Brevibloc 10mg/ml Inj, 250ml

Esmolol is a beta-1 selective (cardioselective) adrenergic receptor blocking agent. It competitively blocks beta-1 adrenergic receptors, primarily in the heart, leading to decreased heart rate, myocardial contractility, and cardiac output. At higher doses, it can also block beta-2 receptors. Its ultra-short duration of action is due to rapid hydrolysis by esterases in red blood cells.

Serious Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high potassium levels, including:
+ Abnormal heartbeat
+ Confusion
+ Weakness, lightheadedness, or dizziness
+ Feeling like passing out
+ Numbness or tingling
+ Shortness of breath
Signs of too much acid in the blood (acidosis), such as:
+ Confusion
+ Rapid breathing
+ Rapid heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling extremely tired or weak
Dizziness or fainting
Excessive sweating
Shortness of breath, significant weight gain, or swelling in the arms or legs
Slow heartbeat
Abnormal heartbeat

If the medication leaks from the vein, it may cause tissue damage. Inform your nurse immediately if you experience any of the following symptoms at the injection site:
Redness
Burning
Pain
Swelling
Blisters
Skin sores
Fluid leakage

Other Possible Side Effects

Like all medications, this drug can cause side effects. However, many people do not experience any side effects or only have mild ones. If you are bothered by any of the following side effects or if they persist, contact your doctor or seek medical attention:
Upset stomach

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
Certain health conditions, including:
+ Respiratory problems like asthma or chronic obstructive pulmonary disease (COPD)
+ Heart conditions, such as heart block, heart failure (weak heart), or shock caused by heart problems
+ Abnormally slow heartbeat
Specific heart-related conditions, including:
+ Sick sinus syndrome, a type of abnormal heartbeat
+ Prinzmetal's angina, a particular type of chest pain
High blood pressure in the lungs (pulmonary hypertension)
If you are taking certain medications, such as diltiazem or verapamil

To ensure your safety, it is crucial to disclose all of your:

Prescription and over-the-counter (OTC) medications
Natural products
Vitamins
* Health problems

Your doctor and pharmacist need this information to determine if it is safe for you to take this medication with your existing health conditions and medications. Never start, stop, or change the dose of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Before engaging in activities that require alertness, such as driving, wait until you understand how this drug affects you.

To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs. Regular blood tests, as directed by your doctor, are crucial to monitor your condition. Additionally, check your blood pressure and heart rate as instructed by your doctor.

This medication may mask certain symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia. This risk is particularly higher in individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have concerns, consult your doctor. If you have diabetes, it is vital to closely monitor your blood sugar levels.

This drug may also make it more challenging to recognize signs of an overactive thyroid, such as a rapid heartbeat. If you have hyperthyroidism and suddenly stop taking this medication, your condition may worsen and become life-threatening. Discuss this with your doctor.

If you have a history of severe allergic reactions, consult your doctor, as you may be at risk of an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, inform your doctor, as this medication may reduce the effectiveness of epinephrine.

Do not abruptly stop taking this medication, as this can lead to increased chest pain and, in some cases, heart attack, particularly if you have certain types of heart disease. To avoid adverse effects, your doctor will guide you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, contact your doctor immediately.

If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor to ensure the best possible outcome for you and your baby.

• Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem): Risk of severe bradycardia, heart block, and hypotension.
• Digoxin: Increased risk of bradycardia and AV block.
• Insulin and oral hypoglycemics: May mask symptoms of hypoglycemia (e.g., tachycardia).

• Other antihypertensives (e.g., ACE inhibitors, diuretics): Additive hypotensive effects.
• Clonidine: Risk of rebound hypertension upon clonidine withdrawal if beta-blocker is not tapered.
• NSAIDs: May reduce the hypotensive effects of beta-blockers.
• Sympathomimetics (e.g., epinephrine, norepinephrine): May cause unopposed alpha-adrenergic stimulation leading to severe hypertension and bradycardia.

• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Dizziness or lightheadedness
• Fatigue or weakness
• Dyspnea (shortness of breath)
• Wheezing or bronchospasm
• Signs of heart failure exacerbation (e.g., peripheral edema, crackles, jugular venous distension)
• Cold extremities
• Confusion or altered mental status

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Beta-blockers may cause bradycardia, hypoglycemia, and respiratory depression in the neonate. Prolonged exposure may lead to intrauterine growth restriction.

L3 (Moderately safe). Esmolol is rapidly metabolized and has a very short half-life, making infant exposure low. However, caution is advised, and monitoring the infant for signs of beta-blockade (e.g., bradycardia, lethargy) is recommended.

Esmolol has been used in pediatric patients for supraventricular tachycardia and hypertension. Dosing is weight-based and requires careful titration and monitoring due to potential for profound bradycardia and hypotension. Safety and efficacy in neonates are not fully established.

Use with caution in elderly patients, as they may be more sensitive to the hypotensive and bradycardic effects of beta-blockers. Start with lower doses and titrate slowly. Monitor closely for adverse effects.

• Esmolol is an ultra-short-acting beta-blocker, making it highly titratable and suitable for acute, critical care settings where rapid control and reversibility are desired.
• Due to its rapid metabolism by esterases, its effects quickly dissipate upon discontinuation of the infusion, allowing for precise control of heart rate and blood pressure.
• It is cardioselective (beta-1 selective) at lower doses, but this selectivity diminishes at higher doses, increasing the risk of beta-2 mediated side effects like bronchospasm.
• Always administer via continuous intravenous infusion after an initial loading dose. Avoid abrupt discontinuation to prevent rebound effects, especially in patients with underlying coronary artery disease.
• Monitor infusion site closely for signs of irritation or extravasation, as esmolol can be irritating to veins.

• Metoprolol (IV)
• Labetalol (IV)
• Diltiazem (IV)
• Verapamil (IV)
• Adenosine (for SVT)
• Nicardipine (IV)
• Fenoldopam (IV)

If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed otherwise, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities offer drug take-back programs, which your pharmacist can help you locate. Some medications may come with an additional patient information leaflet; check with your pharmacist for more information. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide details about the medication taken, the amount, and the time it occurred.