Esmolol is a relatively cardioselective B-blocker with a rapid onset and a very short duration of action. Esmolol is metabolised by esterases in the red blood cells and the elimination half-life is about 9 min. It is used IV for the short-term treatment of supraventricular arrhythmias, sinus tachycardia or hypertension and is particularly useful in the peri-operative period.
Uses
AF
Atrial flutter
Sinus tachycardia
Hypertension
Contraindications
Unstable asthma
Severe bradycardia
Sick sinus syndrome
Second- or third-degree AV block
Uncontrolled heart failure
Hypotension
Administration
• IV bolus: 80 mg loading bolus over 15–30 s, followed by IV infusion
• IV infusion: 50–200 μg/kg/min (210–840 or 21–84 ml/h in a 70-kg individual)
Available in 10-ml vial containing 100 mg esmolol (10 mg/ml) to be used undiluted and 10 ml ampoule containing 2.5 g esmolol (250 mg/ml) requiring dilution to 10 mg/ml solution. Dilute 5 g (two ampoules) in 500 ml sodium chloride 0.9% or glucose 5% (10 mg/ml)
How not to use esmolol
Not compatible with sodium bicarbonate Esmolol 2.5-g ampoules must be diluted before infusion
Cautions
Asthma
Adverse effects
Bradycardia
Heart failure
Hypotension
These side-effects should resolve within 30 min of discontinuing infusion
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