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Action/Kinetics:
Preferentially inhibits beta-1 receptors. Rapid onset ( <5 min) and a short duration of action. Has no membrane-stabilizing or intrinsic sympathomimetic activity. Low lipid solubility.
t
1/2: 9 min. Rapidly metabolized by esterases in RBCs.
Uses:
Supraventricular tachycardia or arrhythmias, sinus tachycardia.
Special Concerns:
Dosage has not been established in children.
Additional Side Effects:
Dermatologic: Inflammation at site of infusion, flushing, pallor, induration, erythema, burning, skin discoloration, edema.
Other: Urinary retention, midscapular pain, asthenia, changes in taste.
Additional Drug Interactions:
-
Digoxin /
Digoxin blood levels
-
Morphine /
Esmolol blood levels
How Supplied:
Injection: 10 mg/mL, 250 mg/mL
Dosage
?IV Infusion
SVT.
Initial: 500 mcg/kg/min for 1 min;
then, 50 mcg/kg/min for 4 min. If after 5 min an adequate effect is not achieved, repeat the loading dose followed by a maintenance infusion of 100 mcg/kg/min for 4 min. This procedure may be repeated, increasing the maintenance infusion by 50 mcg/kg/min increments (for 4 min) until the desired HR or lowered BP is approached.
Then, omit the loading infusion and reduce incremental infusion rate from 50 to 25 mcg/kg/min or less. The interval between titrations may be increased from 5 to 10 min.
Once the HR has been controlled, the client may be transferred to another antiarrhythmic agent. Reduce the infusion rate of esmolol by 50% 30 min after the first dose of the alternative antiarrhythmic agent. If satisfactory control is observed for 1 hr after the second dose of the alternative agent, the esmolol infusion may be stopped.
