Esmolol Medication: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Esmolol is a fast-acting beta-blocker used to manage various heart conditions, including high blood pressure, abnormal heart rhythms, and chest pain. It works by slowing the heart rate and reducing the heart’s workload. Esmolol is typically administered in a hospital setting or under close medical supervision. Always consult a healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist you with any questions or concerns.

Names of Medication

US Brand Name: Brevibloc

Generic Name: Esmolol

The generic name refers to the active ingredient in the medication, while the brand name is assigned by the manufacturer. In this article, the generic name is listed in parentheses for clarity.

Pharmacologic Category

Esmolol belongs to the pharmacologic class of Beta-Blockers, specifically Beta-1 Selective blockers.

Other medications in this category include:

1. Atenolol
2. Metoprolol
3. Bisoprolol

Esmolol Dosage

Esmolol is used to treat several heart-related conditions, and the dosage may vary depending on the specific condition being managed. Always consult your doctor before making any changes to your dosage. If you need assistance, our telemedicine providers are available to help.

Esmolol for Hypertension (High Blood Pressure)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50 mcg/kg/min IV infusion, adjusted every 5 minutes as needed.

Duration: Typically short-term, under medical supervision.

Esmolol for Tachycardia (Fast Heart Rate)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-300 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Atrial Fibrillation

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-200 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Supraventricular Tachycardia (SVT)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-300 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Myocardial Infarction (Heart Attack)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-200 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Heart Failure

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-200 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Perioperative Hypertension (High Blood Pressure Around Surgery)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-300 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Arrhythmias (Irregular Heartbeats)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-300 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Angina (Chest Pain)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-200 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Esmolol for Hyperthyroidism (Thyroid Storm)

Initial Dose: 500 mcg/kg IV bolus over 1 minute.

Maintenance Dose: 50-200 mcg/kg/min IV infusion, adjusted based on response.

Duration: Short-term, under medical supervision.

Dosage Forms and Strengths

Esmolol is available in the following IV solution strengths:

1. 10 mg/mL
2. 20 mg/mL
3. 2500 mg/100 mL (25 mg/mL)

Esmolol Administration Guidelines

Esmolol is administered intravenously (IV), meaning it is delivered directly into the bloodstream through a vein. This medication is typically used in a hospital setting, where your heart rate and blood pressure can be closely monitored. It is crucial to follow your healthcare provider’s instructions carefully. If you have any concerns or questions about your treatment, our telemedicine providers are available to offer guidance.

Contraindications for Esmolol

A contraindication is a specific condition or situation in which a medication should not be used because it may cause harm. If you have any of the following conditions, Esmolol may not be safe for you. Always consult with your healthcare provider before starting any new medication. If you have any of these conditions, discuss alternative treatments with one of our telemedicine providers.

1. Severe bradycardia (slow heart rate): Esmolol slows the heart rate. If your heart rate is already slow, Esmolol could make it dangerously slow, leading to dizziness, fainting, or even heart failure.
2. Heart block (second or third degree): Heart block occurs when the heart’s electrical signals are delayed or blocked. Esmolol can worsen this condition, leading to more severe heart rhythm problems.
3. Cardiogenic shock: This life-threatening condition occurs when the heart can’t pump enough blood to meet the body’s needs. Esmolol can further reduce heart function, worsening the shock.
4. Severe asthma or chronic obstructive pulmonary disease (COPD): Esmolol can narrow the airways, which can be dangerous for people with asthma or COPD, leading to breathing difficulties.
5. Decompensated heart failure: In this condition, the heart cannot pump blood effectively. Esmolol may worsen heart failure by further reducing the heart’s ability to pump blood.
6. Hypersensitivity to Esmolol or any of its components: If you’ve had an allergic reaction to Esmolol or its ingredients, avoid this medication to prevent a potentially serious allergic reaction.

Drug-to-Drug Interactions with Esmolol

Esmolol can interact with other medications, increasing the risk of side effects or reducing the effectiveness of either drug. Always inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some medications that can interact with Esmolol:

1. Calcium channel blockers (e.g., diltiazem [Cardizem], verapamil [Calan]): These medications also slow the heart rate and reduce blood pressure. Taking them with Esmolol can cause an excessive decrease in heart rate and blood pressure.
2. Digoxin (Lanoxin): This medication treats heart failure and arrhythmias. When taken with Esmolol, it can increase the risk of bradycardia (slow heart rate).
3. Clonidine (Catapres): Used to treat high blood pressure, clonidine can cause a dangerous drop in blood pressure when combined with Esmolol.
4. Insulin and oral diabetes medications (e.g., metformin [Glucophage], glipizide [Glucotrol]): Esmolol can mask symptoms of low blood sugar (hypoglycemia), such as rapid heartbeat, making it harder to recognize and treat low blood sugar levels.
5. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen [Advil], naproxen [Aleve]): These medications can reduce the blood pressure-lowering effects of Esmolol.

Esmolol in Pregnancy

Is it safe to take Esmolol when pregnant?

The safety of Esmolol during pregnancy has not been fully established. It is classified as a Category C drug by the FDA, meaning that while animal studies have shown some risk to the fetus, there are no well-controlled studies in humans. Esmolol should only be used during pregnancy if the potential benefits outweigh the risks. If you are pregnant or planning to become pregnant, it is essential to discuss the risks and benefits of Esmolol with your healthcare provider. Our telemedicine providers are available to help you make an informed decision.

Esmolol While Breastfeeding

Is it safe to take Esmolol while breastfeeding?

Esmolol does pass into breast milk, but its effects on a breastfeeding infant are not well studied. Due to its short half-life and rapid breakdown in the body, Esmolol may pose a lower risk to the infant compared to other beta-blockers. However, caution is still advised. Be sure to discuss the risks and benefits with your healthcare provider before using Esmolol while breastfeeding. If you have concerns, our telemedicine providers can help you explore alternative treatment options.

Estimated Cost of Esmolol Medication

The cost of a 30-day supply of Esmolol can vary depending on the dosage and the pharmacy. Without insurance, the estimated cost using a GoodRX coupon ranges from $50 to $100 for a 30-day supply. Prices may differ, so it’s a good idea to check with your local pharmacy or use a discount service like GoodRX to find the best price available.

Possible Alternatives to Esmolol

If Esmolol is not suitable for you, other treatments and lifestyle changes may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore alternatives.

Hypertension (High Blood Pressure)

Alternatives include other beta-blockers (e.g., metoprolol [Lopressor]), ACE inhibitors (e.g., lisinopril [Zestril]), or lifestyle changes such as reducing salt intake, increasing physical activity, and managing stress.

Tachycardia (Fast Heart Rate)

Alternatives may include calcium channel blockers (e.g., diltiazem [Cardizem]) or anti-arrhythmic medications. Lifestyle adjustments, such as avoiding caffeine and managing stress, can also be beneficial.

Atrial Fibrillation

Other treatment options include anticoagulants (e.g., warfarin [Coumadin]) or procedures like electrical cardioversion. Managing underlying conditions, such as high blood pressure, can also support better outcomes.

Supraventricular Tachycardia (SVT)

Alternatives include medications like adenosine or procedures such as catheter ablation.

Myocardial Infarction (Heart Attack)

Treatment may involve other beta-blockers, aspirin, or procedures like angioplasty. Lifestyle changes, such as quitting smoking and adopting a heart-healthy diet, are also crucial for recovery and prevention.

Heart Failure

Alternatives include ACE inhibitors, diuretics, or lifestyle changes like reducing salt intake and monitoring fluid levels to help manage symptoms.

Perioperative Hypertension

Other medications, such as nitroglycerin or calcium channel blockers, may be used to control blood pressure during surgery.

Arrhythmias

Alternatives include anti-arrhythmic medications or procedures like pacemaker implantation, depending on the type and severity of the arrhythmia.

Angina (Chest Pain)

Other treatments may include nitrates (e.g., nitroglycerin), calcium channel blockers, or lifestyle changes such as increasing physical activity and managing stress.

Hyperthyroidism

Alternatives include antithyroid medications (e.g., methimazole), radioactive iodine therapy, or surgery. Managing stress and avoiding stimulants like caffeine can also help alleviate symptoms.

Recent Updates on Esmolol Research

Recent studies have explored new clinical applications for Esmolol. Research suggests that Esmolol may help manage heart rate during surgery, particularly in patients with high blood pressure or arrhythmias. Ongoing studies are also investigating its potential in treating sepsis-related cardiac dysfunction, as it may improve heart function in critically ill patients. As research continues, staying informed about new findings is important. If you have questions about how these updates may affect your treatment, our telemedicine providers are available to discuss the latest research with you.

James Kingsley

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