Blood pressure and rate control
Esmolol (Brevibloc) drip
Brevibloc
Dosing
| Start | Load 500 mcg/kg over 1 minute, then 50 mcg/kg/min |
|---|---|
| Titrate | Re-load and raise by 50 mcg/kg/min every 4 minutes |
| Maximum | 200 mcg/kg/min for rate control; 300 for hypertension |
| Common bags | 2,500 mg in 250 mL (10 mg/mL); 2,000 mg in 100 mL (20 mg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Over 10 mg/mL irritates small veins: use a central line for 20 mg/mL
Watch for
- Bradycardia and hypotension
- Effects wear off within about 20 minutes of stopping
Esmolol: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Aortic Dissection and Hypertensive EmergencyAortic dissection: Beta-blocker FIRST (esmolol or labetalol), then a vasodilator (nicardipine, clevidipine or nitroprusside) if BP stays high
- Endocrine EmergenciesThyroid storm: 1. Beta-blocker: propranolol (also slows T4-to-T3), or esmolol if unstable
- Endocarditis and Valve EmergenciesValve emergencies: LVOT obstruction: SAM; worse on dobutamine; systolic murmur: Stop inotropes; fluid, esmolol, phenylephrine
- CEN Mental Health: Crisis, Suicide Risk, Eating Disorders and AbuseHyperventilation and caffeine: Caffeine (Willson 2018): a Red Bull can holds about 80 mg and a Monster about 160 mg, and one 473 mL product held 357 mg. Roughly 1 g may cause toxic symptoms, 2 g may need hospital care and 5 g or more is typically lethal; tachycardia is near universal above 10 mg/kg. Mild toxicity is irritability, palpitations, nausea, tremor and sweating; severe toxicity brings ve
- Rhythm GalleryAtrial rhythms: PACs, MAT, flutter and AF: Esmolol: 500 mcg/kg over 1 min, then 50–200 mcg/kg/min: Hypotension; wears off within 20 min
Practice Aortic Dissection and Hypertensive Emergency questions free30 exam-style questions with rationales on the topic where esmolol comes up most. No account or download needed.
Other blood pressure and rate control
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.