Section 13 · Monograph
Esmolol
Reviewed Nov 2026FDA label
Breviblocβ1-selective blocker · ultra-short
- Forms
- IV: 100mg/10mL vial; premixed 2,500mg/250mL
- Dose
- Load 500mcg/kg over 1 min, then 50mcg/kg/min; titrate by 50mcg/kg/min steps up to 200-300mcg/kg/min
- MOA
- β1 blockade; half-life about 9 minutes
Indications
- Supraventricular tachycardia and intraoperative/postoperative tachycardia and hypertensionFDA-labeled
Off-Label Uses
- Rapid titratable blood pressure and heart-rate control in aortic dissection and intracerebral hemorrhageOff-label
Mechanism of Action
- Ultra-short-acting cardioselective beta-1 adrenergic blocker metabolized by red-cell esterases
Full Dosing
Adult / usual
- Loading dose 500mcg/kg over 1 minute, then 50mcg/kg/min for 4 minutes; repeat load and increase maintenance by 50mcg/kg/min steps up to about 200-300mcg/kg/min as needed
- Short half-life (about 9 minutes) allows rapid offset after stopping
- Use a large vein; avoid extravasation
Contraindications
- Severe sinus bradycardia, heart block greater than first degree, sick sinus syndrome without pacemaker
- Cardiogenic shock and decompensated heart failure
- Pulmonary hypertension; known hypersensitivity
Drug Interactions
- Verapamil and diltiazem: bradycardia and AV block
- Digoxin levels may rise
- Morphine increases esmolol levels; succinylcholine effect may be prolonged
Adverse Effects
- Hypotension and bradycardia
- Infusion-site reactions and phlebitis
- Dizziness, nausea
- Bronchospasm at higher doses
Monitoring Parameters
- Continuous ECG and blood pressure
- Infusion site
- Respiratory status
Pregnancy & Lactation
- Limited data; fetal bradycardia possible — use if benefit justifies risk
- Unknown whether present in milk