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


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

  • 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



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


    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.