Name: ESMOLOL (BreviblocR)
Classification: beta 1 selective receptor blocker; ultra short acting
  • decreases HR
  • decreases systemic vascular resistance
  • decreases AV conduction
  • decreases myocardial contractility to decrease myocardial oxygen consumption
  • can cause bronchoconstriction
  • Loading Dose:
    • 500 ug/kg IV direct over one minute
  • Maintenance Dose:
    • 50 ug/kg/min IV infusion
    • further partial loading doses of 500 ug/kg with an increase in infusion rate by 50 ug/kg/min may be repeated every 5 minutes to a maximum infusion rate of 300 ug/kg/min, titrate to effect
Administration: IV Infusion:
5 000 mg/500 ml D5W, NS, or RL (10mg/mL)
  • should be weaned off
Adverse Effects:
  • hypotension
  • bradycardia, AV block
  • decreased cardiac output
  • bronchospasm
  • acute pulmonary edema
  • increased SVRI
  • should be used with caution in patients with asthma, COPD, peripheral vascular disease as beta blockade may cause bronchoconstriction, bradyarrhythmias or AV block
Drug Interactions:
  • esmolol + verapamil = increased hypotension, AV block
Monitoring Therapy:
  • ECG: HR, rhythm, PR interval
  • BP
  • cardiac index
  • urine output
  • SVRI (may drop SVRI)
  • PWP (may cause increase due to myocardial depression)
  • breath sounds, chest xray 
  • blood glucose
CCTC Protocol:
  • May be administered by IV infusion by an approved nurse in CCTC.
  • Continuous infusions must be administered by infusion pump.
  • May be titrated by an approved nurse in CCTC.
  • Should not be infused through the injectate port of the right heart catheter.
  • Patient requires placement of an arterial line if continuous infusion administered.

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017

LHSCHealth Professionals

Last Updated January 12, 2017 | © 2007, LHSC, London Ontario Canada