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Pharmacologic class: Beta-adrenergic blocker (cardioselective)
Therapeutic class: Antiarrhythmic, antihypertensive
Pregnancy risk category C
Blocks stimulation of beta-adrenergic receptors (primarily beta1 receptors), thereby reducing atrioventricular conduction and cardiac output and decreasing blood pressure
Injection: 10 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
• Acute myocardial ischemia
• Hypersensitivity to drug
• Heart failure
• Heart block greater than third degree
• Sinus bradycardia
• Cardiogenic shock
Use cautiously in:
• renal impairment, diabetes, bronchospasm, cardiac disease, cerebrovascular insufficiency, peripheral vascular disease, hyperthyroidism, myasthenic conditions
• pregnant or breastfeeding patients.
• 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.
• Large fluid volumes may be needed to infuse drug. Use caution when excessive fluids could be harmful.
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
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 anti-hypertensive effect
• 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.
• 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.