esmolol hydrochloride

es·mo·lol hydrochloride (sm-lôl)

n.

A beta-blocker used to treat certain types of tachycardia.

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esmolol hydrochloride

Brevibloc

Pharmacologic class: Beta-adrenergic blocker (cardioselective)

Therapeutic class: Antiarrhythmic, antihypertensive

Pregnancy risk category C

Action

Blocks stimulation of beta-adrenergic receptors (primarily beta₁ receptors), thereby reducing atrioventricular conduction and cardiac output and decreasing blood pressure

Availability

Injection: 10 mg/ml, 250 mg/ml

⊘Indications and dosages

➣ Supraventricular tachycardia

Adults: Initially, a loading dose of 500 mcg/kg/minute by I.V. infusion over 1 minute, followed by a maintenance infusion of 50 mcg/kg/minute over 4 minutes. If desired response doesn't occur after 5 minutes, repeat loading dose and increase maintenance infusion to 100 mcg/kg/minute for 4 minutes. Repeat sequence as needed, with maintenance dosage increased in increments of 50 mcg/kg/minute, to a maximum maintenance infusion of 200 mcg/kg/minute for 48 hours.

➣ Sinus tachycardia or hypertension

Adults: Initially, 80 mg (1 mg/kg) by I.V. bolus over 30 seconds; then, if needed, 150 mcg/kg/minute by I.V. infusion, to a maximum of 300 mcg/kg/minute

Off-label uses

• Acute myocardial ischemia

Contraindications

• Hypersensitivity to drug
• Heart failure
• Heart block greater than third degree
• Sinus bradycardia
• Cardiogenic shock

Precautions

Use cautiously in:
• renal impairment, diabetes, bronchospasm, cardiac disease, cerebrovascular insufficiency, peripheral vascular disease, hyperthyroidism, myasthenic conditions
• pregnant or breastfeeding patients.

Administration

• Be aware that compatible solutions include 5% dextrose for injection, 5% dextrose in lactated Ringer's injection, 5% dextrose in Ringer's injection, 5% dextrose in 0.45% or 0.9% sodium chloride injection, and lactated Ringer's injection.
• Don't mix with 5% sodium bicarbonate injection.
• Dilute 250-mg/ml dose to a concentration of 10 mg/ml, and administer by infusion control device.
• Know that maximum I.V. solution concentration is 10 mg/ml.
• Large fluid volumes may be needed to infuse drug. Use caution when excessive fluids could be harmful.

Route	Onset	Peak	Duration
I.V.	Immediate	30 min	30 min after infusion

Adverse reactions

CNS: anxiety, depression, dizziness, drowsiness, headache, agitation, fatigue, confusion, speech disorders, asthenia

CV: peripheral ischemia, chest pain, bradycardia, hypotension

GI: nausea, vomiting, heartburn

GU: urinary retention

Respiratory: wheezing, dyspnea

Skin: flushing, pallor, erythema

Other: altered taste, fever, chills, edema, midscapular pain, inflammation or induration at infusion site

Interactions

Drug-drug. Alpha₁-adrenergic blockers: exaggerated antihypertensive effect

Catecholamines, reserpine: increased bradycardia and hypotension

Digoxin: increased digoxin blood level

Morphine: increased esmolol blood level

Succinylcholine: prolonged neuromuscular blockade

Drug-herbs. Ephedra (ma huang), St. John's wort, yohimbe: decreased antihypertensive effect

Patient monitoring

• Monitor vital signs and ECG, particularly for hypotension.
• Assess neurologic status, and institute safety measures as needed.
• Monitor fluid intake and output, watching for urinary retention.
• Check I.V. site regularly.

Patient teaching

• Explain to patient that drug is an emergency measure to control blood pressure, arrhythmias, or heart rate.
• Ensure patient he'll be closely monitored throughout drug therapy.
• Tell patient to report pain or redness at I.V. site.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.