Dose:    0.5 mg/kg as an IV loading dose
               50 to 200 mcg/kg/min as a continuous infusion

Comments: Esmolol is a short-acting beta-blocking agent that is used to treat supraventricular tachycardia or tachycardia for a short-term period (24 to 48 hours). Recent comments have suggested that it may have some utility in treating obstructive cardiomyopathy following the use of dexamethasone for chronic lung disease in VLBW infants. Esmolol is also used for rebound hypertension following repair of aortic coarctation. It is administered using a loading dose of 500 mcg/kg infused over one minute. A maintenance infusion is started at 50 mcg/kg/min and increased by 25 to 50 mcg/kg/min every 5 minutes until heart rate or mean arterial pressure is decreased by 10%. A stable beta-blockade is seen in 10 to 20 minutes. The drug has an extremely short half-life, between 2 and 9 minutes, and is metabolized by red blood cell esterases. The effects of the drug disappear within 10 to 20 minutes after discontinuing the drug.   Futher comments on esmolol.

Toxicity:  Use of concentrations greater than 10 mg/ml is associated with skin necrosis following infiltration. Side effects reported by Cuneo (1994) noted transient nausea and vomiting in one patient. Most adverse reactions reported in adults are mild and/or transient and do not require discontinuing therapy. Some of these include bradycardia, hypotension, tachycardia, hypertension, headaches, sleep disturbances, hyperglycemia, hypoglycemia, gastric pain, gastritis, constipation, diarrhea, rashes, eye irritation, and bronchospasm (Facts and Comparisons, Inc. Drug Facts and Comparisons. Olin, B.R. ed. St. Louis, MO:Facts and Comparisons, Inc; 1996, page 158i-m).

Preparation:  Esmolol (Brevibloc) is a available in a 10 mg/ml "ready to use" concentration.

For bolus infusion, use esmolol 10 mg/ml, unless the dose volume is less than 0.05 mL. If dose volume is less than 0.05 mL, make a dilution of esmolol to 1 mg/mL (1 mL of 10 mg/mL esmolol with 9 mL of D5W [discard after 29 hours], D5LR, D5NS, or NS). See table below for doses. Infuse over 5 minutes. Follow the infusion with a flush over 5 minutes. Use of concentrations greater than 10 mg/ml is associated with skin necrosis following infiltration.

For continuous infusion, pharmacy will send a 30 mL bag with a 10 mg/ml concentration of esmolol. The infusion rate programed from the pump can be double checked using the link to drip sheet calculator pre 8/12 or drip sheet calculator post 8/12.  The previous method of preparing a drip not using standard concentrations and the programable pump can be accessed using this link: esmolol ci.
 

Esmolol Code Sheet

Compatibility: Compatibility with filter and TPN is unknown.  Compatible with D5W, D5 with sodium chloride, D5R, LR, NS, 0.45%NaCl, amikacin, aminophylline, ampicillin, atracurium, calcium chloride, cefazolin, ceftazidime, chloramphenicol, clindamycin, dopamine, enalaprilat, erythromycin lactobionate, famotidine, fentanyl, gentamicin, heparin,  hydrocortisone, insulin, labetalol, magnesium sulfate, metronidazole, midazolam, morphine, nafcillin,  nitroprusside, pancuronium, penicillin G potassium, phenytoin, piperacillin, potassium chloride and phosphate, ranitidine, propofol, sodium acetate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, and vecuronium.  It is incompatible with diazepam, furosemide, procainamide and sodium bicarbonate.