Esmolol comes in an injectable form and is used to treat arrhythmia and hypertension in emergency conditions.
Esmolol blocks beta-1 receptors, which are present on the heart. This prevents the action of nerve chemicals adrenaline and noradrenaline on the heart. As a result, heart beats at a slower rate and with lesser force, and thus pumps out lesser blood into blood vessels. This action of esmolol reduces blood pressure in the hypertensive patients. Since esmolol slows heart rate, it treats tachycardia (fast heart rate), and irregular heart rate and rhythm (arrhythmia).
Esmolol should not be given in conditions where the heart is beating slow or with less force. These include:
Severe sinus bradycardia (extremely low heart rate)
Second or third-degree atrioventricular block (heart block)
Sick sinus syndrome
Decompensated heart failure
Other conditions where esmolol should not be used include:
Known allergy to the drug
Intravenous drug dosage for esmolol varies as per the medical conditions.
For atrial flutter / atrial fibrillation / supraventricular tachycardia: Initial loading dose is 0.5mg/kg/min infused over one minute. Maintenance dose is 0.05 mg/kg/min for 4 minutes. If the response is unsatisfactory within the 1st 5 minutes, give 2nd loading dose of 500 mcg/kg, then maintenance infusion at 100 mcg/kg/min for 4 minutes.
For intra or post-operative supraventricular tachycardia (SVT) or hypertension: Loading dose is 80 mg, then 150 mcg/kg/min is given via infusion, up to 300 mcg/kg/min if needed. Alternatively, the above regimen may also be used to obtain gradual control.
A patient must never administer esmolol injection by himself.
Esmolol is available in solution in a vial or an ampoule which is injected by the physician in to a vein, in a clinical setting where vital signs can be monitored and emergency conditions can be treated immediately.
Esmolol interacts with many medications. Make sure that your doctor is informed about your ongoing medications/ supplements, herbal preparations before it is administered.
Esmolol can mask the symptoms of low blood sugar levels in diabetic patients.
Heart- Low heart rate and blood pressure
Central Nervous System- Dizziness, drowsiness, confusion, headache, agitation, fatigue
Respiratory- Wheezing, difficulty in breathing, nasal congestion
Gastrointestinal- Nausea, vomiting, indigestion, constipation, dry mouth and abdominal discomfort
Local - Pain and inflammation at the site of injection
Esmolol should be administered with extreme precaution, if the patient suffers from one of the following conditions:
Diabetes, since it may mask the effects of low blood sugar levels
Low blood sugar
Low blood pressure
Kidney function problems, since the drug is eliminated from the body in the urine
Respiratory problems like asthma, bronchitis, and emphysema
Pheochromocytoma, which is a tumor of the adrenal glands that secretes large amounts of adrenaline
Prinzmetals angina, where angina occurs due to spasm of a coronary artery
Hyperthyroidism, or high thyroid hormone levels
Hypovolemic patient, where the blood volume is low
Esmolol should be avoided with:
Other beta blockers due to additive effects.
Other drugs that can slow down the heart like verapamil, digitalis, amiodarone and diltiazem.
Drugs used in the treatment of asthma due to opposite effects on the bronchi
Antidiabetes medications since esmolol can block the signs of hypoglycemia
Drugs that act on alpha receptors. Along with alpha agonists like ephedrine, it can produce excessive rise in blood pressure, while with alpha blockers like prazosin, it can result in excess fall in blood pressure
NSAIDs like ibuprofen and naproxen, which may block the effect of esmolol on blood pressure.
Anticholinesterase drugs used in Alzheimer's disease like rivastigmine due to additive effect on the heart and blood pressure
Drugs that lower blood pressure and increase potassium levels like chlorthiazide
Other drugs that may lower blood pressure like antihypertensive medications, aldesleukin, and barbiturates.
Store at room temp; protect from elevated temp. Keep away from children.
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