Formulary
Esmolol hydrochloride: Indications, Dosing, Side Effects and Interactions
Esmolol hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Esmolol hydrochloride: Indications, Dosing, Side Effects and Interactions
Esmolol hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Short-term treatment of supraventricular arrhythmias (including atrial fibrillation, atrial flutter, sinus tachycardia),Tachycardia and hypertension in peri-operative period**
- **Adult** (By Intravenous Infusion): 50-200 micrograms/kg/minute, consult product literature for details of dose titration and doses during peri-operative period.
**Arrhythmias, Hypertensive emergencies for esmolol hydrochloride**
- **Child** (Initially by intravenous injection): Loading dose 500 micrograms/kg, to be given over 1 minute, then (by intravenous infusion) maintenance 50 micrograms/kg/minute for 4 minutes (rate reduced if low blood pressure or low heart rate), if inadequate response, repeat loading dose and increase maintenance infusion, (by intravenous injection) loading dose 500 micrograms/kg, given over 1 minute, then (by intravenous infusion) maintenance 100 micrograms/kg/minute for 4 minutes, if response still inadequate, repeat loading dose and increase maintenance infusion, (by intravenous injection) loading dose 500 micrograms/kg, given over 1 minute, then (by intravenous infusion) maintenance 150 micrograms/kg/minute for 4 minutes, if response still inadequate, repeat loading dose and increase maintenance infusion, (by intravenous injection) loading dose 500 micrograms/kg, given over 1 minute, then (by intravenous infusion) maintenance 200 micrograms/kg/minute for 4 minutes, doses over 300 micrograms/kg/minute not recommended.
**Tetralogy of Fallot for esmolol hydrochloride**
- **Neonate** (Initially by intravenous injection): Initially 600 micrograms/kg, dose to be given over 1-2 minutes, then (by intravenous infusion) 300-900 micrograms/kg/minute if required.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm)
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For esmolol hydrochloride Common or very common Anxiety; appetite decreased; concentration impaired; drowsiness; hyperhidrosis Uncommon Arrhythmias; chills; constipation; costochondritis; dry mouth; dyspepsia; fever; flushing; nasal congestion; oedema; pain; pallor; peripheral vascular disease; pulmonary oedema; respiratory disorders; seizure; skin reactions; speech disorder; taste altered; thinking abnormal; urinary retention Rare or very rare Cardiac arrest; extravasation necrosis; thrombophlebitis Frequency not known Angioedema; coronary vasospasm; hyperkalaemia; metabolic acidosis
Interactions
**Severe interactions:**
- The use of beta-blockers with ergot derivatives may result in severe peripheral vasoconstriction and hypertension.
**Other interactions (19):**
- Calcium antagonists such as dihydropyridine derivatives (e.g., nifedipine) may increase the risk of hypotension.
- Concomitant use of Brevibloc and Class I anti-arrhythmic drugs (e.g., disopyramide, quinidine) and amiodarone may have potentiating effect on atrial-conduction time and induce negative inotropic...
- Concomitant use of Brevibloc and insulin or oral anti-diabetic drugs may intensify the blood sugar lowering effect (especially non-selective beta-blockers).
- NSAIDs may decrease the hypotensive effects of beta-blockers.
- Special caution must be taken when using floctafenine or amisulpride concomitantly with beta-blockers.
- Concomitant administration of tricyclic antidepressants (such as imipramine and amitriptyline), barbiturates or phenothiazines (such as chlorpromazine), as well as other antipsychotic agents (such...
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants. Breast feeding For esmolol hydrochloride Manufacturer advises avoidance.
Renal impairment
Manufacturer advises caution.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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