Esmolol

Esmolol

[1 vial $37.93]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Breviblock

ICU INDICATIONS:

  1. hypertension
  2. tachydysrhythmia

    Note: esmolol is primarily used where there is concern that beta blockade will not be well tolerated because it is very short acting so that if an adverse reaction occurs the drug will wear off rapidly.

PRESENTATION AND ADMINISTRATION:

  • IV:
    100mg in 10ml vial (10mg/ml)
    Use 10mg/ml solution undiluted for loading dose and infusion Store at room temperature. Freezing does not adversely affect the product, but exposure to elevated temperatures should be avoided. Protect from light
    Esmolol loading dose should be administered by a doctor.
    Note: Esmolol is a section 29 medicine.

DOSAGE:

  • IV:
    Loading dose: 500mcg/kg over one minute (eg 70kg patient = 3.5ml of 10mg/ml)
    Maintenance dose: 0-200mcg/kg/minute

    Note: due to its high cost and the fact that cheaper alternatives exist, esmolol is rarely given by infusion

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV:
    Loading dose: 500mcg/kg over one minute
    Maintenance dose: 0-300mcg/kg/minute

CLINICAL PHARMACOLOGY:

  • Esmolol hydrochloride is a beta1-selective (cardioselective) adrenergic receptor blocking agent with a very short duration of action (elimination half-life is approximately 9 minutes).

CONTRAINDICATIONS

  1. sinus bradycardia
  2. heartblock greater than firs tdegree
  3. cardiogenic shock
  4. overt heart failure

WARNINGS

  • Risk of death in unstable patients
    Despite the rapid onset and offset of esmolol effects, several cases of death have been reported in complex clinical states where esmolol was being used to control ventricular rate.
  • Bronchospastic Diseases
    Because of its relative beta1 selectivity and titratability, esmolol may be used with caution in patients with bronchospastic diseases. However, since beta1 selectivity is not absolute, esmolol should be carefully titrated to obtain the lowest possible effective dose. In the event of bronchospasm, the infusion should be terminated immediately; a beta2 stimulating agent may be administered if conditions warrant but should be used with particular caution as patients already have rapid ventricular rates.

PRECAUTIONS

  • General:
    See WARNINGS
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions:
    None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Caution should be exercised when considering the use of esmolol and Verapamil in patients with depressed myocardial function. Fatal cardiac arrests have occurred in patients receiving both drugs. Esmolol should not be used to control supraventricular tachycardia in the presence of agents which are vasoconstrictive and inotropic such as dopamine, epinephrine, and norepinephrine because of the danger of blocking cardiac contractility when systemic vascular resistance is high.

ADVERSE REACTIONS

  • Cardiovascular System:
    Symptomatic hypotension, pallor, flushing, bradycardia (heart rate less than 50 beats per minute), chest pain, syncope, pulmonary oedema and heart block. Central Nervous System: Dizziness, somnolence, confusion, headache, and agitation
  • Respiratory System:
    Bronchospasm, wheezing, and dyspnoea.
  • Gastrointestinal System:
    Nausea, vomiting, dyspepsia, constipation, dry mouth, and abdominal discomfort
  • Skin (infusion site):
    Infusion site reactions including inflammation and induration

Critical Care Drug Manual

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