Cardioselective beta-blocker (ultra-short-acting)

Esmolol hydrochloride

Brand names: Brevibloc

Adult dose

Dose: Loading 500 micrograms/kg IV over 1 min; then 50 micrograms/kg/min infusion, titrate to effect (max 200 micrograms/kg/min)

Route: IV

Frequency: Continuous infusion

Clinical pearls

Half-life ~9 minutes — easily titratable; ideal for perioperative tachycardia, hypertensive emergencies, SVT
ESC AF guidelines: option for acute ventricular rate control
AAGBI use in induction-related hypertension
Preferred over labetalol when fast offset desirable

Contraindications

Severe sinus bradycardia
Sick sinus syndrome
Second/third-degree AV block
Cardiogenic shock
Decompensated heart failure
Severe asthma
Pulmonary hypertension
Phaeochromocytoma (without alpha-block)

Side effects

Hypotension (dose-related, common)
Bradycardia
Bronchospasm
Infusion-site reactions
Nausea
Confusion

Interactions

Verapamil/diltiazem (severe bradycardia/asystole)
Digoxin (bradycardia)
Insulin (mask hypoglycaemia)
Volatile anaesthetics (additive myocardial depression)

Monitoring

Continuous ECG
BP
HR
Bronchospasm signs

Reference: BNF; ESC 2020 AF guidelines; AAGBI guidelines; MHRA SPC; https://bnf.nice.org.uk/drugs/esmolol-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways