esmolol hydrochloride: clinical use

Prescribing considerations

• Reserve for acute, short-term use with continuous ECG and blood-pressure monitoring.
• Use caution in haemodynamic compromise, reduced cardiac function, first-degree heart block, hypovolaemia, asthma or bronchospastic disease, diabetes, peripheral vascular disease and renal impairment.
• Beta-1 selectivity is relative; stop promptly if bronchospasm develops.
• It may mask tachycardia associated with hypoglycaemia or hyperthyroidism.
• The selected products are not indicated for patients younger than 18 years.

Contraindications and cautions

• Hypersensitivity to esmolol, relevant excipients or, for Brevibloc, other beta blockers
• Severe sinus bradycardia
• Sick sinus syndrome or severe atrioventricular conduction disease without a pacemaker
• Second- or third-degree heart block
• Cardiogenic shock, severe hypotension or decompensated heart failure
• Current or recent intravenous verapamil
• Untreated phaeochromocytoma
• Pulmonary hypertension
• Acute asthma attack
• Metabolic acidosis

Monitoring

• Continuous ECG, heart rate and blood pressure
• Signs of reduced cardiac output or worsening heart failure
• Respiratory status in patients with asthma or wheezing
• Blood glucose where hypoglycaemia is possible
• Infusion site for extravasation, inflammation or tissue injury
• Potassium and clinical status where renal impairment raises concern about metabolite accumulation or hyperkalaemia

Clinical pharmacology

Esmolol is a cardioselective beta-adrenergic antagonist without significant intrinsic sympathomimetic or membrane-stabilising activity at therapeutic exposure. Red-blood-cell esterases rapidly hydrolyse it to a minimally active acid metabolite; its intravenous elimination half-life is approximately nine minutes.

Formulation and product differences

• Brevibloc Premixed is a ready-to-use, iso-osmotic infusion in a single-patient bag. It contains a clinically relevant sodium load and must not have additives introduced.
• The selected generic product is a clear, ready-for-intravenous-use solution in a single-use glass vial and is essentially sodium-free.
• The products differ in container, total volume, sodium content and handling requirements.

Solution for infusion

Route: Intravenous

Strengths: 10 mg/mL, 2500 mg

Injection

Route: Parenteral

Strengths: 10 mg/mL