Esmolol (Intravenous)

Esmolol is a medicine that is used, especially during and after surgery in hospital, in order to control a fast heartbeat or irregular heart rhythms.

Overview

In the US, esmolol is sold under the brand names, Esmolol HCI and Brevibloc. The drug is only used in hospital or medical clinic environments and is administered intravenously by a medical professional.

Esmolol is one of a group of drugs known as class II antiarrhythmics, commonly referred to as beta-blockers. It is used to moderate the heartbeat and to control hypertension, usually during or following surgery or other medical procedures. It is also the preferred drug where aortic dissection is suspected.

The drug works by decreasing the rate and force of the heart's contractions and also by blocking certain receptors of the nervous system, which are located in the heart and other body organs. Esmolol also stops the interaction between norepinephrine and epinephrine, two naturally occurring chemicals produced by the body. The overall effect of the medication is to lower the blood pressure, thus increasing the amount of oxygenated blood that arrives in the heart.

It should be noted that this medication is not designed to cure your medical condition. The drug is only used to control and manage the complications that some people suffer when undergoing surgical procedures.

Conditions treated

Esmolol is used during or following surgery or other medical procedures in hospital to treat or prevent the following complications:

  • Arrhythmia
  • Tachycardia
  • Hypertension
  • Aortic dissection

Type of medicine

  • Class II antiarrhythmic (beta-blocker)
  • Solution for intravenous administration

Side effects

In addition to their intended effects, many drugs can cause some effects that are not wanted. Although not everyone experiences any or all of these effects, if you do notice anything unusual, you may need further medical attention.

If you become aware of any of the following odd effects, you must mention them to your treating physician or nurse straight away:

  • Weak or no pulses in the legs
  • Feeling unusually tired or weak
  • Tightness of the chest
  • Reddening, swelling, or burning feeling of skin at the injection site
  • Sudden loss of consciousness
  • Rattling sounds in the chest
  • Slow or irregular heartbeat
  • Shortness of breath
  • Shivering
  • Redness of the arms, face, neck, and sometimes, upper chest
  • Peeling skin
  • Pale skin
  • Cold or blue-colored hands or feet
  • Pain when urinating
  • Tenderness, pain, or swelling of foot or leg
  • Pain in lower back, arms, or legs, especially in calves and/or heels upon exertion
  • Numbness and tingling of fingers, toes, or face
  • Muscle spasms or jerking of extremities
  • Loss of bladder control
  • Feeling lightheaded, dizzy, or faint
  • Itchy skin
  • Increased sweating
  • Feeling unusually cold
  • Feeling unusually warm
  • Feeling dizzy or faint when getting up suddenly from a prone or sitting position
  • Difficulty speaking
  • Difficulty in passing urine (dribbling)
  • Breathing difficulties, including wheezing
  • Dementia
  • Delusions
  • Decrease in urine quantity and/or frequency
  • Coughing up a pink, frothy sputum
  • Convulsions
  • Confusion
  • Chest pain or discomfort
  • Visual disturbances
  • Blurred vision
  • Changes in skin color
  • Crawling, burning, numbness, itching, prickling, tingling, or feeling of "pins and needles"
  • Cyanosis

If you notice any of the following signs, you should summon emergency help straight away. Although an overdose of esmolol is highly unlikely to occur, it can sometimes affect patients who have undetected kidney disease. The symptoms listed below could be indicative of an overdose:

  • Unexpected weight gain
  • Unconsciousness
  • Swelling of lower legs, face, or feet
  • Heart attack
  • No blood pressure or pulse
  • Irregular breathing
  • Extreme fatigue
  • Dilated neck veins

There are some effects that may be caused by esmolol that do not warrant medical assistance. These side effects usually resolve themselves over a day or so, as your body gets used to the drug. Your nurse or doctor may suggest ways in which you can prevent or manage these effects. However, if these effects are persistent or especially problematic for you, be sure to mention them to your doctor:

  • Vomiting
  • Unexpected weight loss
  • Trouble concentrating
  • Tiredness
  • Stuffy nose
  • Stomach upset, pain, discomfort, or soreness
  • Sour or acid stomach
  • Sleepiness or unusual drowsiness
  • Skin reaction or callousing at the injection site
  • Shoulder pain
  • Shaking
  • Restlessness
  • Nervousness
  • Nausea
  • Loss of interest or pleasure
  • Lack or loss of strength
  • Lack of appetite
  • Irritability
  • Insomnia
  • Indigestion
  • Hyperventilation
  • Heartburn
  • Headache
  • Feeling sad or empty
  • Dry mouth
  • Discouragement
  • Constipation
  • Changes in taste, unusual, or unpleasant aftertaste
  • Belching
  • Anxiety

Some people may notice a reaction around the injection site, especially if their skin is sensitive. If your skin becomes inflamed, reddened, itchy, or begins weeping, tell your nurse or doctor straight away.

This list of side effects may not be all-inclusive. If you notice any strange or unusual feelings or effects that have not been mentioned in this overview, you should mention them to your treating physician or nurse straight away.

Dosage

You will only be given esmolol as part of your care package during a hospital or clinic stay. A trained health professional or nurse will administer the drug intravenously. A thin tube called a cannula will be placed into one of your veins, and the medication will be slowly infused through this.

Esmolol is only designed for short-term use, when it is given to stabilize a patient's condition following or during surgery. Once your condition has improved sufficiently, you will be given a different drug that works in a similar way.

The dose of esmolol that you are given will vary from patient to patient, depending on the condition for which you are being treated and how well your body responds to the drug. Your age, weight, and other pre-existing or historical health conditions will also influence the dosage level.

Interactions

Some medications must never be given together, as doing so may cause a serious interaction or nasty side effects. However, if your treating physician deems it appropriate, you may be treated with both drugs, but at different dosage rates or frequencies. You will be given advice on how to mitigate any interaction that does occur.

You must tell your nursing team if you are taking any of the drugs listed in this guide. In particular, it is not recommended to use esmolol with any of the medicines in the bulleted list that follows. If your doctor does decide to give you both drugs, the dose of one or both may be changed:

  • Vildagliptin
  • Verapamil
  • Valdecoxib
  • Urapidil
  • Trimazosin
  • Tolmetin
  • Tolfenamic Acid
  • Tolbutamide
  • Tolazamide
  • Tiaprofenic Acid
  • Terazosin
  • Tenoxicam
  • Tamsulosin
  • Sulindac
  • St John's Wort
  • Sodium Salicylate
  • Sitagliptin
  • Saxagliptin
  • Salsalate
  • Salicylic Acid
  • Rosiglitazone
  • Rofecoxib
  • Rivastigmine
  • Repaglinide
  • Proquazone
  • Propyphenazone
  • Proglumetacin
  • Prazosin
  • Pranoprofen
  • Pramlintide
  • Piroxicam
  • Pioglitazone
  • Piketoprofen
  • Phenylbutazone
  • Phentolamine
  • Phenoxybenzamine
  • Parecoxib
  • Oxyphenbutazone
  • Oxaprozin
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic Acid
  • Nepafenac
  • Nateglinide
  • Naproxen
  • Nabumetone
  • Moxisylyte
  • Morphine Sulfate Liposome
  • Morphine
  • Morniflumate
  • Miglitol
  • Mibefradil
  • Metildigoxin
  • Metformin
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Lumiracoxib
  • Loxoprofen
  • Lornoxicam
  • Lixisenatide
  • Liraglutide
  • Linagliptin
  • Lacosamide
  • Ketorolac
  • Ketoprofen
  • Insulin Lispro, Recombinant
  • Insulin Human Regular
  • Insulin Human Isophane (NPH)
  • Insulin Human Inhaled
  • Insulin Glulisine
  • Insulin Glargine, Recombinant
  • Insulin Detemir
  • Insulin Degludec
  • Insulin Aspart, Recombinant
  • Indomethacin
  • Ibuprofen
  • Glyburide
  • Glipizide
  • Glimepiride
  • Flurbiprofen
  • Flufenamic Acid
  • Floctafenine
  • Fingolimod
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Fenoldopam
  • Felbinac
  • Exenatide
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Empagliflozin
  • Dulaglutide
  • Droxicam
  • Dronedarone
  • Doxazosin
  • Dipyrone
  • Diltiazem
  • Digoxin
  • Digitoxin
  • Diflunisal
  • Diclofenac
  • Dexketoprofen
  • Dexibuprofen
  • Deslanoside
  • Dapagliflozin
  • Crizotinib
  • Clonixin
  • Clonidine
  • Choline Salicylate
  • Chlorpropamide
  • Celecoxib
  • Canagliflozin
  • Bunazosin
  • Bufexamac
  • Bromfenac
  • Aspirin
  • Arbutamine
  • Amtolmetin Guacil
  • Amiodarone
  • Alogliptin
  • Alfuzosin
  • Albiglutide
  • Acetyldigoxin
  • Acemetacin
  • Aceclofenac
  • Acarbose

In addition to interactions between esmolol and other drugs, there may be an interaction when eating certain foodstuffs, using tobacco, or drinking alcohol. You should discuss this aspect of your treatment with your treating physician or nurse.

Medical history

Some medical conditions can affect how esmolol works. You must tell your medical team if you have a history of any other health problems, especially those mentioned below.

Esmolol must NOT be used in patients with the following conditions:

  • Heart failure
  • Heart block or
  • Bradycardia (slow heartbeat) or

Esmolol should be used with caution in patients with the following conditions, as the drug may mask some of the symptoms of these diseases:

  • Hypoglycemia (low blood sugar)
  • Diabetes

Using esmolol in patients suffering from low blood pressure (hypotension) could cause the condition to become worse.

Esmolol must be used with extreme caution in people who have a history of kidney disease, because the slow removal of the drug from the body may increase the risk of an overdose.

Patients who have lung diseases, including emphysema, asthma, and bronchitis should be monitored closely if treated with esmolol, as the drug can cause breathing difficulties.

Warnings

Before you begin using any medication, you must weigh the risks against the benefits of doing so. Your treating medical team will discuss the use of esmolol with you, and you should raise any concerns that you have at this time.

Be sure to tell your treating physician if you are allergic to esmolol or to any other medicines, including over the counter products, herbal and vitamin supplements or remedies. You should also mention any strange reactions that you have experienced to particular food groups, food colors, preservatives, or animal derivatives.

Geriatric patients

Elderly people are more likely to be affected by age-related kidney problems that are not immediately apparent. The dose of esmolol should be adjusted accordingly in these cases.

Pregnancy and breastfeeding

There are no significant warnings relating to esmolol's effect on the unborn baby. However, you should tell your treating physician if you think you may be pregnant, before you are treated with this medicine.

Similarly, although there is no specific evidence to suggest that esmolol passes into breast milk, you should consider using an alternative feeding solution for your infant during the course of your treatment with this drug. Your GP or midwife will be best placed to advise you on this.

Storage

Esmolol is only given to patients in a clinic or hospital environment, where it will be stored in a suitable environment as per the product manufacturer's directions.

Summary

Esmolol is a beta-blocker. It is used in clinics and hospitals to treat patients before, during, and after surgery, and during certain other medical procedures in order to control a rapid or irregular heartbeat and high blood pressure. The drug is very effective in lowering the blood pressure and taking the strain off the heart. Once your condition has been stabilized, you will be given a different drug that works in a similar way.

There are a number of pre-existing medical conditions that preclude the use of esmolol. There are also a large number of medicines that should not be used with esmolol as an interaction may occur that could increase the risk of side effects or make the conditions worse. For these reasons, you must discuss your medical history fully with your doctor before you are treated with esmolol.

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