Esmolol hydrochloride

How it works

It selectively blocks beta-1 adrenoceptors to slow the sinus node and AV nodal conduction, and is rapidly broken down by red-cell esterases, giving a short half-life and quickly reversible action.

Prescribing in practice

• It can cause marked hypotension and bradycardia and is contraindicated in severe bradycardia, high-grade AV block, decompensated heart failure and cardiogenic shock.
• Concentrated ampoules require careful dilution and accurate infusion-pump administration, and extravasation can cause local tissue reactions.
• Use cautiously in bronchospastic airways disease and in diabetes where hypoglycaemic warning signs may be masked.

Monitoring

Use continuous ECG and blood-pressure monitoring with regular checks of the infusion site, titrating against heart rate and blood pressure.

Counselling the patient

• This medicine is given as a carefully controlled infusion that works quickly and wears off quickly.
• Tell the team about light-headedness or discomfort where the drip enters the vein.

Evidence & guidelines

Intravenous esmolol is an established agent for acute, titratable beta-blockade in arrhythmia and perioperative care.