Esmolol Hydrochloride
Pronunciation: (EZ-moe-lol).
- Generic name
- Esmolol hydrochloride
- Brand names
- Esmocard, Esmotab, Brevibloc, Esmolife
- Drug class
- Cardiovascular & Circulatory System
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What Esmolol hydrochloride is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how Esmolol hydrochloride works
Esmolol is a cardioselective beta-1 adrenergic receptor blocker. It competitively inhibits beta-1 receptors in cardiac tissue, leading to decreased heart rate (negative chronotropy), reduced myocardial contractility (negative inotropy), and slowed atrioventricular conduction (negative dromotropy). Its ultra-short half-life allows for rapid titration and quick reversal of effects upon discontinuation. (1)
What Esmolol hydrochloride is used for
Supraventricular tachycardia
Supraventricular tachycardia (2)
Atrial fibrillation/flutter (rate control)
Atrial fibrillation/flutter (rate control) (2)
Perioperative hypertension
Perioperative hypertension (2)
Myocardial ischemia (acute) — off-label/historical use
Not a current FDA-labeled indication for Brevibloc (esmolol); the current FDA label covers SVT/atrial fibrillation-flutter rate control and perioperative tachycardia/hypertension only. Any use for ischemia is a clinician's individualized decision. (2)
Before taking Esmolol hydrochloride
Do not take / not appropriate for
- severe sinus bradycardia, second- or third-degree AV block (unless a pacemaker is present), overt heart failure, cardiogenic shock, and hypersensitivity to esmolol. (Contraindication) (2)
Tell your clinician about
(2)How to take Esmolol hydrochloride
- General Instructions: Esmolol is given by a healthcare professional as an intravenous (IV) infusion. It is not taken by mouth.. Adult Dosing: Typical initial dose: 500 mcg/kg IV bolus over 1 minute, followed by a maintenance infusion of 50 mcg/kg/min. Dose may be titrated every 4–5 minutes as needed, up to a maximum of 200 mcg/kg/min.. Pediatric Dosing: Dosing in children is individualized and must be determined by a pediatric specialist. Close monitoring is required.. Administration: Administered only by trained healthcare professionals in a hospital or clinical setting. Continuous monitoring of heart rate and blood pressure is required.. When To Stop: Esmolol is usually stopped when heart rate and rhythm are controlled or when the underlying condition is resolved. Your doctor will decide when to discontinue.. Storage: Store unopened vials at room temperature, away from light and moisture. Follow hospital protocols for storage and disposal.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2)
Missed dose
Esmolol is administered in a clinical setting, so missed doses are unlikely. If a dose is missed, your healthcare provider will determine the best course of action.
Overdose
Symptoms of overdose include severe bradycardia, hypotension, heart block, or cardiac arrest. Immediate medical intervention is required. Supportive care and medications such as atropine, isoproterenol, or vasopressors may be used. (2)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Hypotension
Incidence: Reported in the clinician-authored database; frequency not established
Bradycardia
Incidence: Reported in the clinician-authored database; frequency not established
Dizziness
Incidence: Reported in the clinician-authored database; frequency not established
Nausea
Incidence: Reported in the clinician-authored database; frequency not established
Injection site reactions
Incidence: Reported in the clinician-authored database; frequency not established
Bronchospasm
Incidence: Reported in the clinician-authored database; frequency not established
Heart failure
Incidence: Reported in the clinician-authored database; frequency not established
Very slow heartbeat, fainting, severe dizziness, or difficulty breathing (esmolol is given under continuous monitoring, but tell your care team immediately of any of these)
(1)Redness, pain, or swelling at the IV/injection site
(1)Serious warnings
May cause dangerously low heart rate or blood pressure — serious
Symptoms: May cause dangerously low heart rate or blood pressure. Use with caution in patients with respiratory conditions like asthma. Can mask symptoms of low blood sugar in diabetics. Not recommended in patients with severe heart failure or heart block. Monitor for signs of allergic reaction or severe side effects.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindications include severe sinus bradycardia, second- or third-degree AV block (unless a pacemaker is present), overt heart failure, cardiogenic shock, and hypersensitivity to esmolol. Precautions: Use with caution in patients with bronchospastic disease, diabetes (may mask hypoglycemia), and those on other negative chronotropic or inotropic agents.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
The FDA label lists additional contraindications not in the clinician database — serious
Symptoms: The FDA label lists additional contraindications not in the clinician database: sick sinus syndrome, pulmonary hypertension, and concomitant use with IV cardiodepressant calcium-channel blockers such as verapamil given in close proximity. It also warns of risk of unopposed alpha-adrenergic stimulation (dangerous blood pressure rise) if esmolol is given to a patient with pheochromocytoma without prior alpha-blockade, of hyperkalemia association, and that abrupt discontinuation in patients with coronary artery disease can provoke myocardial ischemia — any change in therapy in these patients must be directed by the treating clinician.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Esmolol can interact with other medications that affect heart rate or blood pressure, such as other beta-blockers, calcium channel blockers (e.g., verapamil, diltiazem), digoxin, and certain anesthetics. Always inform your healthcare provider about all medicines you are taking. | (1) |
| Anticholinesterase drugs | Esmolol may prolong the neuromuscular blockade produced by anticholinesterase-reversed agents; relevant to anesthesia teams managing concurrent care. | (2) |
| Vasoconstrictive agents (epinephrine, norepinephrine, dopamine) | The FDA label advises avoiding concomitant use with these agents. | (2) |
| Other antihypertensive agents | Combined use can increase the risk of rebound hypertension if either drug is stopped abruptly; any discontinuation is managed by the treating clinician. | (2) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
The FDA label classifies esmolol as Pregnancy Category C: animal reproduction studies have shown an adverse effect on the fetus, and there are no adequate, well-controlled studies in humans. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, decided by the treating clinician. (2)
Breastfeeding
It is not known whether esmolol is excreted in human breast milk. The FDA label advises weighing the risks and benefits with your healthcare provider before breastfeeding while receiving esmolol. (2)
Children
Frequency: Not applicable.. Weight Based: Not recommended for pediatric use.. Max Daily Dose: Not applicable.. Max Single Dose: Not applicable.. Age Restrictions: Safety not established in children. (2)
Renal_impairment
Renal impairment: the FDA label states no dosage adjustment is required for maintenance infusions of 150 mcg/kg/min for up to 4 hours; data are limited for higher doses or longer durations, so use with clinician oversight. Hepatic impairment: no special precautions are needed, since esmolol is metabolized by red blood cell esterases rather than the liver. (2)
Hepatic_impairment
Renal impairment: the FDA label states no dosage adjustment is required for maintenance infusions of 150 mcg/kg/min for up to 4 hours; data are limited for higher doses or longer durations, so use with clinician oversight. Hepatic impairment: no special precautions are needed, since esmolol is metabolized by red blood cell esterases rather than the liver. (2)
Monitoring
(2)Storage
Store unopened vials/premixed bags at 25°C (77°F), with excursions permitted between 15°C and 30°C (59-86°F); protect from freezing and excessive heat. Once a bag has been prepared/entered, use within 24 hours. Follow hospital protocols for storage and disposal.
Study the drug class: Beta blockers
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Supraventricular tachycardia / perioperative tachycardia and hypertension
Dose summary: SVT/sinus tachycardia: optional loading dose 500 mcg/kg over 1 minute, then 50 mcg/kg/min, titrated up to a max of 200 mcg/kg/min. Perioperative tachycardia/hypertension: immediate control 1 mg/kg bolus over 30 seconds then 150 mcg/kg/min (max 300 mcg/kg/min for hypertension); gradual control 500 mcg/kg bolus over 1 minute then 50 mcg/kg/min.
Renal context: No dosage adjustment required for maintenance infusions of 150 mcg/kg/min for up to 4 hours per the FDA label; limited data at higher doses/longer durations. Hepatic impairment requires no special precautions (esterase-metabolized, not hepatic). (1) (2)
Frequently asked questions
What is esmolol used for?
Esmolol is used to rapidly control heart rate in conditions like supraventricular tachycardia, atrial fibrillation, and during surgery to manage high blood pressure or abnormal heart rhythms.
How quickly does esmolol work?
Esmolol acts within 1–2 minutes after starting the IV infusion, making it ideal for emergency or short-term use.
Can esmolol be used in pregnancy?
Esmolol should only be used during pregnancy if clearly needed and prescribed by a doctor, as there is limited safety data.
Is esmolol safe for children?
Esmolol can be used in children under specialist supervision, with dosing carefully adjusted and close monitoring.
What happens if I stop esmolol suddenly?
Abruptly stopping esmolol can cause a rapid increase in heart rate or blood pressure. Always follow your doctor's instructions for discontinuation.
Can I take esmolol with other heart medications?
Esmolol may interact with other heart medications. Your healthcare provider will decide if it is safe to use with your current medicines.
What should I do if I feel faint or dizzy while on esmolol?
Tell your healthcare provider immediately if you feel faint, dizzy, or experience any unusual symptoms while receiving esmolol.
What happens if I take too much Esmolol?
Taking too much Esmolol can lead to severe bradycardia (very slow heart rate), hypotension (low blood pressure), heart failure, and bronchospasm. Symptoms may include dizziness, fainting, and extreme fatigue. If you suspect an overdose, seek emergency medical attention immediately. Prompt medical intervention is crucial to manage these potentially life-threatening effects.
Can I drink alcohol while taking Esmolol?
It is generally advisable to avoid or limit alcohol consumption while taking Esmolol. Alcohol can exacerbate the blood pressure-lowering effects of beta-blockers, potentially leading to increased dizziness, lightheadedness, or fainting. Combining alcohol with Esmolol may also increase the risk of sedation. Always consult your healthcare provider for personalized advice regarding alcohol and your medication.
Is Esmolol safe during pregnancy?
The safety of Esmolol during pregnancy is not definitively established, and it is generally used only when the potential benefits outweigh the potential risks to the fetus. Esmolol is categorized as a Pregnancy Category C drug, meaning animal reproduction studies have shown an adverse effect on the fetus, but there are no adequate and well-controlled studies in humans. Always consult your doctor to discuss the risks and benefits if you are pregnant or planning to become pregnant.
What is the mechanism of action of Esmolol hydrochloride?
Esmolol is a cardioselective beta-1 adrenergic receptor blocker. It competitively inhibits beta-1 receptors in cardiac tissue, leading to decreased heart rate (negative chronotropy), reduced myocardial contractility (negative inotropy), and slowed atrioventricular conduction (negative dromotropy). Its ultra-short half-life allows for rapid titration and quick reversal of effects upon discontinuation. (1)
What is the generic name of Esmolol Hydrochloride?
The generic name is Esmolol hydrochloride. It is sold under brand names including Esmocard, Esmotab, Brevibloc, Esmolife.
What class of drug is Esmolol hydrochloride?
Esmolol Hydrochloride is classed as: Cardiovascular & Circulatory System.
References
- Esmolol Clinician-Authored Medicine RecordMedGuideGlobal · Not country-specific · accessed 2026-08-06 · source 1
- BREVIBLOC (esmolol hydrochloride) injection, for intravenous use — prescribing informationU.S. Food and Drug Administration · United States · accessed 2026-08-06 · source 2
- ESMOLOL HYDROCHLORIDE IN SODIUM CHLORIDE INJECTION [MYLAN INSTITUTIONAL LLC] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 3
- Esmolol Hydrochloride — FDA approval record (Drugs@FDA ANDA208538)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- Esmolol — RxNorm normalized drug concept (RXCUI 203222)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient Esmolol hydrochloride names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Brevibloc20 mg/mL, 10 mg/mL · baxter healthcare company
- Esmolol Hydrochloride in Water10 mg/mL, 20 mg/mL · wg critical care, llc
Canada
- BREVIBLOC
- BREVIBLOC PREMIXED