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Esmolol Hydrochloride: Brands, Price & Uses in Bangladesh
Esmolol Hydrochloride is an ultra-short-acting, cardioselective beta-1 adrenergic blocking agent given by intravenous (IV) infusion.
About Esmolol Hydrochloride
Indications of Esmolol Hydrochloride
Esmolol Hydrochloride is an ultra-short-acting, cardioselective beta-1 adrenergic blocking agent given by intravenous (IV) infusion. Its evidence-based uses include:
- Established/approved use: Rapid control of ventricular rate in patients with supraventricular tachyarrhythmias, including atrial fibrillation and atrial flutter, in perioperative, postoperative, or other urgent/emergent circumstances.
- Established/approved use: Management of noncompensatory sinus tachycardia where the rapid heart rate requires urgent intervention on clinical judgment.
- Established/approved use: Short-term control of tachycardia and hypertension occurring during and immediately after surgery (perioperative tachycardia/hypertension), such as during induction and intubation, or in the immediate postoperative period.
- Guideline-supported/adjunct use: Emergency short-term rate/blood pressure control in hypertensive emergencies or aortic dissection, typically as part of combination therapy with other agents, in a monitored critical-care setting.
- Off-label use (used in specialist practice, not a primary labeled indication): Test-dosing to predict tolerance of longer-acting beta-blockers, and selected pediatric ICU tachyarrhythmia/hypertension management under specialist supervision.
Esmolol Hydrochloride is intended only for short-term, continuously monitored use in a hospital or critical-care setting.
Dosage & Administration of Esmolol Hydrochloride
General principle
Esmolol Hydrochloride is given only as a continuous, carefully monitored intravenous infusion (with or without an initial loading dose), in a setting with continuous ECG and blood pressure monitoring. Dosing is individualized and titrated to the desired heart rate/blood pressure response.
| Indication | Typical adult dosing |
|---|---|
| Supraventricular tachyarrhythmia (e.g., rate control in atrial fibrillation/flutter) | Loading dose of 500 micrograms/kg (0.5 mg/kg) IV over 1 minute, followed by a maintenance infusion starting at 50 micrograms/kg/minute for 4 minutes. If an inadequate response is seen, the loading dose may be repeated and the maintenance infusion increased in increments (e.g., up to 100, 150, then 200 micrograms/kg/minute), with each new infusion rate preceded by a repeat loading dose. Maintenance infusions above 200 micrograms/kg/minute are not generally recommended. |
| Perioperative tachycardia and/or hypertension | An initial bolus dose (e.g., 80 mg / approximately 1 mg/kg) may be given over 30 seconds, followed by an infusion of 150 micrograms/kg/minute, titrated up to 300 micrograms/kg/minute as needed, per institutional protocol and product labeling. |
See Dosage and Administration sections below for further detail, and Use in Special Populations for renal/hepatic and elderly considerations.
Side Effects of Esmolol Hydrochloride
Side effects of Esmolol Hydrochloride are generally dose-related and resolve quickly after the infusion is stopped or the rate is reduced, given its very short half-life.
- Very common/common: Hypotension (the most frequently reported effect), injection/infusion-site reactions (pain, redness, induration, or, rarely, skin necrosis with extravasation), dizziness, somnolence, headache, nausea, and sweating.
- Common cardiac effects: Bradycardia, and less commonly first-degree AV block or other conduction disturbances.
- Less common: Confusion, agitation, or altered mental status (especially at higher infusion rates), bronchospasm in susceptible individuals, flushing, and mild elevations in liver enzymes.
- Rare/serious: Severe bradycardia, high-degree AV block, severe hypotension, or bronchospasm requiring dose reduction or discontinuation (see Contraindications and Precautions and Warnings).
Report any unusual or severe symptoms to the treating medical team immediately, as Esmolol Hydrochloride is used under continuous monitoring.
Contraindications of Esmolol Hydrochloride
Esmolol Hydrochloride is contraindicated in patients with:
- Known hypersensitivity to Esmolol Hydrochloride or any component of the formulation.
- Severe sinus bradycardia.
- Sick sinus syndrome or second- or third-degree atrioventricular (AV) block, in patients without a functioning pacemaker.
- Cardiogenic shock.
- Decompensated (overt) heart failure.
- Severe, uncontrolled hypotension.
- Pulmonary hypertension with right ventricular failure (as noted in specific product labeling).
Frequently Asked Questions about Esmolol Hydrochloride
What is Esmolol Hydrochloride used for?
Esmolol Hydrochloride is used mainly in hospital settings to quickly control fast heart rates (such as in atrial fibrillation or atrial flutter) and to manage rapid heart rate and high blood pressure occurring during and after surgery.
How is Esmolol Hydrochloride given?
Esmolol Hydrochloride is given only as an intravenous (IV) infusion by trained medical staff, usually with an initial loading dose followed by a continuous infusion that is adjusted based on your heart rate and blood pressure response. It is never given by mouth or injected at home.
Who should not receive Esmolol Hydrochloride?
Esmolol Hydrochloride should not be given to people with severe slow heart rate, certain heart blockages without a pacemaker, cardiogenic shock, decompensated heart failure, severe low blood pressure, or a known allergy to the medicine.
What are the common side effects of Esmolol Hydrochloride?
The most common side effects of Esmolol Hydrochloride include low blood pressure, slow heart rate, dizziness, drowsiness, headache, nausea, and reactions at the injection site. Most side effects improve quickly once the infusion is stopped or slowed, since the medicine leaves the body very fast.
Is Esmolol Hydrochloride safe during pregnancy or breastfeeding?
Esmolol Hydrochloride should be used during pregnancy only if clearly needed and if the expected benefit outweighs the possible risk to the baby, as it may affect the baby's heart rate, blood pressure, or blood sugar if used near delivery. Breastfeeding mothers should consult their physician, since it is not fully known whether the medicine passes into breast milk, although exposure is expected to be minimal due to its short duration of action. Always consult a physician before use in pregnancy or breastfeeding.
What happens if too much Esmolol Hydrochloride is given?
An overdose of Esmolol Hydrochloride can cause a very slow heart rate, very low blood pressure, worsening heart failure, or difficulty breathing. Because it is given only in hospital under close monitoring, the medical team will stop the infusion immediately and provide emergency treatment if this occurs; this situation always requires immediate medical attention.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.