esmolol (Rx)

Brand and Other Names:Brevibloc
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

infusion bags

  • 2g/100mL
  • 2.5g/250mL

injectable solution

  • 10mg/mL
  • 20mg/mL

Intraoperative Tachycardia/Hypertension

Immediate control

  • Initial bolus: 80 mg (~1 mg/kg) IVP over 30 sec, THEN
  • 0.15-0.3 mg/kg/min IV infusion PRN  

Postoperative/gradual control

  • Load 0.5 mg/kg IV over 1 min, THEN
  • 0.05 mg/kg/min IV for 4 min
  • If inadequate response in 5 min
  • 2nd loading dose of 0.5 mg/kg/min for 1 min, THEN
  • 0.1 mg/kg/min IV  

Supraventricular Tachycardia

Load: 0.5 mg/kg IV over 1 min, THEN

Maintenance: Start 0.05 mg/kg/min IV for 4 min, may increase by 0.05 mg/kg up to 0.2 mg/kg/min  

If HR/BP not controlled after 5 min, repeat bolus (ie, 500 mcg/kg/min for 1 min), then initiate infusion of 0.1 mg/kg/min IV

May administer a 3rd bolus if needed, then a maintenance infusion of 0.15 mg/kg/min IV

Higher maintenance doses may be required, up to 0.25-0.3 mg/kg/min

Hypertensive Emergency

Load 0.25-0.5 mg/kg IVP over 1 min, THEN  

0.05-0.1 mg/kg/min IV for 4 min

May repeat loading dose or increase infusion up to 0.3 mg/kg/min if necessary

Renal Impairment

Not necessary to supplement dose; not dialyzable

Additional Information

Less effective than thiazide diuretics in black and geriatric patients

Shown to decrease mortality in hypertension and post-myocardial infarction

Other Indications & Uses

Paroxysmal Atrial Tachycardia, PSVT, ST

Off-label: Acute MI, angina, NSTEMI

Dosage Forms & Strengths

infusion bags

  • 2g/100mL
  • 2.5g/250mL

injectable solution

  • 10mg/mL
  • 20mg/mL

Supraventricular Tachycardia (Off-label)

Load with 500-600 mcg/kg IV over 2 min, THEN 200 mcg/kg/min IV infusion (range 50-250 mcg/kg/min)  

Postoperative Hypertension (Off-label)

Load with 500-600 mcg/kg IV over 2 min, THEN 200 mcg/kg/min IV infusion (range 50-250 mcg/kg/min)  

Hypertension

2.5 mg PO qDay; increase dose gradually

Supraventricular tachycardia

Load: 0.5 mg/kg/IV over 1 min, THEN

Maintenance: Start 0.05 mg/kg/min IV for 4 min, may increase by 0.05 mg/kg up to 0.2 mg/kg/min  

If HR/BP not controlled after 5 min, repeat bolus (ie, 0.5 mg/kg/min for 1 min), then initiate infusion of 0.1 mg/kg/min IV

May administer a 3rd bolus if needed, then a maintenance infusion of 0.15 mg/kg/min IV

Higher maintenance doses may be required, up to 0.25-0.3 mg/kg/min

Hypertensive emergency

Load 0.25-0.5 mg/kg IVP over 1 min, THEN

0.05-0.1 mg/kg/min IV for 4 min

May repeat loading dose or increase infusion up to 0.3 mg/kg/min if necessary

Intraoperative tachycardia/hypertension

Immediate control

- Initial bolus: 80 mg (~1 mg/kg) IVP over 30 sec, THEN

- 0.15-0.3 mg/kg/min IV infusion PRN

Postoperative/gradual control

- Load 0.5 mg/kg over 1 min, THEN

- 0.05 mg/kg/min IV for 4 min

- If inadequate response in 5 min

- 2nd loading dose of 0.5 mg/kg/min for 1 min, THEN

- 0.1 mg/kg/min

Next:

Interactions

Interaction Checker

and esmolol

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              Serious - Use Alternative (22)

              • acebutolol

                acebutolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • atenolol

                atenolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • betaxolol

                betaxolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • bisoprolol

                bisoprolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • carvedilol

                carvedilol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • celiprolol

                celiprolol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • clonidine

                clonidine, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • digoxin

                digoxin, esmolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • diltiazem

                diltiazem, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • fexinidazole

                fexinidazole, esmolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .

              • labetalol

                esmolol and labetalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • lofexidine

                lofexidine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              • metoprolol

                esmolol and metoprolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • nadolol

                esmolol and nadolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • nebivolol

                esmolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • penbutolol

                esmolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • pindolol

                esmolol and pindolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • propranolol

                esmolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • rivastigmine

                esmolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • sotalol

                esmolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • timolol

                esmolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • verapamil

                verapamil, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              Monitor Closely (172)

              • acebutolol

                acebutolol and esmolol both increase serum potassium. Use Caution/Monitor.

              • aceclofenac

                esmolol and aceclofenac both increase serum potassium. Use Caution/Monitor.

                aceclofenac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • acemetacin

                esmolol and acemetacin both increase serum potassium. Use Caution/Monitor.

                acemetacin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • albuterol

                esmolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • aldesleukin

                aldesleukin increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfuzosin

                alfuzosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of Alfuzosin may be enhanced.

              • aluminum hydroxide

                aluminum hydroxide decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • amifostine

                amifostine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • amiloride

                esmolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • amiodarone

                amiodarone, esmolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

              • amlodipine

                esmolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • amobarbital

                amobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • arformoterol

                esmolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • asenapine

                asenapine and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • aspirin

                esmolol and aspirin both increase serum potassium. Use Caution/Monitor.

                aspirin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aspirin rectal

                esmolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

                aspirin rectal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                esmolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

              • atazanavir

                atazanavir increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.

              • atenolol

                atenolol and esmolol both increase serum potassium. Use Caution/Monitor.

              • avanafil

                avanafil increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • bendroflumethiazide

                esmolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • betaxolol

                betaxolol and esmolol both increase serum potassium. Use Caution/Monitor.

              • bismuth subsalicylate

                bismuth subsalicylate, esmolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

              • bisoprolol

                bisoprolol and esmolol both increase serum potassium. Use Caution/Monitor.

              • bretylium

                esmolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • bumetanide

                esmolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • butabarbital

                butabarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • butalbital

                butalbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • calcium acetate

                calcium acetate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium carbonate

                calcium carbonate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

                calcium carbonate decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium chloride

                calcium chloride decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium citrate

                calcium citrate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium gluconate

                calcium gluconate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

              • candesartan

                candesartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • carbenoxolone

                esmolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbidopa

                carbidopa increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • carvedilol

                carvedilol and esmolol both increase serum potassium. Use Caution/Monitor.

              • celecoxib

                esmolol and celecoxib both increase serum potassium. Use Caution/Monitor.

                celecoxib decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • celiprolol

                celiprolol and esmolol both increase serum potassium. Use Caution/Monitor.

              • chlorothiazide

                esmolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorthalidone

                esmolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • choline magnesium trisalicylate

                esmolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

                choline magnesium trisalicylate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • clevidipine

                esmolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • clonidine

                esmolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

                clonidine, esmolol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive sympatholytic action may worsen sinus node dysfunction and atrioventricular (AV) block.

              • cyclopenthiazide

                esmolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dasiglucagon

                esmolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

              • desflurane

                desflurane, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • diclofenac

                esmolol and diclofenac both increase serum potassium. Use Caution/Monitor.

                diclofenac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • diflunisal

                esmolol and diflunisal both increase serum potassium. Use Caution/Monitor.

                diflunisal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • digoxin

                esmolol and digoxin both increase serum potassium. Use Caution/Monitor.

                esmolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

              • diltiazem

                esmolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • dobutamine

                esmolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

              • dopexamine

                esmolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.

              • doxazosin

                doxazosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of doxozosin may be enhanced.

              • drospirenone

                esmolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

              • ephedrine

                esmolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • epinephrine

                esmolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • epinephrine racemic

                esmolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.

              • eprosartan

                eprosartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • ethacrynic acid

                esmolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ether

                esmolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

              • etodolac

                esmolol and etodolac both increase serum potassium. Use Caution/Monitor.

                etodolac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • etomidate

                etomidate, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • felodipine

                esmolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • fenbufen

                esmolol and fenbufen both increase serum potassium. Use Caution/Monitor.

              • fenoprofen

                esmolol and fenoprofen both increase serum potassium. Use Caution/Monitor.

                fenoprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • fingolimod

                esmolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.

              • flurbiprofen

                esmolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.

                flurbiprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • formoterol

                esmolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • furosemide

                esmolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • gentamicin

                esmolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glucagon

                glucagon decreases toxicity of esmolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

              • glucagon intranasal

                glucagon intranasal decreases toxicity of esmolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

              • hawthorn

                hawthorn increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor.

              • hydralazine

                hydralazine increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • hydrochlorothiazide

                esmolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ibuprofen

                esmolol and ibuprofen both increase serum potassium. Use Caution/Monitor.

                ibuprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ibuprofen IV

                ibuprofen IV decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                esmolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.

              • indacaterol, inhaled

                indacaterol, inhaled, esmolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

              • indapamide

                esmolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • indomethacin

                esmolol and indomethacin both increase serum potassium. Use Caution/Monitor.

                indomethacin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • insulin degludec

                esmolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin degludec/insulin aspart

                esmolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin inhaled

                esmolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • iodixanol

                esmolol increases toxicity of iodixanol by unspecified interaction mechanism. Use Caution/Monitor. Use of beta-blockers lowers the threshold for and increases the severity of contrast reactions, and reduces the responsiveness of treatment of hypersensitivity reactions with epinephrine. .

              • irbesartan

                irbesartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • isoproterenol

                esmolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

              • isradipine

                esmolol, isradipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • ivabradine

                ivabradine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

              • ketamine

                ketamine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • ketoprofen

                esmolol and ketoprofen both increase serum potassium. Use Caution/Monitor.

                ketoprofen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ketorolac

                esmolol and ketorolac both increase serum potassium. Use Caution/Monitor.

                ketorolac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ketorolac intranasal

                esmolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • labetalol

                esmolol and labetalol both increase serum potassium. Use Caution/Monitor.

              • lasmiditan

                esmolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

              • levalbuterol

                esmolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • levodopa

                levodopa increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • lornoxicam

                esmolol and lornoxicam both increase serum potassium. Use Caution/Monitor.

                lornoxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • losartan

                losartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • lurasidone

                lurasidone increases effects of esmolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              • maraviroc

                maraviroc, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

              • meclofenamate

                meclofenamate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                esmolol and meclofenamate both increase serum potassium. Use Caution/Monitor.

              • mefenamic acid

                esmolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.

                mefenamic acid decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • mefloquine

                mefloquine increases levels of esmolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

              • meloxicam

                esmolol and meloxicam both increase serum potassium. Use Caution/Monitor.

                meloxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • metaproterenol

                esmolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

              • methyclothiazide

                esmolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • metolazone

                esmolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metoprolol

                esmolol and metoprolol both increase serum potassium. Use Caution/Monitor.

              • moxisylyte

                moxisylyte and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nabumetone

                esmolol and nabumetone both increase serum potassium. Use Caution/Monitor.

                nabumetone decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nadolol

                esmolol and nadolol both increase serum potassium. Use Caution/Monitor.

              • naproxen

                esmolol and naproxen both increase serum potassium. Use Caution/Monitor.

                naproxen decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nebivolol

                esmolol and nebivolol both increase serum potassium. Use Caution/Monitor.

              • nicardipine

                esmolol, nicardipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • nifedipine

                esmolol, nifedipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • nimodipine

                esmolol, nimodipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • nisoldipine

                esmolol, nisoldipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • nitroglycerin rectal

                nitroglycerin rectal, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

              • norepinephrine

                esmolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • olmesartan

                olmesartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • oxaprozin

                esmolol and oxaprozin both increase serum potassium. Use Caution/Monitor.

                oxaprozin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • oxymetazoline topical

                oxymetazoline topical increases and esmolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • parecoxib

                esmolol and parecoxib both increase serum potassium. Use Caution/Monitor.

                parecoxib decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • penbutolol

                esmolol and penbutolol both increase serum potassium. Use Caution/Monitor.

              • pentobarbital

                pentobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • phenobarbital

                phenobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • phenoxybenzamine

                phenoxybenzamine and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • phentolamine

                phentolamine and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • pindolol

                esmolol and pindolol both increase serum potassium. Use Caution/Monitor.

              • pirbuterol

                esmolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • piroxicam

                esmolol and piroxicam both increase serum potassium. Use Caution/Monitor.

                piroxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ponesimod

                ponesimod and esmolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

              • potassium acid phosphate

                esmolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium chloride

                esmolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium citrate

                esmolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.

              • prazosin

                prazosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of prazosin may be enhanced.

              • primidone

                primidone decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • propofol

                propofol, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • propranolol

                esmolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • sacubitril/valsartan

                sacubitril/valsartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • salicylates (non-asa)

                esmolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

                salicylates (non-asa) decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • salmeterol

                esmolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • salsalate

                esmolol and salsalate both increase serum potassium. Use Caution/Monitor.

                salsalate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • saquinavir

                saquinavir, esmolol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.

              • secobarbital

                secobarbital decreases levels of esmolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • sevelamer

                sevelamer decreases levels of esmolol by increasing elimination. Use Caution/Monitor.

              • sevoflurane

                sevoflurane, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • sildenafil

                esmolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

              • silodosin

                silodosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Increased risk of dizziness and orthostatic hypotension when silodosin is administered concurrently with antihypertensives.

              • siponimod

                siponimod, esmolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

              • sodium bicarbonate

                sodium bicarbonate decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sodium citrate/citric acid

                sodium citrate/citric acid decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sotalol

                esmolol and sotalol both increase serum potassium. Use Caution/Monitor.

              • spironolactone

                esmolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • succinylcholine

                esmolol and succinylcholine both increase serum potassium. Use Caution/Monitor.

              • sulfasalazine

                esmolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.

                sulfasalazine decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • sulindac

                esmolol and sulindac both increase serum potassium. Use Caution/Monitor.

                sulindac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tadalafil

                tadalafil increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • telmisartan

                telmisartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • terazosin

                terazosin and esmolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Additive hypotensive effects may occur when terazosin is used in combination with esmolol.

              • terbutaline

                esmolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor.

              • theophylline

                esmolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.

              • timolol

                esmolol and timolol both increase serum potassium. Use Caution/Monitor.

              • tolfenamic acid

                esmolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

                tolfenamic acid decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolmetin

                esmolol and tolmetin both increase serum potassium. Use Caution/Monitor.

                tolmetin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolvaptan

                esmolol and tolvaptan both increase serum potassium. Use Caution/Monitor.

              • torsemide

                esmolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • triamterene

                esmolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

              • valsartan

                valsartan and esmolol both increase serum potassium. Use Caution/Monitor.

                esmolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • verapamil

                esmolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • xipamide

                xipamide increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (32)

              • adenosine

                esmolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • agrimony

                agrimony increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • cevimeline

                cevimeline increases effects of esmolol by unspecified interaction mechanism. Minor/Significance Unknown.

              • ciprofloxacin

                ciprofloxacin increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

              • cocaine

                esmolol increases effects of cocaine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

              • cornsilk

                cornsilk increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • dihydroergotamine

                dihydroergotamine, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dihydroergotamine intranasal

                dihydroergotamine intranasal, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dipyridamole

                dipyridamole, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

              • escitalopram

                escitalopram increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

              • fenoldopam

                fenoldopam increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • forskolin

                forskolin increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • guanfacine

                esmolol, guanfacine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

              • imaging agents (gadolinium)

                esmolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

              • levobetaxolol

                levobetaxolol increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • lily of the valley

                esmolol, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.

              • maitake

                maitake increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • melatonin

                melatonin decreases toxicity of esmolol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

              • metipranolol ophthalmic

                metipranolol ophthalmic increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • neostigmine

                esmolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • noni juice

                esmolol and noni juice both increase serum potassium. Minor/Significance Unknown.

              • octacosanol

                octacosanol increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • physostigmine

                esmolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • pilocarpine

                pilocarpine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • quinacrine

                quinacrine increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

              • reishi

                reishi increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • sertraline

                sertraline increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, esmolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • tizanidine

                tizanidine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                treprostinil increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • yohimbe

                esmolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Hypotension, asymptomatic (25-38%)

              Hypotension, symptomatic (12%)

              1-10%

              Injection site pain (8%)

              Nausea (7%)

              Dizziness (3%)

              Somnolence (3%)

              Agitation (2%)

              Confusion(2%)

              Headache (2%)

              Fatigue (1%)

              Vomiting (1%)

              <1%

              Bradycardia

              Chest pain

              Anxiety

              Anorexia

              Depression

              Abdominal discomfort

              Constipation

              Dry mouth

              Dyspepsia

              Taste perversion

              Bronchospasm

              Dyspnea

              Nasal congestion

              Wheezing

              Frequency Not Defined

              Decreased exercise tolerance

              Raynaud's phenomenon

              May increase triglyceride levels and insulin resistance, and decrease HDL levels

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              Warnings

              Contraindications

              Hypersensitivity

              Sinus bradycardia, 2°/3° heart block, cardiogenic shock, overt cardiac failure

              Asthma/COPD

              Sick sinus syndrome without permanent pacemaker

              Cautions

              Anesthesia/surgery (myocardial depression), bronchospastic disease, cerebrovascular insufficiency, CHF, DM, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions

              Sudden discontinuation can exacerbate angina and lead to myocardial infarction

              Increased risk of stroke after surgery

              Use in pheochromocytoma

              Avoid abrupt withdrawal

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              Pregnancy & Lactation

              Pregnancy Category: C; D in 2nd and 3rd trimesters (expert analysis)

              Lactation: excretion in milk unknown; use with caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Class II antiarrhythmic; selective beta1-blocker with little or no effect on beta2 receptors except at high doses. It does not have intrinsic sympathomimetic activity

              Pharmacokinetics

              Onset of action: 2-10 min (IV)

              Duration: 10-30 min

              Protein Bound: 55%

              Vd: 3.4 L/kg

              Metabolism: Extensively metabolized by esterase in cytosol of red blood cells

              Metabolites: Major acid metabolite (ASL-8123), methanol (inactive)

              Excretion: Urine (73-88%)

              Half-Life

              • Parent drug (esmolol): 9 min
              • Acid metabolite: 3.7 hr
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              Administration

              IV Compatibilities

              Solution: compatible with common solvents

              Additive: aminophylline, atracurium, bretylium, heparin

              Y-site: (partial list): aminophylline, amiodarone, ampicillin, butorphanol, calcium chloride, cefazolin, cimetidine, clindamycin, diltiazem, dopamine, enalaprilat, erythromycin, famotidine, fentanyl, gentamicin, heparin, hydrocortisone, labetalol, linezolid, magnesium sulfate, metronidazole, midazolam, morphine, nitroglycerin, norepinephrine, KCl, ranitidine, sodium nitroprusside, trimethoprim/sulfamethoxazole, vancomycin

              IV Incompatibilities

              Solution: NaHCO3 (5%)

              Additive: Procainamide

              Y-site: Amphocetrin B cholesteryl sulfate, furosemide, lansoprazole, pantoprazole, warfarin

              IV Preparation

              Solution: 5 g in 500 mL or 2.5 g in 250 mL NS (10 mg/mL)

              IV Administration

              Do NOT infuse into small veins or through butterfly catheter

              Infuse at concentration 10 mg/mL, usually with infusion control device

              If local reaction develops, change infusion site

              Do not stop abruptly; possibility of withdrawal effects

              Intended for short-term use, no longer than 48 hr

              Watch for irritation & infiltration

              • Extravasation may cause tissue damage or necrosis

              Storage

              Store at room temp; protect from elevated temp

              Freezing does not affect product adversely

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              esmolol intravenous
              -
              100 mg/10 mL (10 mg/mL) vial
              esmolol intravenous
              -
              100 mg/10 mL (10 mg/mL) vial
              esmolol intravenous
              -
              100 mg/10 mL (10 mg/mL) vial
              esmolol intravenous
              -
              100 mg/10 mL (10 mg/mL) vial
              esmolol intravenous
              -
              100 mg/10 mL (10 mg/mL) vial
              Brevibloc intravenous
              -
              100 mg/10 mL (10 mg/mL) vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              esmolol intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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              Code Definition
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.