrhythmias.The Esmolol vs Placebo Multicenter Study Group." Am Heart J 111 (1986): 42-8

8. Wallis DE, Pope C, Littman WJ, Scanlon PJ "Safety and efficacy of esmolol for unstable angina pectoris." Am J Cardiol 62 (1988): 1033-7

9. Morganroth J, Horowitz LN, Anderson J, Turlapaty P "Comparative efficacy and tolerance of esmolol to propranolol for control of supraventricular tachyarrhythmia." Am J Cardiol 56 (1985): f33-9

10. Sung RJ, Blanski L, Kirshenbaum J, MacCosbe P, Turlapaty P, Laddu AR "Clinical experience with esmolol, a short-acting beta-adrenergic blocker in cardiac arrhythmias and myocardial ischemia." J Clin Pharmacol 26 (1986): a15-26

11. Girard D, Shulman BJ, Thys DM, Mindich BP, Mikula SK, Kaplan JA "The safety and efficacy of esmolol during myocardial revascularization." Anesthesiology 65 (1986): 157-64

12. Alexander R, Binns J, Hetreed M "A controlled trial of the effects of esmolol on cardiac function." Br J Anaesth 72 (1994): 594-5

13. The Esmolol Research Group "Intravenous esmolol for the treatment of supraventricular tachyarrhythmia: results of a multicenter, baseline-controlled safety and efficacy study in 160 patients." Am Heart J 112 (1986): 498-505

14. Iskandrian AS, Bemis CE, Hakki AH, Panidis I, Heo J, Toole JG, Hua TA, Allin D, Kane-Marsch S "Effects of esmolol on patients with left ventricular dysfunction." J Am Coll Cardiol 8 (1986): 225-31

Not all side effects for Brevibloc may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.