Dangerous Drug: Esmolol Hydrochloride(ess’ moe lol)
Brevibloc
PREGNANCY CATEGORY C
Drug Classes
Antiarrhythmic
Beta1-selective adrenergic blocker
Therapeutic Actions
Blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, reducing the influence of the sympathetic nervous system on these tissues; decreasing the excitability of the heart, cardiac output, and release of renin; and lowering BP and heart rate. At low doses, acts relatively selectively at the beta1-adrenergic receptors of the heart; has very rapid onset and short duration.
Indications
Supraventricular tachycardia, when rapid but short-term control of ventricular rate is desirable (atrial fibrillation, flutter, perioperative or postoperative situations)
Noncompensatory tachycardia when heart rate requires specific intervention
Intraoperative and postoperative tachycardia and hypertension when intervention is needed
Unlabeled use: Unstable angina
Contraindications and Cautions
Contraindicated with hypersensitivity to components of drug, sick sinus syndrome, decompensated HF, cardiogenic shock, second- or third-degree heart block (in the absence of a pacemaker), bradycardia, concurrent use of calcium channel blocker.
Use cautiously with bronchospastic disease, diabetes, pregnancy, lactation.
Available Forms
Injection—10 mg/mL, 20 mg/mL
Dosages
Adults
Individualize dosage by titration (with or without a loading dose). Optional loading dose of 500 mcg/kg/min IV for 1 min followed by a maintenance dose of 50 mcg/kg/min for 4 min. If adequate response is not observed in 5 min, repeat dose and follow with maintenance infusion of 100 mcg/kg/min. Repeat optional loading dose titration as necessary, increasing rate of maintenance dose in increments of 50 mcg/kg/min. As desired heart rate or safe end point is approached, omit loading infusion and decrease incremental dose in maintenance infusion to 25 mcg/kg/min (or less), or increase interval between titration steps from 5 to 10 min. Usual range is 50–200 mcg/kg/min. Infusions for up to 24 hr have been used; up to 48 hr may be well tolerated. Dosage should be individualized based on patient response; do not exceed 300 mcg/kg/min.
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