Active Ingredient: Esmolol
Esmolol is indicated for supraventricular tachycardia (except for pre- excitation syndromes), and for the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other circumstances where short-term control of the ventricular rate with a short acting agent is desirable.
For this indication, competent medicine agencies globally authorize below treatments:
Intravenous
50 - 200 ug per kg of body weight
From 50 To 200 ug per kg of body weight once every day
The dosage of esmolol should be titrated individually. A starting dose is required, followed by a maintenance dosage.
The effective dose of esmolol is within the range of 50 to 200 micrograms/kg/min, although doses as high as 300 micrograms/kg/min have been used. In a few patients the average effective dosage of 25 micrograms/kg/min has been adequate.
Repeat 500 micrograms/kg/min for 1 minute.
Increase maintenance infusion to 200 micrograms/kg/min and maintain.
As the desired heart rate or safety end-point (e.g. lowered blood pressure) is approached, OMIT the loading infusion and reduce the incremental dose in the maintenance infusion from 50 micrograms/kg/min to 25 micrograms/kg/min or lower. If necessary, the interval between the titration steps may be increased from 5 to 10 minutes.
NB: Maintenance doses above 200 micrograms/kg/min have not been shown to have significantly increased benefits, and the safety of doses above 300 micrograms/kg/min has not been studied.
In the event of an adverse reaction, the dosage of esmolol may be reduced or discontinued. Pharmacological adverse reactions should resolve within 30 minutes.
If a local infusion site reaction develops, an alternative infusion site should be used and caution should be taken to prevent extravasation.
The administration of esmolol infusions for longer than 24 hours has not been thoroughly evaluated. Infusion durations greater than 24 hours should only be used with caution.
Abrupt discontinuation of esmolol in patients has not been reported to produce the withdrawal effects which may occur with abrupt withdrawal of beta-blockers following chronic use in coronary artery disease (CAD) patients. However, caution should still be used in discontinuing esmolol infusions abruptly in CAD patients.
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