Esmolol

BREVIBLOC

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Esmolol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Esmolol ballicule

Esmolol BREVIBLOC mascot mnemonic cartoon — Visual mnemonic: Esmolol mascot
**“Easy mole Brief block”**

What it isUltra-short-acting IV beta-1 blocker cleared by red-cell esterases; acute tachyarrhythmia and perioperative control.

Why this oneA nine-minute half-life means a mistake wears off in minutes, which is why it suits unstable patients.

What limits itInfusion only, and large volumes at high doses. Bradycardia and hypotension; avoid in decompensated heart failure.

Esmolol molecular structure (skeletal formula) — Molecular structure: Esmolol

FDA-approved for

acute tachyarrhythmias (IV) (1986)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Supraventricular tachycardia / noncompensatory sinus tachycardia	Adults	Optional load 500 mcg/kg over 1 min, then 50 mcg/kg/min infusion	50-200 mcg/kg/min	200 mcg/kg/min
Perioperative tachycardia / hypertension	Adults	Load 500 mcg/kg over 1 min (or 1 mg/kg over 30 s for immediate control), then 50 mcg/kg/min	50-200 mcg/kg/min	200 (tachycardia) / 300 (hypertension) mcg/kg/min

Titration Titrate using ventricular rate or blood pressure at intervals of >=4 minutes

Renal Undefined

Hepatic Undefined

Maintenance doses >200 mcg/kg/min not recommended for ventricular rate control

Instructions

Administer by continuous IV infusion
Effective maintenance dose 50-200 mcg/kg/min
Maintenance infusions may continue up to 48 hours

Available strengths

inj 10 mg/mL

Contraindications

Severe sinus bradycardia
Heart block greater than first degree; sick sinus syndrome
Decompensated heart failure
Cardiogenic shock
IV cardiodepressant calcium-channel antagonists (e.g., verapamil) in close proximity
Pulmonary hypertension

Cautions

Hypotension (dose-related)
Bradycardia incl. sinus pause/cardiac arrest
Cardiac failure
Exacerbation of reactive airway disease
Masks symptoms of hypoglycemia in diabetes
Unopposed alpha-agonism/severe hypertension in untreated pheochromocytoma
Myocardial ischemia on abrupt discontinuation in CAD

Adverse reactions

Hypotension (symptomatic and asymptomatic)
Infusion site reactions
Nausea
Dizziness
Somnolence

Pregnancy Use only if benefit justifies risk; fetal bradycardia reported with use in last trimester/labor

Lactation Unknown whether excreted in human milk; weigh importance to mother

Cost

Esmolol (BREVIBLOC)

Strength		#/mo	generic $/unit	CostPlus
10 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Esmolol is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskBradycardia; avoid in decompensated heart failure

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryC

Defining liabilityHypotension, bradycardia and cardiac decompensation during infusion

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Memory aids: interaction avatars

Box: minimal PK interactions

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