Dosing & Uses
Dosage Forms & Strengths
infusion bags
- 2g/100mL
- 2.5g/250mL
injectable solution
- 10mg/mL
- 20mg/mL
Intraoperative Tachycardia/Hypertension
Immediate control
Postoperative/gradual control
- Load 0.5 mg/kg IV over 1 min, THEN
- 0.05 mg/kg/min IV for 4 min
- If inadequate response in 5 min
- 2nd loading dose of 0.5 mg/kg/min for 1 min, THEN
- 0.1 mg/kg/min IV
Supraventricular Tachycardia
Load: 0.5 mg/kg IV over 1 min, THEN
Maintenance: Start 0.05 mg/kg/min IV for 4 min, may increase by 0.05 mg/kg up to 0.2 mg/kg/min
If HR/BP not controlled after 5 min, repeat bolus (ie, 500 mcg/kg/min for 1 min), then initiate infusion of 0.1 mg/kg/min IV
May administer a 3rd bolus if needed, then a maintenance infusion of 0.15 mg/kg/min IV
Higher maintenance doses may be required, up to 0.25-0.3 mg/kg/min
Hypertensive Emergency
Load 0.25-0.5 mg/kg IVP over 1 min, THEN
0.05-0.1 mg/kg/min IV for 4 min
May repeat loading dose or increase infusion up to 0.3 mg/kg/min if necessary
Renal Impairment
Not necessary to supplement dose; not dialyzable
Additional Information
Less effective than thiazide diuretics in black and geriatric patients
Shown to decrease mortality in hypertension and post-myocardial infarction
Other Indications & Uses
Paroxysmal Atrial Tachycardia, PSVT, ST
Off-label: Acute MI, angina, NSTEMI
Dosage Forms & Strengths
infusion bags
- 2g/100mL
- 2.5g/250mL
injectable solution
- 10mg/mL
- 20mg/mL
Supraventricular Tachycardia (Off-label)
Load with 500-600 mcg/kg IV over 2 min, THEN 200 mcg/kg/min IV infusion (range 50-250 mcg/kg/min)
Postoperative Hypertension (Off-label)
Load with 500-600 mcg/kg IV over 2 min, THEN 200 mcg/kg/min IV infusion (range 50-250 mcg/kg/min)
Hypertension
2.5 mg PO qDay; increase dose gradually
Supraventricular tachycardia
Load: 0.5 mg/kg/IV over 1 min, THEN
Maintenance: Start 0.05 mg/kg/min IV for 4 min, may increase by 0.05 mg/kg up to 0.2 mg/kg/min
If HR/BP not controlled after 5 min, repeat bolus (ie, 0.5 mg/kg/min for 1 min), then initiate infusion of 0.1 mg/kg/min IV
May administer a 3rd bolus if needed, then a maintenance infusion of 0.15 mg/kg/min IV
Higher maintenance doses may be required, up to 0.25-0.3 mg/kg/min
Hypertensive emergency
Load 0.25-0.5 mg/kg IVP over 1 min, THEN
0.05-0.1 mg/kg/min IV for 4 min
May repeat loading dose or increase infusion up to 0.3 mg/kg/min if necessary
Intraoperative tachycardia/hypertension
Immediate control
- Initial bolus: 80 mg (~1 mg/kg) IVP over 30 sec, THEN
- 0.15-0.3 mg/kg/min IV infusion PRN
Postoperative/gradual control
- Load 0.5 mg/kg over 1 min, THEN
- 0.05 mg/kg/min IV for 4 min
- If inadequate response in 5 min
- 2nd loading dose of 0.5 mg/kg/min for 1 min, THEN
- 0.1 mg/kg/min
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (23)
- acebutolol
acebutolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- atenolol
atenolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- betaxolol
betaxolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- bisoprolol
bisoprolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- carvedilol
carvedilol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- celiprolol
celiprolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- clonidine
clonidine, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.
- digoxin
digoxin, esmolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.
- diltiazem
diltiazem, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.
- fexinidazole
fexinidazole, esmolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .
- labetalol
esmolol and labetalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- lofexidine
lofexidine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
- mavacamten
esmolol, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.
- metoprolol
esmolol and metoprolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- nadolol
esmolol and nadolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- nebivolol
esmolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- penbutolol
esmolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- pindolol
esmolol and pindolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- propranolol
esmolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- rivastigmine
esmolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.
- sotalol
esmolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- timolol
esmolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- verapamil
verapamil, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.
Monitor Closely (173)
- acebutolol
acebutolol and esmolol both increase serum potassium. Use Caution/Monitor.
- aceclofenac
esmolol and aceclofenac both increase serum potassium. Use Caution/Monitor.
aceclofenac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - acemetacin
esmolol and acemetacin both increase serum potassium. Use Caution/Monitor.
acemetacin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - albuterol
esmolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor. - aldesleukin
aldesleukin increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- alfuzosin
alfuzosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of Alfuzosin may be enhanced.
- aluminum hydroxide
aluminum hydroxide decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.
- amifostine
amifostine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
- amiloride
esmolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.
- amiodarone
amiodarone, esmolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.
- amlodipine
esmolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- amobarbital
amobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- arformoterol
esmolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor. - asenapine
asenapine and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- aspirin
esmolol and aspirin both increase serum potassium. Use Caution/Monitor.
aspirin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aspirin rectal
esmolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.
aspirin rectal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
esmolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor. - atazanavir
atazanavir increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.
- atenolol
atenolol and esmolol both increase serum potassium. Use Caution/Monitor.
- avanafil
avanafil increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- bendroflumethiazide
esmolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- betaxolol
betaxolol and esmolol both increase serum potassium. Use Caution/Monitor.
- bismuth subsalicylate
bismuth subsalicylate, esmolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.
- bisoprolol
bisoprolol and esmolol both increase serum potassium. Use Caution/Monitor.
- bretylium
esmolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
- bumetanide
esmolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butabarbital
butabarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- butalbital
butalbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- calcium acetate
calcium acetate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.
- calcium carbonate
calcium carbonate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.
calcium carbonate decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours. - calcium chloride
calcium chloride decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.
- calcium citrate
calcium citrate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.
- calcium gluconate
calcium gluconate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.
- candesartan
candesartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - carbenoxolone
esmolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbidopa
carbidopa increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.
- carvedilol
carvedilol and esmolol both increase serum potassium. Use Caution/Monitor.
- celecoxib
esmolol and celecoxib both increase serum potassium. Use Caution/Monitor.
celecoxib decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - celiprolol
celiprolol and esmolol both increase serum potassium. Use Caution/Monitor.
- chlorothiazide
esmolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorthalidone
esmolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- choline magnesium trisalicylate
esmolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.
choline magnesium trisalicylate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - clevidipine
esmolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- clonidine
esmolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.
clonidine, esmolol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive sympatholytic action may worsen sinus node dysfunction and atrioventricular (AV) block. - cyclopenthiazide
esmolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dasiglucagon
esmolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.
- desflurane
desflurane, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- diclofenac
esmolol and diclofenac both increase serum potassium. Use Caution/Monitor.
diclofenac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - diflunisal
esmolol and diflunisal both increase serum potassium. Use Caution/Monitor.
diflunisal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - digoxin
esmolol and digoxin both increase serum potassium. Use Caution/Monitor.
esmolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia. - diltiazem
esmolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- dobutamine
esmolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor. - dopexamine
esmolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor. - doxazosin
doxazosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of doxozosin may be enhanced.
- drospirenone
esmolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.
- ephedrine
esmolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor. - epinephrine
esmolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - epinephrine racemic
esmolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. - eprosartan
eprosartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - ethacrynic acid
esmolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ether
esmolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.
- etodolac
esmolol and etodolac both increase serum potassium. Use Caution/Monitor.
etodolac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - etomidate
etomidate, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- felodipine
esmolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- fenbufen
esmolol and fenbufen both increase serum potassium. Use Caution/Monitor.
- fenoprofen
esmolol and fenoprofen both increase serum potassium. Use Caution/Monitor.
fenoprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - fingolimod
esmolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.
- flurbiprofen
esmolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.
flurbiprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - formoterol
esmolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor. - furosemide
esmolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gentamicin
esmolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glucagon
glucagon decreases toxicity of esmolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- glucagon intranasal
glucagon intranasal decreases toxicity of esmolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- hawthorn
hawthorn increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor.
- hydralazine
hydralazine increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.
- hydrochlorothiazide
esmolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen
esmolol and ibuprofen both increase serum potassium. Use Caution/Monitor.
ibuprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ibuprofen IV
ibuprofen IV decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
esmolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor. - indacaterol, inhaled
indacaterol, inhaled, esmolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.
- indapamide
esmolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indomethacin
esmolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - insulin degludec
esmolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
- insulin degludec/insulin aspart
esmolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
- insulin inhaled
esmolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
- iodixanol
esmolol increases toxicity of iodixanol by unspecified interaction mechanism. Use Caution/Monitor. Use of beta-blockers lowers the threshold for and increases the severity of contrast reactions, and reduces the responsiveness of treatment of hypersensitivity reactions with epinephrine. .
- irbesartan
irbesartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - isoproterenol
esmolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor. - isradipine
esmolol, isradipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- ivabradine
ivabradine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.
- ketamine
ketamine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- ketoprofen
esmolol and ketoprofen both increase serum potassium. Use Caution/Monitor.
ketoprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ketorolac
esmolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ketorolac intranasal
esmolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.
ketorolac intranasal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - labetalol
esmolol and labetalol both increase serum potassium. Use Caution/Monitor.
- lasmiditan
esmolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.
- levalbuterol
esmolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor. - levodopa
levodopa increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
- lornoxicam
esmolol and lornoxicam both increase serum potassium. Use Caution/Monitor.
lornoxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - losartan
losartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - lurasidone
lurasidone increases effects of esmolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
- maraviroc
maraviroc, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- meclofenamate
meclofenamate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
esmolol and meclofenamate both increase serum potassium. Use Caution/Monitor. - mefenamic acid
esmolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.
mefenamic acid decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - mefloquine
mefloquine increases levels of esmolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.
- meloxicam
esmolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - metaproterenol
esmolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor. - methyclothiazide
esmolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylphenidate transdermal
methylphenidate transdermal decreases effects of esmolol by anti-hypertensive channel blocking. Use Caution/Monitor.
- metolazone
esmolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
esmolol and metoprolol both increase serum potassium. Use Caution/Monitor.
- moxisylyte
moxisylyte and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- nabumetone
esmolol and nabumetone both increase serum potassium. Use Caution/Monitor.
nabumetone decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nadolol
esmolol and nadolol both increase serum potassium. Use Caution/Monitor.
- naproxen
esmolol and naproxen both increase serum potassium. Use Caution/Monitor.
naproxen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nebivolol
esmolol and nebivolol both increase serum potassium. Use Caution/Monitor.
- nicardipine
esmolol, nicardipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- nifedipine
esmolol, nifedipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- nimodipine
esmolol, nimodipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- nisoldipine
esmolol, nisoldipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.
- nitroglycerin rectal
nitroglycerin rectal, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.
- norepinephrine
esmolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - olmesartan
olmesartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - oxaprozin
esmolol and oxaprozin both increase serum potassium. Use Caution/Monitor.
oxaprozin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - oxymetazoline topical
oxymetazoline topical increases and esmolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
esmolol and parecoxib both increase serum potassium. Use Caution/Monitor.
parecoxib decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - penbutolol
esmolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- pentobarbital
pentobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- phenobarbital
phenobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- phenoxybenzamine
phenoxybenzamine and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- phentolamine
phentolamine and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- pindolol
esmolol and pindolol both increase serum potassium. Use Caution/Monitor.
- pirbuterol
esmolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor. - piroxicam
esmolol and piroxicam both increase serum potassium. Use Caution/Monitor.
piroxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ponesimod
ponesimod and esmolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.
- potassium acid phosphate
esmolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
esmolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
esmolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
- prazosin
prazosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of prazosin may be enhanced.
- primidone
primidone decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- propofol
propofol, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- propranolol
esmolol and propranolol both increase serum potassium. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - salicylates (non-asa)
esmolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.
salicylates (non-asa) decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - salmeterol
esmolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - salsalate
esmolol and salsalate both increase serum potassium. Use Caution/Monitor.
salsalate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - saquinavir
saquinavir, esmolol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.
- secobarbital
secobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- sevelamer
sevelamer decreases levels of esmolol by increasing elimination. Use Caution/Monitor.
- sevoflurane
sevoflurane, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- sildenafil
esmolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.
- silodosin
silodosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Increased risk of dizziness and orthostatic hypotension when silodosin is administered concurrently with antihypertensives.
- siponimod
siponimod, esmolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.
- sodium bicarbonate
sodium bicarbonate decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.
- sodium citrate/citric acid
sodium citrate/citric acid decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.
- sotalol
esmolol and sotalol both increase serum potassium. Use Caution/Monitor.
- spironolactone
esmolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.
- succinylcholine
esmolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulfasalazine
esmolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - sulindac
esmolol and sulindac both increase serum potassium. Use Caution/Monitor.
sulindac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tadalafil
tadalafil increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- telmisartan
telmisartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - terazosin
terazosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Additive hypotensive effects may occur when terazosin is used in combination with esmolol.
- terbutaline
esmolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor. - theophylline
esmolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.
- timolol
esmolol and timolol both increase serum potassium. Use Caution/Monitor.
- tolfenamic acid
esmolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
tolfenamic acid decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolmetin
esmolol and tolmetin both increase serum potassium. Use Caution/Monitor.
tolmetin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolvaptan
esmolol and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
esmolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triamterene
esmolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.
- valsartan
valsartan and esmolol both increase serum potassium. Use Caution/Monitor.
esmolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - verapamil
esmolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- xipamide
xipamide increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor.
Minor (31)
- adenosine
esmolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.
- agrimony
agrimony increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- cevimeline
cevimeline increases effects of esmolol by unspecified interaction mechanism. Minor/Significance Unknown.
- ciprofloxacin
ciprofloxacin increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.
- cocaine topical
esmolol increases effects of cocaine topical by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.
- cornsilk
cornsilk increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- dihydroergotamine
dihydroergotamine, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- dihydroergotamine intranasal
dihydroergotamine intranasal, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- dipyridamole
dipyridamole, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.
- escitalopram
escitalopram increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.
- fenoldopam
fenoldopam increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.
- forskolin
forskolin increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- guanfacine
esmolol, guanfacine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.
- imaging agents (gadolinium)
esmolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.
- levobetaxolol
levobetaxolol increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- lily of the valley
esmolol, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- maitake
maitake increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- metipranolol ophthalmic
metipranolol ophthalmic increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- neostigmine
esmolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.
- noni juice
esmolol and noni juice both increase serum potassium. Minor/Significance Unknown.
- octacosanol
octacosanol increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- physostigmine
esmolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.
- pilocarpine
pilocarpine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- quinacrine
quinacrine increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.
- reishi
reishi increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- sertraline
sertraline increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.
- shepherd's purse
shepherd's purse, esmolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.
- tizanidine
tizanidine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.
- treprostinil
treprostinil increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.
- yohimbe
esmolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
>10%
Hypotension, asymptomatic (25-38%)
Hypotension, symptomatic (12%)
1-10%
Injection site pain (8%)
Nausea (7%)
Dizziness (3%)
Somnolence (3%)
Agitation (2%)
Confusion(2%)
Headache (2%)
Fatigue (1%)
Vomiting (1%)
<1%
Bradycardia
Chest pain
Anxiety
Anorexia
Depression
Abdominal discomfort
Constipation
Dry mouth
Dyspepsia
Taste perversion
Bronchospasm
Dyspnea
Nasal congestion
Wheezing
Frequency Not Defined
Decreased exercise tolerance
Raynaud's phenomenon
May increase triglyceride levels and insulin resistance, and decrease HDL levels
Warnings
Contraindications
Hypersensitivity
Sinus bradycardia, 2°/3° heart block, cardiogenic shock, overt cardiac failure
Asthma/COPD
Sick sinus syndrome without permanent pacemaker
Cautions
Sudden discontinuation can exacerbate angina and lead to myocardial infarction
Increased risk of stroke after surgery
Use caution in pheochromocytoma
Avoid abrupt withdrawal
Anesthesia/surgery (myocardial depression), bronchospastic disease, cerebrovascular insufficiency, CHF, DM, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions
Effects on blood sugar
- Beta-blockers may prevent early warning signs of hypoglycemia, such as tachycardia, and increase risk for severe or prolonged hypoglycemia at any time during treatment, especially in patients with diabetes mellitus or children and patients who are fasting (eg, surgery, not eating regularly, or are vomiting)
- If severe hypoglycemia occurs, patients should be instructed to seek emergency treatment; elevated blood glucose levels and increased insulin requirements can occur in diabetic patients
Pregnancy & Lactation
Pregnancy Category: C; D in 2nd and 3rd trimesters (expert analysis)
Lactation: excretion in milk unknown; use with caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Class II antiarrhythmic; selective beta1-blocker with little or no effect on beta2 receptors except at high doses. It does not have intrinsic sympathomimetic activity
Pharmacokinetics
Onset of action: 2-10 min (IV)
Duration: 10-30 min
Protein Bound: 55%
Vd: 3.4 L/kg
Metabolism: Extensively metabolized by esterase in cytosol of red blood cells
Metabolites: Major acid metabolite (ASL-8123), methanol (inactive)
Excretion: Urine (73-88%)
Half-Life
- Parent drug (esmolol): 9 min
- Acid metabolite: 3.7 hr
Administration
IV Compatibilities
Solution: compatible with common solvents
Additive: aminophylline, atracurium, bretylium, heparin
Y-site: (partial list): aminophylline, amiodarone, ampicillin, butorphanol, calcium chloride, cefazolin, cimetidine, clindamycin, diltiazem, dopamine, enalaprilat, erythromycin, famotidine, fentanyl, gentamicin, heparin, hydrocortisone, labetalol, linezolid, magnesium sulfate, metronidazole, midazolam, morphine, nitroglycerin, norepinephrine, KCl, ranitidine, sodium nitroprusside, trimethoprim/sulfamethoxazole, vancomycin
IV Incompatibilities
Solution: NaHCO3 (5%)
Additive: Procainamide
Y-site: Amphocetrin B cholesteryl sulfate, furosemide, lansoprazole, pantoprazole, warfarin
IV Preparation
Solution: 5 g in 500 mL or 2.5 g in 250 mL NS (10 mg/mL)
IV Administration
Do NOT infuse into small veins or through butterfly catheter
Infuse at concentration 10 mg/mL, usually with infusion control device
If local reaction develops, change infusion site
Do not stop abruptly; possibility of withdrawal effects
Intended for short-term use, no longer than 48 hr
Watch for irritation & infiltration
- Extravasation may cause tissue damage or necrosis
Storage
Store at room temp; protect from elevated temp
Freezing does not affect product adversely
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| esmolol intravenous - | 100 mg/10 mL (10 mg/mL) vial |  | |
| esmolol intravenous - | 100 mg/10 mL (10 mg/mL) vial |  | |
| esmolol intravenous - | 100 mg/10 mL (10 mg/mL) vial |  | |
| esmolol intravenous - | 100 mg/10 mL (10 mg/mL) vial |  | |
| esmolol intravenous - | 100 mg/10 mL (10 mg/mL) vial |  | |
| esmolol intravenous - | 100 mg/10 mL (10 mg/mL) vial |  | |
| Brevibloc intravenous - | 100 mg/10 mL (10 mg/mL) vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
esmolol intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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