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esmolol

esmolol
  • Restricted Medications Cardiac Monitor (IV infusion)
Drug Name Form Strength Non-Formulary Restricted TX Sub Notes
Brevibloc SOLUTION, INTRAVENOUS 10 mg/mL; 2500 mg/250 mL premix      
Display Selective beta-Adrenergic Blocking Agents, Class II Antiarrhythmics Class : 12160808, 24040416
Medication comments:
Warning: Pump Care Area Special Med!
esmolol should generally not be interrupted during procedures unless there is a specific physician order.

Beta Blockers require the following prior to each administered dose:
1) Nursing staff shall obtain the patient’s pulse and record in the EMR.
2) If the pulse is less than 50, the nurse shall obtain an apical heart rate. If the apical heart rate is less than 50, the nurse shall hold the dose and notify the provider for further orders.
3) This is applicable to all routes of administration
Per policy, these medications require cardiac and/or special monitoring.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes CCU, OR, PACU, CCL, ED PCU 2N (Tele) 1N (Tele), 3N (Tele) Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) BirthPlace SNF ICS OPS
esmolol (Brevibloc)
IV Infusion		 Y N N N N N N N N
Iredell Memorial Hospital ICU Adult Infusion Guidelines  
The following orders are intended to provide a specific, safe, and effective means of initiating and titrating medications for critically ill patients. Physicians may modify doses and/or parameters as necessary pending patients' status.For all medications listed below, the responsible LIP is to be notified if unable to titrate or the maximum dose is reached andgoals of therapy are not met.
Drug Name Onset Preparation Compatible fluids
esmolol (Brevibloc) 2-10 min 2500 mg/250 ml *premixed  
Starting Dose for ICU Sedation Titration Guidelines (for increasing and decreasing doses) with Maximum dose
Begin infusion at 50 mcg/kg/min. For SVT: titrate by 50 mcg/kg/min every 4 min to keep HR ≤ 100 beats per min. Max = 200 mcg/kg/min.
Per policy, these hazardous drugs have special waste requirements. 
Generic (Brand) Waste Requirements
esmolol (Brevibloc) Pre-mix bags ⇒  BLACK BUCKET 
Adult Extravasation Management
esmolol (Brevibloc)
Agent type: Non-Chemotherapeutic
Vesicant/Irritant: Vesicant
Local Care: Cold compress
Antidote: Hyaluronidase (may consider for refractory peripheral cases in addition to supportive measures)
Antidote link(s):
Last updated: Mar. 14, 2026
  • Hazardous Waste BLACK BUCKET
UpToDate Lexidrug

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Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



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