Esmolol, an ultrashort-acting, selective β₁-adrenoceptor antagonist: pharmacodynamic and pharmacokinetic properties

Abstract

The effects of esmolol at different rates of infusion (100, 250 and 500 μg·kg⁻¹ BW·min⁻¹) were compared with β-adrenoceptor occupancy (β₁ and β₂, estimated by a subtype selective radioreceptor assay) and plasma concentrations of esmolol and its acid metabolite were measured by HPLC. Up to a rate of infusion of esmolol of 500 μg·kg⁻¹ BW·min⁻¹ there was a maximal β₁-receptor occupancy of 84.7% while β₂-receptor occupancy was below the detection limit; confirming the β₁ selectivity of esmolol. Exercise-induced increases in heart rate and systolic blood pressure were reduced by esmolol in a dose-dependent manner. The estimated EC₅₀ values of rate of infusion for the reduction in heart rate and systolic blood pressure during exercise were 113 and 134 μg·kg⁻¹ BW · min⁻¹, respectively. Additionally, heart rate and systolic blood pressure were reduced moderately at rest. Because of the short elimination half-life of esmolol caused by the rapid hydrolysis to its acid metabolite, 45 min after end of infusion high plasma concentrations of the metabolite (maximally 80 μg·ml⁻¹) but no esmolol were detectable. Since no in vivo effects have been observed, despite the presence of high plasma concentrations of the metabolite, the metabolite did not participate in the observed effects up to an infusion rate of esmolol of 500 μg·kg⁻¹ BW·min⁻¹. The plasma concentrations of antagonist detected by radioreceptor assay and plasma concentrations of esmolol detected by HPLC showed a good correlation (r=0.97). Since the cardiovascular effects, determined before and 45 min after termination of infusion of esmolol were similar, it can be concluded that the observed effects on heart rate and systolic blood pressure are exclusively mediated by esmolol.