ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Ultra-short-acting selective beta-1 blocker Pregnancy: Use with caution. Fetal bradycardia possible.

Esmolol

Brand names: Brevibloc

Adult dose

Dose: 500 mcg/kg IV loading over 1 min; maintenance 50–200 mcg/kg/min
Route: IV infusion
Frequency: Continuous infusion
Max: 200 mcg/kg/min (maintenance)
SVT/AF with rapid ventricular response: 500 mcg/kg over 1 min, then 50–100 mcg/kg/min maintenance, titrate to HR. Acute aortic dissection: combine with IV vasodilator (GTN/nitroprusside). Perioperative tachycardia: IV bolus 500 mcg/kg, then infusion.

Paediatric dose

Dose: 500 micrograms/kg
Route: IV
Frequency: Loading bolus over 1 min, then 50–200 micrograms/kg/min infusion
Max: 500 micrograms/kg loading; 200 micrograms/kg/min maintenance
Concentration: 10000 micrograms/ml
BNFc paediatric cardiology specialist use: loading 500 micrograms/kg IV over 1 min, then maintenance infusion 50–200 micrograms/kg/min titrated to HR. SVT/AF with rapid ventricular response; perioperative tachycardia; thyroid storm. Half-life 2–9 min — rapid offset on stopping.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required (hydrolysed by red blood cell esterases).

Paediatric weight-based calculator

BNFc paediatric cardiology specialist use: loading 500 micrograms/kg IV over 1 min, then maintenance infusion 50–200 micrograms/kg/min titrated to HR. SVT/AF with rapid ventricular response; perioperative tachycardia; thyroid storm. Half-life 2–9 min — rapid offset on stopping.

Clinical pearls

  • Half-life 9 minutes — effects resolve within 20–30 minutes of stopping (ideal for titration)
  • Ideal for perioperative tachycardia/hypertension — rapidly on/off
  • Rate control in AF/SVT: when full effect needed quickly and reversibility important
  • Aortic dissection: first-line IV beta-blocker (combined with vasodilator)
  • 10 mg/mL solution requires dilution for peripheral use (use 250 mg/mL bags for central infusion)

Contraindications

  • Asthma (severe)
  • Severe bradycardia or AV block
  • Cardiogenic shock
  • Cocaine toxicity

Side effects

  • Hypotension
  • Bradycardia
  • Bronchospasm
  • Phlebitis at infusion site (concentrated solution — prefer central or large vein)

Interactions

  • Digoxin — additive bradycardia
  • Verapamil/diltiazem — AV block risk
  • MAOIs — hypertensive crisis

Monitoring

  • Continuous ECG
  • BP every 5 min
  • HR
  • SpO2

Reference: BNFc; BNF; ESC AF/ACS Guidelines; ACEP Arrhythmia Management. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways