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
- Follow this with infusion at 50mcg/kg/min for 4min
- 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.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| 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 | 300-500mcg/kg IV load over 1 min, then 25-50mcg/kg/min infusion | Sympathetic blockade | IV | Adult |
| Hypertensive emergency | 500 mcg/kg bolus then 50-300 mcg/kg/min | Antihypertensive (rate control) | IV drip | 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 | 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 | 500 mcg/kg over 30 sec | Refractory VF | IVP | 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 |