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Editor: Katherine L. Fredlund Updated: 1/30/2024 10:35:08 PM


Esmolol, or esmolol hydrochloride, is an intravenous cardioselective β-1 adrenergic antagonist.[1] Esmolol is used in various settings, including urgent care, perioperative care, and postoperative care. In the contemporary era, esmolol has the following indications.

FDA-Approved Indications

Esmolol has received approval from the United States Food and Drug Administration (FDA) for short-term use in managing supraventricular tachycardia, including rapid ventricular rates in individuals with atrial fibrillation or atrial flutter. Esmolol is a valuable emergency medication for focal atrial tachycardia, particularly in individuals experiencing active bronchospasm.[2] According to 2019 AHA/ACC/HRS (American College of Cardiology/American Heart Association/Heart Rhythm Society) guidelines, intravenous β-blockers such as esmolol are recommended to slow a rapid ventricular response in patients with AF who do not have heart failure, hemodynamic instability, or bronchospasm.[3] Similarly, the 2023 AHA/ACC/ACCP/HRS (American Heart Association/American College of Cardiology/American College of Clinical Pharmacy/Heart Rhythm Society) guidelines endorse esmolol in hemodynamically stable atrial fibrillation with rapid ventricular response.[4]

Furthermore, esmolol has proven to be a safe and efficient medication used for controlling blood pressure during surgery due to its short half-life.[5] The drug is also indicated in sinus tachycardia, where a rapid heartbeat requires immediate intervention, especially in the case of acute coronary syndrome.[6]

Off-Label Uses

Esmolol has various off-label uses, such as managing rate and rhythm in conditions such as aortic dissection, acute coronary syndrome, non-ST elevation myocardial infarction, hypertensive emergencies, thyrotoxicosis, refractory ventricular tachycardia, refractory to defibrillation, and ventricular fibrillation.[7] The drug is also used for mitigating the catecholamine response during electroconvulsive therapy.[8]

According to a recent study, esmolol may improve survival for patients with refractory ventricular fibrillation (RVF) in prehospital settings.[9] A topical esmolol formulation is investigated for diabetic foot ulcers and shows promising results in a phase 3 randomized controlled trial.[10] The randomized, double-blind, placebo-controlled trial investigated the effectiveness of a single bolus dose of esmolol in attenuating cardiorespiratory responses during extubation, highlighting the potential as a safe and effective strategy in managing extubation-related complications.[11]

Hypertensive emergency: Loading dose of 500 to 1000 mcg/kg over 1 minute (can be repeated once), followed by infusion of 50 mcg/kg/min until the maximum dose of 200 mcg/kg/min is achieved.[12][13]

Aortic dissection: Loading dose of 500 mcg/kg over 2 to 5 minutes, followed by 10 mcg/kg infusion to 20 mcg/kg/min.[14]

Acute coronary syndrome: Loading dose of 500 mcg/kg over 1 minute, followed by 50 mcg/kg per minute infusion titrated every 5 to 15 minutes until the maximum dose of 300 mcg/kg/min.[15]

Electroconvulsive therapy: Loading dose of 1000 mcg/kg over 1 minute before administration of anesthesia.[16]

Thyrotoxicosis: 50 to 100 mcg/kg/min.

Intubation cholinergic response: Loading dose of 1000 to 2000 mcg/kg administered 1.5 to 3 min before endotracheal intubation.

Ventricular tachycardia, ventricular fibrillation: Loading dose of 500 mcg/kg bolus, followed by 50 mcg/kg/min.

Mechanism of Action

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Mechanism of Action

Esmolol is a short-acting, cardio-selective β-blocker, a class II antiarrhythmic agent that is a competitive antagonist of the β-1-adrenergic receptors primarily in the myocytes.[17] By blocking the adrenergic activity of epinephrine and norepinephrine, it decreases contractility (negative inotropic effect), heart rate (negative chronotropic effect), and conduction.[18] Esmolol increases atrioventricular refractory time, decreases oxygen demand of the myocardium, and decreases atrioventricular conduction (negative dromotropic effect). A minor β-2-adrenergic blockade is reported with high IV infusion doses. Esmolol does not have any membrane-stabilizing activity or α-adrenergic blockade.


Absorption: Esmolol is rapidly absorbed, the onset of action is within 60 seconds, and it maintains a steady state within 5 minutes of initiating infusion.[19] A steady state is achieved at 2 minutes if a loading dose is administered. The drug has a 9-minute half-life and rapid renal clearance.

Distribution: Esmolol has plasma protein binding of 55%. The mean apparent volume of distribution is approximately 0.33 to 0.53 L/kg.[20]

Metabolism: Fast metabolism translates into the rapid decrease of pharmacological effect (within 10 to 30 minutes) once the infusion is discontinued, making esmolol safer when titrated appropriately.[21] Hydrolysis by the erythrocyte esterases metabolizes esmolol to an acid metabolite and methanol, eliminating the need for dose adjustments in renal or hepatic dysfunction.[20]

Elimination: The metabolite has a half-life of 3.7 hours and is excreted via urine. Esmolol has a higher clearance (281 mL/kg/min) in infants than in adults and children.[19]


Available Dosage Forms and Strengths

Esmolol is available in various formulations, including an injection of 100 mg per 10 mL vial (10 mg/mL), a premixed injection bag with 2500 mg in 250 mL (10 mg/mL), and a double-strength premixed injection bag of 2000 mg in 100 mL (20 mg/mL). Esmolol is administered intravenously, preferably through central venous access; however, it can also be infused peripherally.

FDA approval was based on adult subjects. Pediatric dosages have been experimental and unapproved by the FDA. Esmolol should be used short-term, with a maintenance dose infusion under 48 hours. Most patients on esmolol infusions will be transitioned to other long-term agents. Once the effects of esmolol are no longer needed, it should not be tapered gradually.[6] New medication should be initiated, titrating esmolol down by 50% and reassessing hemodynamic stability. If the patient is stable, continue slowly titrating the esmolol down while titrating the new agent until the desired heart rate and blood pressure are achieved. Peripheral extravasations can cause thrombophlebitis. If the extravasation occurs, the infusion should be stopped, the line should be gently aspirated, and the limb should be elevated.

Adult Dosage

Perioperative and postoperative tachycardia and hypertension (2 methods): A 1000 mcg/kg bolus over 30 seconds, followed by 150 mcg/kg per minute infusion, with a maximum dose of 300 mcg/kg per minute.

A bolus of 500 mcg/kg over 1 minute, followed by 50 mcg/kg/min infusion for 4 minutes. If the desired therapeutic effect is not achieved, the esmolol dose may be increased to 50 mcg/kg/min until the maximum dose of 300 mcg/kg/min.[22]

Supraventricular tachycardia and non-compensatory sinus tachycardia: A bolus loading dose of 500 mcg/kg over 1 minute was followed by a 50 mcg/kg/min infusion for 4 minutes. If the desired effect is not reached, it may increase in 50 mcg/kg per minute increments until the maximum dose of 200 mcg/kg per minute. For rapid efficacy, follow the initial loading dose and infusion of 50 mcg/kg per minute by a second 500 mcg/kg bolus over 1 minute and increase drip to 100 mcg/kg per minute for 4 minutes.[23] 

Specific Patient Populations

Hepatic impairment: Esmolol does not require dosage adjustment for hepatic impairment.[24]

Renal impairment: Esmolol does not require dosage adjustment for renal impairment.[25]

Pregnancy considerations: Esmolol is a category C drug in pregnancy. During trials in third-trimester pregnancy and labor, Esmolol causes fetal bradycardia, which persisted after the drug infusion was discontinued.[26]

Breastfeeding considerations: Esmolol has 55% plasma protein binding, < 1% renal excretion, and a short half-life of <10 minutes; hence, infants have no risk of accumulation. There is inconclusive data regarding milk excretion; however, it should not be used in breastfeeding mothers due to the serious potential for adverse effects.[20][27]

Pediatric patients: The safety and effectiveness of esmolol are unestablished in pediatric patients. However, esmolol is used off-label for supraventricular tachycardia.[28]

Older patients: The initiation of esmolol dosage in older patients is usually recommended at the lower end of the range due to a higher prevalence of reduced renal or cardiac function and increased occurrences of concurrent diseases or concomitant drug therapies.

Adverse Effects

  • The most common adverse reaction with esmolol is hemodynamic compromise, which happens to over 10% of all patients.[29]
  • The risk of asymptomatic (25%) and symptomatic (12%) hypotension occurs at all doses, but the risk is dose-dependent.[30] Hypotension in esmolol patients appears once doses reach 150 mcg/kg per minute. In clinical trials, esmolol-induced hypotension is usually corrected by titrating or discontinuing the infusion.
  • Patients also experienced dizziness (3%), peripheral ischemia (1%), and infusion site reaction (8%), such as blistering, necrosis, or thrombophlebitis.[23] 
  • Rare adverse drug reactions (less than 1% of patients without comorbidities) include bradycardia, decompensated heart failure, cardiac arrest, and heart block.[31]
  • Esmolol does not show any significant laboratory abnormalities, and patients tolerated the drug while being infused for up to 24 hours. However, some cases of hyperkalemia with esmolol use have been reported. Therefore, electrolyte levels should be monitored for hyperkalemia in patients with renal disease.[32]
  • Hypoglycemic-induced tachycardia is not present with esmolol, like other β-blockers. Patients with diabetes who are on esmolol should be closely monitored. Esmolol is reported to exacerbate coronary vasospasms, such as Prinzmetal’s Angina.[33]
  • In the setting of a patient with pheochromocytoma, esmolol is given with an α-blocker to avoid β-blockage without opposed alpha. Patients with a history of hyperthyroidism should be closely monitored after discontinuation of esmolol as it may exacerbate hyperthyroidism. Esmolol may also aggravate arterial insufficiency in patients with a history of significant peripheral vascular disease.[34]
  • As the excipient contains methanol, esmolol is ingested by patients with methanol poisoning.[19]

Drug-Drug Interactions

Numerous drug-drug interactions exist with esmolol, the most significant being:

  • Digoxin: A 10% to 20% increase in digoxin levels may aggravate slow AV conduction and heart rate.
  • Anticholinesterases: Prolonged neuromuscular junction blockage and recovery time.
  • Calcium channel blockers: Decreases myocardial contractility and may trigger cardiac arrest.
  • Vasoconstrictor and inotropic agents: Esmolol should not be used to control heart rate elevation in patients who receive peripheral vascular constrictive agents such as epinephrine, norepinephrine, and dopamine.[35][36]


Box Warnings

Esmolol is contraindicated in patients with sinus bradycardia, sick sinus syndrome, atrioventricular heart block, heart failure, cardiogenic shock, pulmonary hypertension, and a history of hypersensitivity reactions to esmolol. In addition, esmolol and calcium channel blockers should not be administered together, as this may exacerbate hypotension and bradycardia. Patients with first-degree heart block and nodal dysfunctions are at an increased risk of progressive heart block, bradycardia, and AV dissociation. Patients with preexisting heart failure are at greater risk of decompensated heart failure and cardiogenic shock.[37] Clinicians should be cautious when using β-blockers, such as esmolol, in patients with airway diseases such as asthma and COPD. However, the β-2 receptor's effects are minimal; some risks may exist at higher doses.[38]

Warning and Precautions

Esmolol can attenuate reflex tachycardia and increase the risk of hypotension in patients with hypovolemia. Manufacturer labeling suggests that patients using beta blockers may be less responsive to the usual doses of epinephrine used for anaphylactic or anaphylactoid reactions. However, a retrospective observational study examined patients presenting with anaphylaxis in the emergency department and found that 8% required more than one epinephrine dose, and only 13% of those patients were using β-blockers, suggesting no substantial association between β-blocker usage and the need for multiple doses of epinephrine. Overall, the study did not establish a clinically significant link between β-blocker use and the requirement for epinephrine dosing in individuals experiencing anaphylaxis.[39] The case report documented that the use of esmolol in sterile water was associated with significant hyponatremia and subsequent seizures. Awareness of medication formulations and potential adverse effects is crucial in clinical management.[40]


Esmolol is a fast-acting medication that can quickly alter heart rate and pressure. When the patient is on esmolol, it is recommended that they have continuous blood pressure monitoring, heart rate, mean arterial pressure, and, if possible, ECG.[41] An arterial line provides the best method of continuous blood pressure monitoring, which is beneficial in use with esmolol. The peripheral intravenous (IV) site should be checked regularly for any signs or symptoms of infiltration and extravasation.

As mentioned above, in patients with comorbidities, appropriate serum concentrations, such as glucose (diabetes), thyroid function tests (hyperthyroid), and potassium (renal insufficiency), are monitored. Peripheral pulses should be checked in patients with peripheral vascular disease.[42] The CHA2DS2-VASc score is measured for risk stratification of a thromboembolic event and decision regarding anticoagulation according to AHA/ACC guidelines.[3]


Signs and Symptoms of Overdose

An overdose of esmolol can result in a myriad of symptoms and effects. Cardiac signs of toxicity include but are not limited to bradycardia, AV block of any degree, complete AV dissociation, decreased contractility, cardiogenic shock, asystole, and pulseless electrical activity.[43] Neurologic signs of toxicity include but are not limited to respiratory irregularities, seizures, coma, and psychiatric symptomatology.[44] Other symptoms of toxicity may include bronchospasms, gastrointestinal mesenteric ischemia, and peripheral cyanosis.

Management of Overdose

Since esmolol has an ultra-short half-life, toxicity should be treated by discontinuing the infusion. Acute toxicity is often self-limited and treated supportively. Toxicity that results in bradycardia should be treated by atropine, pacing, and other anticholinergic agents. Cardiogenic shock is treated with inotropic agents such as dobutamine, dopamine, and isoproterenol. Although rare, bronchospasms are treated with a β-2 agonist, such as albuterol.[45] The Advanced Cardiac Life Support protocols should treat pulseless electrical activity and cardiac arrest. As with other β-blocker overdoses, calcium chloride is given to mitigate the effects of esmolol when metabolized. High-dose insulin euglycaemic therapy and veno-arterial extracorporeal membrane oxygenation are associated with reduced mortality.[46]

Enhancing Healthcare Team Outcomes

Healthcare professionals, including those in the MICU and CCU who administer esmolol, should be familiar with the adverse effects. Esmolol is an ultra-fast-acting medication that controls heart rate and pressure. Therefore, when the patient is on esmolol, it is recommended that nursing staff continuously monitor patients for blood pressure, heart rate, mean arterial pressure, and, if possible, ECG. An arterial line will provide the best continuous blood pressure monitoring method, which is beneficial when used with esmolol. The intravenous site should be checked regularly to prevent infiltration and extravasation. The pharmacist should perform medication reconciliation and inform the prescriber of any concerns.

Given the pharmacodynamics of esmolol, it is advisable to use an interprofessional team approach to the drug. This interprofessional team includes clinicians, specialists, nurses, and pharmacists, all coordinating their activities and communicating openly so team members are operating from the same information and can intervene or report the need for intervention and achieve optimal patient outcomes related to esmolol therapy. According to the 2016 ESC (European Society of Cardiology), managing patients with atrial fibrillation requires coordination from an interprofessional team consisting of specialists, stroke clinicians, cardiologists, clinicians, AF surgeons, allied healthcare professionals, patients, and family members and integrated care has the potential to enhance patient outcomes.[47]



O'Flaherty D. Esmolol. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 1993 Jul:40(7):687-8     [PubMed PMID: 8104725]

Level 3 (low-level) evidence


Das G, Tschida V, Gray R, Dhurandhar R, Lester R, McGrew F, Askenazi J, Kaplan K, Emanuele M, Turlapaty P. Efficacy of esmolol in the treatment and transfer of patients with supraventricular tachyarrhythmias to alternate oral antiarrhythmic agents. Journal of clinical pharmacology. 1988 Aug:28(8):746-50     [PubMed PMID: 2905710]


January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019 Jul 9:140(2):e125-e151. doi: 10.1161/CIR.0000000000000665. Epub 2019 Jan 28     [PubMed PMID: 30686041]

Level 1 (high-level) evidence


Writing Committee Members, Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2024 Jan 2:83(1):109-279. doi: 10.1016/j.jacc.2023.08.017. Epub 2023 Nov 30     [PubMed PMID: 38043043]

Level 1 (high-level) evidence


Gray RJ, Bateman TM, Czer LS, Conklin CM, Matloff JM. Esmolol: a new ultrashort-acting beta-adrenergic blocking agent for rapid control of heart rate in postoperative supraventricular tachyarrhythmias. Journal of the American College of Cardiology. 1985 Jun:5(6):1451-6     [PubMed PMID: 2860148]


Garnock-Jones KP. Esmolol: a review of its use in the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension. Drugs. 2012 Jan 1:72(1):109-32. doi: 10.2165/11208210-000000000-00000. Epub     [PubMed PMID: 22191799]


Sung RJ, Blanski L, Kirshenbaum J, MacCosbe P, Turlapaty P, Laddu AR. Clinical experience with esmolol, a short-acting beta-adrenergic blocker in cardiac arrhythmias and myocardial ischemia. Journal of clinical pharmacology. 1986 Mar:26(S1):A15-A26     [PubMed PMID: 2870082]


Aydogan MS, Yücel A, Begec Z, Colak YZ, Durmus M. The hemodynamic effects of dexmedetomidine and esmolol in electroconvulsive therapy: a retrospective comparison. The journal of ECT. 2013 Dec:29(4):308-11. doi: 10.1097/YCT.0b013e3182972bec. Epub     [PubMed PMID: 23774056]

Level 2 (mid-level) evidence


Patrick C, Crowe RP, Ward B, Mohammed A, Keene KR, Dickson R. Feasibility of prehospital esmolol for refractory ventricular fibrillation. Journal of the American College of Emergency Physicians open. 2022 Apr:3(2):e12700. doi: 10.1002/emp2.12700. Epub 2022 Apr 9     [PubMed PMID: 35425942]

Level 2 (mid-level) evidence


Rastogi A, Kulkarni SA, Agarwal S, Akhtar M, Arsule S, Bhamre S, Bhosle D, Desai S, Deshmukh M, Giriraja KV, Jagannath J, Kashiva RY, Kesavan R, Khandelwal D, Kolte S, Kongara S, Darivemula AK, Madhusudan C, Pyare Saheb Qureshi MAH, Ramu M, Rathod G, Yalamanchi SR, Shakya S, Shetty P, Singh S, Deshpande SK, Viswanathan V, Unnikrishnan AG. Topical Esmolol Hydrochloride as a Novel Treatment Modality for Diabetic Foot Ulcers: A Phase 3 Randomized Clinical Trial. JAMA network open. 2023 May 1:6(5):e2311509. doi: 10.1001/jamanetworkopen.2023.11509. Epub 2023 May 1     [PubMed PMID: 37184839]

Level 1 (high-level) evidence


Mendon A FÍT, Barreto Filho JH, Hungria MBCS, Magalh Es TC. Efficacy of a single dose of esmolol to prevent extubation-related complications during emergence from anesthesia: a randomized, double-blind, placebo-controlled trial. Brazilian journal of anesthesiology (Elsevier). 2023 Jul-Aug:73(4):426-433. doi: 10.1016/j.bjane.2021.08.012. Epub 2021 Sep 21     [PubMed PMID: 34560115]

Level 1 (high-level) evidence


Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part 2. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2009 Aug 15:66(16):1448-57. doi: 10.2146/ajhp080348.p2. Epub     [PubMed PMID: 19667001]


. Esmolol. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012:():     [PubMed PMID: 31644101]


Krenz JR, O'Brien ME, Lee J, Hayes BD. Evaluation of esmolol for heart rate control in patients with acute aortic dissection. The American journal of emergency medicine. 2021 Jun:44():312-314. doi: 10.1016/j.ajem.2020.04.018. Epub 2020 Apr 14     [PubMed PMID: 32354528]


Kloner RA, Kirshenbaum J, Lange R, Antman EM, Braunwald E. Experimental and clinical observations on the efficacy of esmolol in myocardial ischemia. The American journal of cardiology. 1985 Oct 23:56(11):40F-48F     [PubMed PMID: 2864848]

Level 3 (low-level) evidence


Howie MB, Hiestand DC, Zvara DA, Kim PY, McSweeney TD, Coffman JA. Defining the dose range for esmolol used in electroconvulsive therapy hemodynamic attenuation. Anesthesia and analgesia. 1992 Nov:75(5):805-10     [PubMed PMID: 1358003]

Level 1 (high-level) evidence


do Vale GT, Ceron CS, Gonzaga NA, Simplicio JA, Padovan JC. Three Generations of β-blockers: History, Class Differences and Clinical Applicability. Current hypertension reviews. 2019:15(1):22-31. doi: 10.2174/1573402114666180918102735. Epub     [PubMed PMID: 30227820]


Agrios J, Kaladaridou A, Bramos D, Skaltsiotes E, Pamboucas C, Papadopoulou E, Toumanidis S, Moulopoulos S. The acute effects of esmolol on left ventricular hemodynamic, rotational mechanics and strain in intact and infracted myocardium: An experimental study. Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese. 2021 Jul-Aug:62(4):322-323. doi: 10.1016/j.hjc.2020.07.008. Epub 2020 Aug 13     [PubMed PMID: 32800920]


Wiest DB, Haney JS. Clinical pharmacokinetics and therapeutic efficacy of esmolol. Clinical pharmacokinetics. 2012 Jun 1:51(6):347-56. doi: 10.2165/11631590-000000000-00000. Epub     [PubMed PMID: 22515557]


. Esmolol. Drugs and Lactation Database (LactMed®). 2006:():     [PubMed PMID: 30000207]


Covinsky JO. Esmolol: a novel cardioselective, titratable, intravenous beta-blocker with ultrashort half-life. Drug intelligence & clinical pharmacy. 1987 Apr:21(4):316-21     [PubMed PMID: 2882993]


Poveda-Jaramillo R, Monaco F, Zangrillo A, Landoni G. Ultra-Short-Acting β-Blockers (Esmolol and Landiolol) in the Perioperative Period and in Critically Ill Patients. Journal of cardiothoracic and vascular anesthesia. 2018 Jun:32(3):1415-1425. doi: 10.1053/j.jvca.2017.11.039. Epub 2017 Nov 23     [PubMed PMID: 29398384]


Wiest D. Esmolol. A review of its therapeutic efficacy and pharmacokinetic characteristics. Clinical pharmacokinetics. 1995 Mar:28(3):190-202     [PubMed PMID: 7758250]


Buchi KN, Rollins DE, Tolman KG, Achari R, Drissel D, Hulse JD. Pharmacokinetics of esmolol in hepatic disease. Journal of clinical pharmacology. 1987 Nov:27(11):880-4     [PubMed PMID: 3323260]


Flaherty JF, Wong B, La Follette G, Warnock DG, Hulse JD, Gambertoglio JG. Pharmacokinetics of esmolol and ASL-8123 in renal failure. Clinical pharmacology and therapeutics. 1989 Mar:45(3):321-7     [PubMed PMID: 2563962]


Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA, ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. European heart journal. 2018 Sep 7:39(34):3165-3241. doi: 10.1093/eurheartj/ehy340. Epub     [PubMed PMID: 30165544]


Ostman PL, Chestnut DH, Robillard JE, Weiner CP, Hdez MJ. Transplacental passage and hemodynamic effects of esmolol in the gravid ewe. Anesthesiology. 1988 Nov:69(5):738-41     [PubMed PMID: 2903702]

Level 3 (low-level) evidence


Oeffl N,Schober L,Faudon P,Schweintzger S,Manninger M,Köstenberger M,Sallmon H,Scherr D,Kurath-Koller S, Antiarrhythmic Drug Dosing in Children-Review of the Literature. Children (Basel, Switzerland). 2023 May 8;     [PubMed PMID: 37238395]


Yu SK, Tait G, Karkouti K, Wijeysundera D, McCluskey S, Beattie WS. The safety of perioperative esmolol: a systematic review and meta-analysis of randomized controlled trials. Anesthesia and analgesia. 2011 Feb:112(2):267-81. doi: 10.1213/ANE.0b013e3182025af7. Epub 2010 Dec 2     [PubMed PMID: 21127279]

Level 1 (high-level) evidence


Byrd RC, Sung RJ, Marks J, Parmley WW. Safety and efficacy of esmolol (ASL-8052: an ultrashort-acting beta-adrenergic blocking agent) for control of ventricular rate in supraventricular tachycardias. Journal of the American College of Cardiology. 1984 Feb:3(2 Pt 1):394-9     [PubMed PMID: 6141193]


. Beta Adrenergic Blocking Agents. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012:():     [PubMed PMID: 31643457]


Cork RC, Kramer TH, Dreischmeier B, Behr S, DiNardo JA. The effect of esmolol given during cardiopulmonary bypass. Anesthesia and analgesia. 1995 Jan:80(1):28-40     [PubMed PMID: 7802296]

Level 1 (high-level) evidence


Pham D, Addison D, Kayani W, Misra A, Jneid H, Resar J, Lakkis N, Alam M. Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis. Emergency medicine journal : EMJ. 2018 Sep:35(9):559-563. doi: 10.1136/emermed-2017-207065. Epub 2018 Jun 19     [PubMed PMID: 29921621]

Level 1 (high-level) evidence


Askenazi J, MacCosbe PE, Hoff J, Turlapaty P, Hua TA, Laddu A. Hemodynamic effects of esmolol, an ultrashort-acting beta blocker. Journal of clinical pharmacology. 1987 Aug:27(8):567-73     [PubMed PMID: 2888793]


Lowenthal DT, Porter RS, Achari R, Turlapaty P, Laddu AR, Matier WL. Esmolol-digoxin drug interaction. Journal of clinical pharmacology. 1987 Aug:27(8):561-6     [PubMed PMID: 2888792]


Kim KS, Kim KH, Shin WJ, Yoo HK. Neuromuscular interactions between mivacurium and esmolol in rabbits. Anaesthesia. 1998 Feb:53(2):140-5     [PubMed PMID: 9534636]

Level 3 (low-level) evidence


Bensky KP, Donahue-Spencer L, Hertz GE, Anderson MT, James R. The dose-related effects of bolus esmolol on heart rate and blood pressure following laryngoscopy and intubation. AANA journal. 2000 Oct:68(5):437-42     [PubMed PMID: 11759128]

Level 1 (high-level) evidence


Sheppard D, DiStefano S, Byrd RC, Eschenbacher WL, Bell V, Steck J, Laddu A. Effects of esmolol on airway function in patients with asthma. Journal of clinical pharmacology. 1986 Mar:26(3):169-74     [PubMed PMID: 2870080]

Level 1 (high-level) evidence


White JL, Greger KC, Lee S, Kahoud RJ, Li JT, Lohse CM, Campbell RL. Patients Taking β-Blockers Do Not Require Increased Doses of Epinephrine for Anaphylaxis. The journal of allergy and clinical immunology. In practice. 2018 Sep-Oct:6(5):1553-1558.e1. doi: 10.1016/j.jaip.2017.12.020. Epub 2018 Feb 13     [PubMed PMID: 29449164]


Zavala S, Kaminsky N, Roels C. Precipitation of hyponatremia and seizures by esmolol in sterile water formulation. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2024 Jan 1:81(1):e18-e20. doi: 10.1093/ajhp/zxad248. Epub     [PubMed PMID: 37787750]


Tao Y, Jingyi W, Xiaogan J, Weihua L, Xiaoju J. [Effect of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock]. Zhonghua wei zhong bing ji jiu yi xue. 2015 Nov:27(11):885-9     [PubMed PMID: 27132454]


Barbier GH, Shettigar UR, Appunn DO. Clinical rationale for the use of an ultra-short acting beta-blocker: esmolol. International journal of clinical pharmacology and therapeutics. 1995 Apr:33(4):212-8     [PubMed PMID: 7620691]

Level 3 (low-level) evidence


Litman RS, Zerngast BA. Cardiac arrest after esmolol administration: a review of acute beta-blocker toxicity. The Journal of the American Osteopathic Association. 1996 Oct:96(10):616-8     [PubMed PMID: 8936932]

Level 3 (low-level) evidence


Kapitein B, Biesmans RCG, van der Sijs H, de Wildt SN. Propylene Glycol-Related Delirium After Esmolol Infusion. The Annals of pharmacotherapy. 2014 Jul:48(7):940-942     [PubMed PMID: 24687543]


Sun KO. Bronchospasm after esmolol and neostigmine. Anaesthesia and intensive care. 1993 Aug:21(4):457-9     [PubMed PMID: 8105719]

Level 3 (low-level) evidence


Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Baxter H, Bourke E, Wong A. Treatment for beta-blocker poisoning: a systematic review. Clinical toxicology (Philadelphia, Pa.). 2020 Oct:58(10):943-983. doi: 10.1080/15563650.2020.1752918. Epub 2020 Apr 20     [PubMed PMID: 32310006]

Level 1 (high-level) evidence


Kirchhof P. Integrated care of patients with atrial fibrillation: the 2016 ESC atrial fibrillation guidelines. Heart (British Cardiac Society). 2017 May:103(10):729-731. doi: 10.1136/heartjnl-2016-310843. Epub 2017 Jan 11     [PubMed PMID: 28077464]