Brevibloc 10mg/ml Sdv Inj, 10ml
It is used to treat a fast heartbeat. It is used to treat high blood pressure.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antiarrhythmic (Class II), Antihypertensive
Pharmacologic Class
Beta-1 Selective Adrenergic Blocker
Pregnancy Category
Category C
FDA Approved
Dec 1987
DEA Schedule
Not Controlled
Overview
What is this medicine?
Esmolol is a very fast-acting medicine given through a vein (IV) to quickly slow down your heart rate or lower your blood pressure. It's often used in emergencies or during surgery because its effects wear off very quickly once the infusion is stopped.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. This medication is administered as an intravenous infusion, which means it is given slowly into a vein over a period of time.
For proper storage and disposal, consult with your doctor, nurse, or pharmacist if you need to keep this medication at home, as they can provide guidance on how to handle it.
If you miss a dose, contact your doctor immediately to determine the best course of action.
For proper storage and disposal, consult with your doctor, nurse, or pharmacist if you need to keep this medication at home, as they can provide guidance on how to handle it.
If you miss a dose, contact your doctor immediately to determine the best course of action.
Lifestyle & Tips
- This medication is administered in a hospital or clinical setting by healthcare professionals.
- Report any discomfort at the injection site immediately.
- Inform your healthcare provider if you have a history of asthma, chronic obstructive pulmonary disease (COPD), heart failure, or very slow heart rate.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Initial loading dose 500 mcg/kg over 1 minute, followed by a maintenance infusion of 50 mcg/kg/min for 4 minutes. If adequate response is not achieved, repeat loading dose and increase maintenance infusion to 100 mcg/kg/min. Titrate further as needed, up to a maximum of 200 mcg/kg/min.
Dose Range:
50 - 200 mg
Condition-Specific Dosing:
supraventricularTachycardia:
Loading: 500 mcg/kg over 1 min; Maintenance: 50-200 mcg/kg/min titrated to effect.
perioperativeHypertensionTachycardia:
Loading: 500 mcg/kg over 1 min; Maintenance: 50-200 mcg/kg/min titrated to effect.
myocardialIschemia:
Loading: 500 mcg/kg over 1 min; Maintenance: 50-200 mcg/kg/min titrated to effect.
Pediatric Dosing
Neonatal:
Not established for routine use; limited data for specific conditions.
Infant:
Dosing established for supraventricular tachycardia (SVT) and hypertension in some guidelines (e.g., 50-500 mcg/kg loading, then 25-200 mcg/kg/min maintenance infusion). Use with extreme caution.
Child:
Dosing established for SVT and hypertension (e.g., 50-500 mcg/kg loading, then 25-200 mcg/kg/min maintenance infusion). Use with extreme caution.
Adolescent:
Dosing established for SVT and hypertension (e.g., 50-500 mcg/kg loading, then 25-200 mcg/kg/min maintenance infusion). Use with extreme caution.
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed.
Moderate:
No adjustment needed.
Severe:
No adjustment needed.
Dialysis:
Esmolol is not significantly removed by hemodialysis. No adjustment needed.
Hepatic Impairment:
Mild:
No adjustment needed.
Moderate:
No adjustment needed.
Severe:
No adjustment needed.
Pharmacology
Mechanism of Action
Esmolol is a cardioselective beta-1 adrenergic receptor blocker. It competitively blocks beta-1 receptors primarily located in the heart, leading to decreased heart rate, myocardial contractility, and conduction velocity through the AV node. At higher doses, it can also block beta-2 receptors.
Pharmacokinetics
Absorption:
Bioavailability:
100%
Tmax:
Not applicable (IV administration)
FoodEffect:
Not applicable (IV administration)
Distribution:
Vd:
3.4 L/kg
ProteinBinding:
Approximately 55%
CnssPenetration:
Limited
Elimination:
HalfLife:
Distribution half-life: approximately 2 minutes; Elimination half-life: approximately 9 minutes (terminal half-life of the active drug is 4-5 minutes).
Clearance:
Approximately 117 mL/kg/min
ExcretionRoute:
Metabolites are primarily excreted renally.
Unchanged:
<2% (of parent drug)
Pharmacodynamics
OnsetOfAction:
Within 60 seconds
PeakEffect:
5-10 minutes
DurationOfAction:
10-30 minutes after discontinuation of infusion
Safety & Warnings
BLACK BOX WARNING
Abrupt discontinuation of beta-blockers in patients with coronary artery disease may exacerbate angina, precipitate myocardial infarction, or ventricular arrhythmias. When discontinuing chronically administered esmolol, reduce the dosage gradually over a period of 1 to 2 weeks. If angina worsens or acute coronary insufficiency develops, promptly reinstitute esmolol, at least temporarily, and take other measures appropriate for the management of unstable angina pectoris. Patients should be warned against interruption or discontinuation of therapy without the physician's advice.
Side Effects
Urgent 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 immediate medical attention:
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 acidosis (too much acid in the blood), 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 you experience any of these symptoms, notify your healthcare provider immediately.
Additional Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
* Upset stomach
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, 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.
Important: If you notice any signs of tissue damage at the injection site, such as redness, burning, pain, swelling, blisters, skin sores, or fluid leakage, inform your nurse immediately.
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 immediate medical attention:
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 acidosis (too much acid in the blood), 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 you experience any of these symptoms, notify your healthcare provider immediately.
Additional Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
* Upset stomach
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, 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.
Important: If you notice any signs of tissue damage at the injection site, such as redness, burning, pain, swelling, blisters, skin sores, or fluid leakage, inform your nurse immediately.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Shortness of breath or wheezing
- Chest pain or discomfort
- Swelling in your ankles or feet
- Unusual fatigue or weakness
- Very slow heart rate
Before Using This Medicine
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 you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD)
+ Heart conditions, including heart block, heart failure (weak heart), shock caused by heart problems, or slow heartbeat
Specific heart-related conditions, including:
+ Sick sinus syndrome, a type of abnormal heartbeat
+ Prinzmetal's angina, a certain type of chest pain
High 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 provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
Your health problems, including any medical conditions or allergies
Before starting, stopping, or changing the dose of any medication, including this one, you must consult with your doctor to confirm that it is safe to do so. This will help prevent potential interactions between your medications and health conditions.
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 you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD)
+ Heart conditions, including heart block, heart failure (weak heart), shock caused by heart problems, or slow heartbeat
Specific heart-related conditions, including:
+ Sick sinus syndrome, a type of abnormal heartbeat
+ Prinzmetal's angina, a certain type of chest pain
High 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 provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
Your health problems, including any medical conditions or allergies
Before starting, stopping, or changing the dose of any medication, including this one, you must consult with your doctor to confirm that it is safe to do so. This will help prevent potential interactions between your medications and health conditions.
Precautions & Cautions
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, get up slowly from a sitting or lying position. Be cautious when climbing stairs.
As directed by your doctor, have regular blood tests and monitor your blood pressure and heart rate.
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 is particularly concerning for individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have questions or concerns, discuss them with your doctor.
If you have diabetes, it is crucial to closely monitor your blood sugar levels while taking this medication.
This drug may also conceal symptoms 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. Consult your doctor for guidance.
If you have a history of severe allergic reactions, inform your doctor. You may be at risk for an even more severe reaction if you are exposed to the allergen again. Additionally, if you use epinephrine to treat severe allergic reactions, discuss this with your doctor, as epinephrine may be less effective while taking this medication.
Do not abruptly stop taking this medication, as this can lead to increased chest pain and, in some cases, heart attack. The risk is higher if you have certain types of heart disease. To avoid adverse effects, your doctor will instruct 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, inform your doctor. You will need to discuss the potential benefits and risks of this medication to both you and your baby.
To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position. Be cautious when climbing stairs.
As directed by your doctor, have regular blood tests and monitor your blood pressure and heart rate.
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 is particularly concerning for individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have questions or concerns, discuss them with your doctor.
If you have diabetes, it is crucial to closely monitor your blood sugar levels while taking this medication.
This drug may also conceal symptoms 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. Consult your doctor for guidance.
If you have a history of severe allergic reactions, inform your doctor. You may be at risk for an even more severe reaction if you are exposed to the allergen again. Additionally, if you use epinephrine to treat severe allergic reactions, discuss this with your doctor, as epinephrine may be less effective while taking this medication.
Do not abruptly stop taking this medication, as this can lead to increased chest pain and, in some cases, heart attack. The risk is higher if you have certain types of heart disease. To avoid adverse effects, your doctor will instruct 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, inform your doctor. You will need to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe bradycardia (very slow heart rate)
- Severe hypotension (very low blood pressure)
- Cardiogenic shock
- Bronchospasm
- Acute cardiac failure
- Hypoglycemia
What to Do:
Treatment is symptomatic and supportive. May include atropine for bradycardia, vasopressors for hypotension, glucagon, and/or intravenous fluids. In severe cases, cardiac pacing may be required. Call 1-800-222-1222 (Poison Control) or seek immediate medical attention.
Drug Interactions
Major Interactions
- Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem): Increased risk of bradycardia, AV block, and heart failure.
- Digoxin: Additive bradycardia and AV block.
- Insulin and oral hypoglycemics: May mask symptoms of hypoglycemia (e.g., tachycardia, palpitations).
- Clonidine: May potentiate rebound hypertension upon clonidine withdrawal.
- Other beta-blockers: Additive effects.
Moderate Interactions
- NSAIDs (e.g., ibuprofen, naproxen): May reduce the antihypertensive effect of esmolol.
- Sympathomimetics (e.g., epinephrine, norepinephrine): May antagonize the effects of esmolol.
- Anesthetics (e.g., halothane, isoflurane): May enhance hypotensive effects.
Minor Interactions
- Alpha-1 blockers (e.g., prazosin): May increase risk of first-dose hypotension.
Monitoring
Baseline Monitoring
Heart Rate (HR)
Rationale: To establish baseline and guide titration.
Timing: Prior to initiation of infusion.
Blood Pressure (BP)
Rationale: To establish baseline and guide titration.
Timing: Prior to initiation of infusion.
Electrocardiogram (ECG)
Rationale: To assess baseline rhythm and PR interval.
Timing: Prior to initiation of infusion.
Routine Monitoring
Heart Rate (HR)
Frequency: Continuously or every 5-15 minutes during titration, then regularly (e.g., hourly) during maintenance.
Target: Individualized, typically target HR reduction (e.g., <100 bpm for SVT) or specific range.
Action Threshold: Bradycardia (<50 bpm or symptomatic), inadequate response.
Blood Pressure (BP)
Frequency: Continuously or every 5-15 minutes during titration, then regularly (e.g., hourly) during maintenance.
Target: Individualized, typically target BP reduction or specific range.
Action Threshold: Hypotension (e.g., SBP <90 mmHg or symptomatic), inadequate response.
ECG (rhythm and PR interval)
Frequency: Continuously or periodically, especially during titration.
Target: Normal sinus rhythm or controlled ventricular rate; PR interval within normal limits.
Action Threshold: New or worsening AV block, significant arrhythmias.
Infusion Site
Frequency: Regularly (e.g., every 4-8 hours).
Target: No signs of irritation or extravasation.
Action Threshold: Redness, swelling, pain, or signs of phlebitis.
Symptom Monitoring
- Bradycardia (dizziness, lightheadedness, syncope)
- Hypotension (dizziness, lightheadedness, weakness)
- Bronchospasm (wheezing, shortness of breath, cough)
- Signs of heart failure exacerbation (dyspnea, peripheral edema, crackles)
- Fatigue
- Nausea/vomiting
- Injection site reactions
Special Patient Groups
Pregnancy
Esmolol is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Beta-blockers can cause fetal bradycardia, hypoglycemia, and growth restriction. Neonates of mothers who received esmolol near term should be monitored for signs of beta-blockade.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless clearly needed.
Second Trimester:
Potential for fetal bradycardia and growth restriction.
Third Trimester:
Increased risk of fetal/neonatal bradycardia, hypoglycemia, and respiratory depression. Monitor neonate for several days post-delivery.
Lactation
Esmolol is excreted in breast milk in small amounts. Due to its very short half-life and low oral bioavailability, infant exposure is expected to be minimal. Generally considered compatible with breastfeeding, but monitor the infant for signs of beta-blockade (e.g., bradycardia, lethargy).
Infant Risk:
Low
Pediatric Use
Use in pediatric patients is established for certain indications (e.g., SVT, hypertension) but requires careful titration and close monitoring due to potential for severe bradycardia and hypotension. Dosing is weight-based. Safety and efficacy in neonates are not fully established.
Geriatric Use
No specific dose adjustment is required based on age alone, as esmolol's metabolism is independent of renal or hepatic function. However, elderly patients may be more sensitive to the effects of beta-blockers and may have age-related comorbidities (e.g., impaired cardiac function, renal impairment) that warrant cautious titration and close monitoring for adverse effects like bradycardia and hypotension.
Clinical Information
Clinical Pearls
- Esmolol is an ultra-short-acting beta-blocker, making it ideal for acute, emergent situations where rapid control of heart rate or blood pressure is needed, and quick reversibility is desired.
- Its rapid onset and offset allow for precise titration and quick adjustment of therapy.
- Due to its short half-life, continuous infusion is required for sustained effect.
- It is metabolized by esterases in red blood cells, so its elimination is not dependent on renal or hepatic function, making it a suitable option in patients with organ dysfunction.
- Caution is advised in patients with bronchospastic disease (e.g., asthma, COPD) due to potential for beta-2 blockade at higher doses, leading to bronchoconstriction.
- Avoid abrupt discontinuation, especially in patients with coronary artery disease, to prevent rebound effects.
Alternative Therapies
- Other IV beta-blockers (e.g., metoprolol, labetalol) for acute rate/BP control, though with longer durations of action.
- Calcium channel blockers (e.g., diltiazem, verapamil) for rate control in SVT.
- Adenosine for acute termination of SVT.
- Other IV antihypertensives (e.g., nicardipine, clevidipine, nitroglycerin, sodium nitroprusside) for acute blood pressure control.
- Amiodarone for various arrhythmias.
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 10ml vial (generic) per 10ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
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 to do so by a healthcare professional, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. 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 medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure prompt and effective treatment.