ESMOLOL (Brevibloc)


Name: ESMOLOL (BreviblocR)
Classification: beta 1 selective receptor blocker; ultra short acting
  • decreases HR
  • decreases AV conduction
  • decreases myocardial contractility to decrease myocardial oxygen consumption

An alpha blocking agent must be used with esmolol prior to excision of a pheochromocytoma.


Ultra short half-life with onset of action 2-10 minutes after bolus dose, which is maintained for 10-30 minutes.

  • 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:
2,500 mg/250 ml dextrose 5%, sodium chloride 0.9% or Ringer's Lactate (10mg/mL)
  • should be weaned off
Adverse Effects:
  • hypotension
  • bradycardia, AV block
  • decreased cardiac output
  • bronchoconstriction (potential to block beta receptors in airways)
  • acute pulmonary edema
  • increased SVRI
  • phlebitis, skin necrosis
  • 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:
  • IV site
  • continuous heart rate and rhythm
  • PR interval
  • blood pressure
  • urine output
  • blood glucose
  • breath sounds

Intended for short term use or to test response to beta blockers. For continued use, consider longer acting agent.

Adult Critical Care Protocol:
  • May be administered IV direct by a nurse in Adult Critical Care
  • IV direct by physician only
  • Should be administered via central venous line whenever possible
  • Continuous infusions must be administered by infusion device and the pump library must be enabled

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 18, 2018