| name | Esmolol |
| classification | Beta-adrenergic blocker, short-acting |
| pharmacokinetics | Esmolol is a short-acting beta-blocker with rapid onset and offset of action. It is metabolized rapidly by esterases in red blood cells, resulting in a very short half-life (8-10 minutes). This allows for precise titration of the dose for controlling heart rate. |
| suggested dosage | Dosage is highly variable and dependent on the specific clinical context. It should be administered intravenously and titrated by a healthcare professional to achieve the desired hemodynamic effect. Initial doses are typically in the range of 50 mcg/kg/min, but can vary depending on patient response. Maintenance doses are adjusted frequently based on heart rate and other monitored parameters. |
| indications | | 1 | Rapid control of supraventricular tachycardias (SVTs) | | 2 | Management of acute hypertension | | 3 | Post-operative control of hypertension and tachycardia | | 4 | Control of arrhythmias during cardiac procedures | | 5 | Treatment of certain types of angina |
|
| safety in pregnancy | Esmolol crosses the placenta. Limited data are available regarding use during pregnancy. The drug should be used with caution and only when the potential benefits outweigh the potential risks to the fetus, especially in critical situations. Consult with a specialist or the prescribing information. |
| safety in breastfeeding | Esmolol is excreted in breast milk. Although the amount is likely low, the drug should be used with caution in breastfeeding mothers, and only if the potential benefits outweigh any risks to the infant. Consult with a specialist or the prescribing information. |
| side effects | | 1 | Bradycardia | | 2 | Hypotension | | 3 | Bronchospasm (in patients with asthma or COPD, less likely with esmolol than other beta-blockers) | | 4 | AV block | | 5 | Heart failure | | 6 | Nausea | | 7 | Vomiting | | 8 | Dizziness | | 9 | Fatigue | | 10 | Weakness | | 11 | Peripheral vasoconstriction | | 12 | Headache | | 13 | Sleep disturbances |
|
| alternatives | | 1 | | drug | Metoprolol | | comments | Longer acting beta-blocker with a wider range of indications, but slower onset of action. |
| | 2 | | drug | Propranolol | | comments | Non-selective beta-blocker with a broader range of indications than esmolol but potentially more side effects. |
| | 3 | | drug | Atenolol | | comments | Longer acting beta-blocker, suitable for some indications but not as rapidly titratable as esmolol. |
|
|
| contraindications | | 1 | Severe bradycardia | | 2 | Second or third-degree AV block (without a pacemaker) | | 3 | Severe hypotension | | 4 | Cardiogenic shock | | 5 | Significant peripheral vascular disease | | 6 | Bronchospastic disease (e.g., asthma, COPD) in untreated or poorly controlled conditions, although less likely than other beta-blockers. | | 7 | Hypersensitivity to esmolol or other beta-blockers |
|
| interactions | | 1 | Concurrent use of other beta-blockers, calcium channel blockers, or other drugs that depress myocardial function may increase the risk of bradycardia and hypotension. | | 2 | Use with drugs that slow conduction through the heart (e.g., digoxin) requires careful monitoring. | | 3 | Esmolol may potentiate the effects of insulin. |
|
| warnings and precautions | | 1 | Close monitoring of heart rate and blood pressure is essential during and after administration. | | 2 | Patients with a history of heart failure or asthma need careful consideration. | | 3 | Use with caution in patients with renal or hepatic impairment. | | 4 | Dosage adjustments may be necessary based on patient factors (e.g., age, renal/hepatic function). | | 5 | Rapid discontinuation of esmolol can lead to rebound hypertension or arrhythmia. |
|
| additional informations | Esmolol is typically reserved for short-term use. The dosage and duration of use are critically dependent on the individual patient's condition and should be decided on by a healthcare professional. |
| patient specific considerations | | age | 25 years (young adult, generally well-tolerated, but potential for variable responses), | | weight | 70 kg (standard weight for a 25-year-old male). Weight-based dosing may be appropriate. Consult prescribing information and clinical judgment. |
|
