Esmolol hydrochloride is available as a 10-mg/mL premixed, ready-to-use solution in 10-mL single-dose (preservative-free) vials and 250-mL bags.2869; 3234 Each mL of the ready-to-use solution also contains sodium acetate trihydrate 2.8 mg and glacial acetic acid 0.546 mg in water for injection with or without sodium chloride 5.9 mg, and may contain sodium hydroxide and/or hydrochloric acid for pH adjustment during manufacturing.2869; 3234 Vials may be used to prepare loading doses for administration by hand-held syringe while the maintenance infusion is being readied.2869; 3234
Esmolol hydrochloride also is available as a double-strength 20-mg/mL premixed, ready-to-use solution in 100-mL bags.2869 Each mL of the double-strength ready-to-use solution also contains sodium chloride 4.1 mg, sodium acetate trihydrate 2.8 mg, and glacial acetic acid 0.546 mg, and also may contain sodium hydroxide and/or hydrochloric acid for pH adjustment during manufacturing.2869
Esmolol hydrochloride (WG Critical Care) is available as a premixed, ready-to-use, preservative-free solution at a concentration of 10 mg/mL in 250-mL bags and 20 mg/mL (double strength) in 100-mL bags intended for single-patient use.3235 Each mL of the ready-to-use solution also contains ethanol 1.23% (v/v), propylene glycol 10 mg, sodium acetate trihydrate 0.68 mg, and glacial acetic acid 0.27 mg in water for injection, and may contain sodium hydroxide for pH adjustment during manufacturing.3235
pH
Esmolol hydrochloride 10- and 20-mg/mL solutions (Brevibloc, Baxter; generic) have a pH ranging from 4.5 to 5.5.2869; 3234
Esmolol hydrochloride 10- and 20-mg/mL solutions (WG Critical Care) have a pH ranging from 4.5 to 6.5.3235
Osmolarity
Esmolol hydrochloride 10- and 20-mg/mL solutions (Brevibloc, Baxter) are iso-osmotic having an osmolarity of 312 mOsm/L.2869
Esmolol hydrochloride 10- and 20-mg/mL solutions (WG Critical Care) have an osmolarity of 320 to 450 mOsmol/L and 440 to 500 mOsm/L, respectively.3235
Trade Name(s)
Brevibloc
Esmolol hydrochloride may be administered as a continuous infusion at a concentration of 10 or 20 mg/mL with or without a loading dose administered by intravenous bolus injection over 30 to 60 seconds.2869; 3234; 3235
Esmolol hydrochloride may cause serious venous irritation, including thrombophlebitis, and more serious local reactions, including skin necrosis and blistering, especially when associated with extravasation.2869; 3234; 3235 The manufacturer recommends avoiding infusions into a small vein or through a butterfly catheter.2869; 3234; 3235 If a local infusion site reaction develops, an alternative infusion site should be used; extravasation should be avoided.2869; 3234; 3235
Esmolol hydrochloride is a clear, colorless to light yellow solution.2869; 3234; 3235 Intact vials and bags should be stored at controlled room temperature and protected from elevated temperatures and freezing.2869; 3234; 3235 Bags should remain in their overwrap until ready for use.2869; 3235
Esmolol hydrochloride solutions should be visually inspected for particulate matter and discoloration prior to administration.2869; 3234; 3235 Following withdrawal of solution from the bag (e.g., a bolus dose), infusion of the remaining solution should begin immediately and any unused portion not infused by 24 hours after withdrawal from the bag should be discarded.2869; 3235
pH Effects
Esmolol hydrochloride is relatively stable at neutral pH; the optimal pH is 4.5 to 5.5. However, ester hydrolysis occurs rapidly in strongly acidic or basic solutions.1358; 1359
Standardize 4 Safety
One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.
Table 1: Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Esmolol3635; 3636
| Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
| Adults | 10 mg/mL 20 mg/mL | mcg/kg/minute (note dosing units differ from concentration units) |
| Pediatric patients (50 kg) | 10 mg/mL 20 mg/mL | mcg/kg/minute (note dosing units differ from concentration units) |
For a list of references cited in the text of this monograph, search the monograph titled References.