Esmolol: Difference between revisions

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Latest revision as of 21:55, 20 March 2026

General

Adult Dosing

  • Loading dose = 500mcg/kg bolus over 1min
    • Follow this with infusion at 50mcg/kg/min for 4min
      • If no response give another 500 bolus, increased infusion to 100
      • If no response give another 500 bolus, increased infusion to 200
  • Symptomatic AAA (controversial)
    • 500mcg/kg bolus
    • Infusion of 50-200mcg/kg/min titrated to goal SBP

Pediatric Dosing

Special Populations

  • Pregnancy Rating: C
  • Lactation: Unknown if excreted in breast milk
  • Renal Dosing
    • Adult: No adjustment required
  • Hepatic Dosing
    • Adult: No adjustment required

Contraindications

  • Allergy to class/drug
  • Cardiogenic shock
  • 2nd or 3rd AV block

Indications

  • Supraventricular arrhythmias
  • Heart rate and blood pressure control in Symptomatic Aortic Aneurysm (titrate to HR <60 bmp)
  • Off label use: refractory VF

Adverse Reactions

  • Hypotension
  • Bronchospasm

Pharmacology

  • Half-life: Adults - 9min Children 18mo-16yrs 2.7-4.8min
  • Metabolism: Red Blood Cell Esterase
  • Excretion: Renal
  • Mechanism of Action: Class II - Short-acting Beta1 blocker
  • Onset of action = 1-4min
  • Duration of action = <30min


Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

IndicationDoseContextRoutePopulation
Atrial fibrillation with RVR0.5mg/kg bolus over 1min, then 50-200mcg/kg/minRate control (beta-blocker); easily titratableIVAdult
Electrical storm300-500mcg/kg IV load over 1 min, then 25-50mcg/kg/min infusionSympathetic blockadeIVAdult
Hypertensive emergency500 mcg/kg bolus then 50-300 mcg/kg/minAntihypertensive (rate control)IV dripAdult
Nontraumatic thoracic aortic dissection0.5mg/kg bolus, then 50-200mcg/kg/min infusionFirst-line heart rate control; easily titratableIVAdult
Paroxysmal supraventricular tachycardia500 mcg/kg IV over 60 sec; repeat bolus after 2-5 min if needed; then infusion 50-300 mcg/kg/minBeta-blocker (short-acting, titratable)IV/IV dripAdult
Pulseless arrest500 mcg/kg over 30 secRefractory VFIVPAdult
Thyroid storm250-500 mcg/kg IV loading, then 50-100 mcg/kg/min dripBeta-blocker (preferred if CHF/asthma)IV dripAdult

See Also

References