Esmolol

General

• Type: Beta blockers
• Dosage Forms:
• Common Trade Names: Brevibloc

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

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.

	Indication	Dose	Context	Route	Population
Atrial fibrillation with RVR#Esmolol Rate control (beta-blocker); easily titratable Adult	Atrial fibrillation with RVR	0.5mg/kg bolus over 1min, then 50-200mcg/kg/min	Rate control (beta-blocker); easily titratable	IV	Adult
Electrical storm#Esmolol Sympathetic blockade Adult	Electrical storm	300-500mcg/kg IV load over 1 min, then 25-50mcg/kg/min infusion	Sympathetic blockade	IV	Adult
Hypertensive emergency#Esmolol Antihypertensive (rate control) Adult	Hypertensive emergency	500 mcg/kg bolus then 50-300 mcg/kg/min	Antihypertensive (rate control)	IV drip	Adult
Nontraumatic thoracic aortic dissection#Esmolol First-line heart rate control; easily titratable Adult	Nontraumatic thoracic aortic dissection	0.5mg/kg bolus, then 50-200mcg/kg/min infusion	First-line heart rate control; easily titratable	IV	Adult
Paroxysmal supraventricular tachycardia#Esmolol Beta-blocker (short-acting, titratable) Adult	Paroxysmal supraventricular tachycardia	500 mcg/kg IV over 60 sec; repeat bolus after 2-5 min if needed; then infusion 50-300 mcg/kg/min	Beta-blocker (short-acting, titratable)	IV/IV drip	Adult
Pulseless arrest#Esmolol Refractory VF Adult	Pulseless arrest	500 mcg/kg over 30 sec	Refractory VF	IVP	Adult
Thyroid storm#Esmolol Beta-blocker (preferred if CHF/asthma) Adult	Thyroid storm	250-500 mcg/kg IV loading, then 50-100 mcg/kg/min drip	Beta-blocker (preferred if CHF/asthma)	IV drip	Adult

See Also

• Beta-blockers
• Beta-blocker toxicity
• Antiarrhythmics
• Antihypertensive medications