Esmolol Hydrochloride

What it is and how it works

Mechanism of Action Esmolol hydrochloride in sodium chloride injection is a beta 1 -selective (cardioselective) adrenergic receptor blocking agent with rapid onset, a very short duration of action, and no significant intrinsic sympathomimetic or membrane stabilizing activity at therapeutic dosages. Its elimination half-life after intravenous infusion is approximately 9 minutes. Esmolol hydrochloride in sodium chloride injection inhibits the beta1 receptors located chiefly in cardiac muscle, but this preferential effect is not absolute and at higher doses it begins to inhibit beta 2 receptors located chiefly in the bronchial and vascular musculature.

Indications

Esmolol hydrochloride in sodium chloride injection is a beta adrenergic blocker indicated for the short-term treatment of: • Control of ventricular rate in supraventricular tachycardia including atrial fibrillation and atrial flutter and control of heart rate in noncompensatory sinus tachycardia • Control of perioperative tachycardia and hypertension Supraventricular Tachycardia or Noncompensatory Sinus Tachycardia Esmolol hydrochloride in sodium chloride injection is indicated for the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short term control of ventricular rate with a short-acting agent is desirable. Esmolol hydrochloride in sodium chloride injection is also indicated in noncompensatory sinus tachycardia where, in the physician’s judgment, the rapid heart rate requires specific intervention. Esmolol hydrochloride in sodium chloride injection is intended for short-term use.

Dosage and administration (summary)

• Administer intravenously ( 2.1 , 2.2 ) • Titrate using ventricular rate or blood pressure at ≥ 4-minute intervals ( 2.1 , 2.2 ) • Supraventricular tachycardia (SVT) or noncompensatory sinus tachycardia o Optional loading dose: 500 mcg per kg infused over one minute o Then 50 mcg per kg per minute for the next 4 minutes o Adjust dose as needed to a maximum of 200 mcg per kg per minute o Additional loading doses may be administered • Perioperative tachycardia and hypertension o Loading dose: 500 mcg per kg over 1 minute for gradual control (1 mg per kg over 30 seconds for immediate control) o Then 50 mcg per kg per min for gradual control (150 mcg per kg per minute for immediate control) adj…

Contraindications

Esmolol hydrochloride in sodium chloride injection is contraindicated in patients with: • Severe sinus bradycardia: May precipitate or worsen bradycardia resulting in cardiogenic shock and cardiac arrest . • Heart block greater than first degree: Second- or third-degree atrioventricular block may precipitate or worsen bradycardia resulting in cardiogenic shock and cardiac arrest . • Sick sinus syndrome: May precipitate or worsen bradycardia resulting in cardiogenic shock and cardiac arrest .

Warnings and precautions

• Risk of hypotension, bradycardia, and cardiac failure: Monitor for signs and symptoms of cardiovascular adverse effects. Reduce or discontinue use ( 5.1 , 5.2 , 5.3 , 5.10 ) • Risk of exacerbating reactive airway disease • Diabetes: May mask symptoms of hypoglycemia and alter glucose levels; monitor • Risk of unopposed alpha-agonism and severe hypertension in untreated pheochromocytoma • Risk of myocardial ischemia when abruptly discontinued in patients with coronary artery disease ( 5.12 , 5.15 ) Hypotension Hypotension can occur at any dose but is dose-related.

Pregnancy

Pregnancy Esmolol hydrochloride has been shown to produce increased fetal resorptions with minimal maternal toxicity in rabbits when given in doses approximately 8 times the maximum human maintenance dose (300 mcg/kg/min). There are no adequate and well-controlled studies in pregnant women.

Storage and supply

How Supplied Esmolol Hydrochloride in Sodium Chloride Injection 2500 mg/250 mL (10 mg/mL) (Single-dose Plastic Bag) • NDC 67457-657-25 Esmolol Hydrochloride in Sodium Chloride Injection 2000 mg/100 mL (20 mg/mL) (Single-dose Plastic Bag) • NDC 67457-658-10 Storage Store at 25°C (77°F). Excursions permitted to 15° to 30°C (59° to 86°F) .

Source: Esmolol Hydrochloride In Sodium Chloride (Esmolol Hydrochloride In Sodium Chloride) — US FDA prescribing information, 2026-03-05, DailyMed. Summarised and shortened; the full label governs. Iranian registration, indications and labelling may differ.