Esmolol

How it works

It is a cardioselective beta-1 adrenoceptor antagonist that slows the sinus rate and AV nodal conduction; its rapid hydrolysis by red-cell esterases gives a very short half-life and quickly reversible effect.

Prescribing in practice

• Because of its negative inotropic and chronotropic effects it can cause significant hypotension and bradycardia, and is contraindicated in severe bradycardia, high-grade heart block, decompensated heart failure and cardiogenic shock.
• Its very short duration means effects resolve within minutes of stopping the infusion, which is an advantage if adverse effects occur but requires continuous titration.
• Use with caution in asthma or bronchospastic disease and in diabetes, where it may mask signs of hypoglycaemia.

Monitoring

Administer with continuous ECG and blood-pressure monitoring and frequent infusion-site review, titrating to heart rate and blood-pressure response.

Counselling the patient

• This is given as a closely monitored drip and acts and wears off very quickly.
• Report dizziness or any infusion-site pain to the team.

Evidence & guidelines

Esmolol is a recognised option for acute rate control of supraventricular arrhythmias and perioperative haemodynamic control.