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Esmolol

A Review of its Use in the Short-Term Treatment of Tachyarrhythmias and the Short-Term Control of Tachycardia and Hypertension

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Abstract

Supraventricular tachyarrhythmia (including atrial fibrillation), hypertension and tachycardia in the perioperative setting, and acute ischaemic heart disease are generally agreed to require rapid attention and treatment. Prolonged tachyarrhythmia or hypertension can result in significant morbidity, such as cerebro-vascular events, myocardial infarction and other end-organ damage. This article reviews the clinical efficacy and tolerability of intravenous infusions of esmolol for the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension, and provides an overview of the pharmacological properties of the drug.

Esmolol, a cardioselective β-blocker, has been proven effective in the control of elevated haemodynamic parameters in patients with supraventricular tachyarrhythmia, hypertension and tachycardia in the perioperative setting, and acute ischaemic heart disease, as well as being associated with a reduced risk of some clinical sequelae to increased haemodynamic parameters. Esmolol is, moreover, generally well tolerated; while it is associated with an increased risk of hypotension, this is rapidly reversible.

Definitive conclusions on the efficacy of esmolol are difficult to reach, as most trials investigating esmolol have limitations such as small patient populations, and few studies investigate the same parameters. Ideally, several further studies would be beneficial; however, as esmolol is a well established, older drug, these are less likely to occur.

Despite this, esmolol, as a fast-acting, rapidly reversible, easily titratable β-blocker, is an established option for the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension.

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Disclosure

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the author on the basis of scientific and editorial merit.

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  1. Adis, a Wolters Kluwer Business, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand

    Karly P. Garnock-Jones

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Correspondence to Karly P. Garnock-Jones.

Additional information

Various sections of the manuscript reviewed by: N. Edvardsson, Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden; M. Hinterseer, Department of Cardiology, University of Munich, Munich, Germany; G. Landoni, Department of Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milan, Italy.

Data Selection

Sources: Medical literature (including published and unpublished data) on esmolol was identified by searching databases (including MEDLINE, EMBASE) for articles published since 1996, bibliographies from published literature, clinical trial registries/databases and websites (including those of regional regulatory agencies and the manufacturer). Additional information (including contributory unpublished data) was also requested from the company developing the drug.

Search strategy: MEDLINE, EMBASE and AdisBase search terms were ‘esmolol’ and (‘tachycardia, supraventricular’ or ‘supraventricular tachycardia’ or ‘tachycardia’ or ‘hypertension’ or ‘blood pressure’ or ‘perioperative’ or ‘preoperative’ or ‘preoperative treatment’ or ‘cardiac surgery’ or ‘thoracic surgery’ or ‘heart surgery’ or ‘noncardiac surgery’). Searches were last updated 18 November 2011.

Selection: Studies in patients undergoing surgery with tachycardia or hypertension who received esmolol. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.

Index terms: Esmolol, tachycardia, hypertension, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability.

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Garnock-Jones, K.P. Esmolol. Drugs 72, 109–132 (2012). https://doi.org/10.2165/11208210-000000000-00000

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