Esmolol (Brevibloc) Considerations for Use*

US/FDA Approved Indication: Heart Rate Control for Atrial Fibrillation

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Black Box Warning* Abrupt cessation may exacerbate angina pectoris and MI.

Mechanism of Action

Blocks binding of catecholamines to beta-1 receptors; mainly beta-1 selective

Dosing

Acute setting: 500 mcg/kg IV over 1 min, then 50 to 200 mcg/kg/min

Hepatic Impairment: No dosage adjustment needed

Renal Impairment: No dosage adjustment needed

Contraindications
  • AV block
  • Bradycardia
  • cardiogenic shock
  • decompensated heart failure
  • pulmonary edema
  • Major Side Effects

    hypotension, heart block, bradycardia, bronchospasm , HF

    Dosage forms and Strengths

    IV: 10 mg/mL , 20 mg/mL solution for injection

    Special Notes

    Half-life: 9 minutes

    Esmolol infusions should not be abruptly discontinued; the infusion rate should be tapered

    Avoid using butterfly needles and very small veins for infusion; infusion via central line is preferred when feasible

    Avoid extravasation

    Counseling

    n/a

    * Refer to prescribing information for more complete information.
    †Dosages given in the table may differ from those recommended by the manufacturers.


    Sources:

    1. American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Washington, DC: American College of Cardiology.
    2. Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
    3. Tarascon Pocket Pharmacopoeia® 2012.