Home Drug Guide Esmolol Hydrochloride

Drug Guide

Generic Name

Esmolol Hydrochloride

Brand Names Brevibloc, Brevibloc In Plastic Container, Brevibloc Double Strength In Plastic Container, Esmolol Hydrochloride In Plastic Container, Esmolol Hydrochloride Double Strength In Plastic Container

Classification

Therapeutic: Beta-adrenergic blocker, antiarrhythmic

Pharmacological: Selective beta-1 adrenergic receptor antagonist

FDA Approved Indications

Short-term treatment of supraventricular tachycardia (SVT)
Atrial fibrillation/flutter with rapid ventricular response
Ventricular tachycardia

Mechanism of Action

Esmolol selectively blocks beta-1 adrenergic receptors in the heart, resulting in decreased heart rate, myocardial contractility, and cardiac output, thereby exerting antiarrhythmic effects.

Dosage and Administration

Adult: Initial dose of `500 mcg/kg` IV over 1 minute, followed by continuous infusion of 50-150 mcg/kg/min, titrated based on response.

Pediatric: For pediatric use, doses are titrated based on weight and clinical response; consult specific protocols.

Geriatric: Start at lower doses; monitor closely due to increased sensitivity.

Renal Impairment: Adjustments not typically required, but monitoring is advised.

Hepatic Impairment: No specific adjustments recommended.

Pharmacokinetics

Absorption: Administered intravenously; bioavailability not applicable.

Distribution: Widely distributed; volume of distribution approximately 0.2-0.3 L/kg.

Metabolism: Rapidly metabolized in the plasma by esterases to inactive metabolites.

Excretion: Excreted primarily in urine.

Half Life: Approximately 9 minutes.

Contraindications

Known hypersensitivity to esmolol or other beta-blockers.
Severe obstructive airway disease (e.g., asthma).
Second- or third-degree AV block without pacemaker.

Precautions

Use with caution in patients with heart failure, severe hypertension, or cooking asthmatic conditions.
Monitor blood pressure and heart rate closely.

Adverse Reactions - Common

Hypotension (Common)
Bradycardia (Common)
Nausea (Uncommon)
Dizziness (Uncommon)

Adverse Reactions - Serious

Severe bradycardia or AV block requiring intervention (Rare)
Anaphylactic reactions (Rare)

Drug-Drug Interactions

Other antiarrhythmics, especially calcium channel blockers and other beta-blockers.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor heart rate, blood pressure, and ECG continuously during administration.

Diagnoses:

Risk for decreased cardiac output

Implementation: Administer via infusion pump; titrate dose based on clinical response.

Evaluation: Assess for effectiveness in controlling arrhythmias and monitor for adverse effects.

Patient/Family Teaching

Notify healthcare provider if you experience chest pain, dizziness, or slow heartbeat.
Do not halt medication abruptly without medical advice.

Special Considerations

Black Box Warnings:

Use with caution in patients with heart failure; may worsen symptoms.
Avoid abrupt discontinuation to prevent exacerbation of angina or arrhythmias.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Severe bradycardia, hypotension, bronchospasm.

Treatment: Discontinue drug immediately; supportive care, atropine for bradycardia, vasopressors for hypotension, and advanced cardiac life support if needed.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

Stability: Stable when stored properly; check expiration date.