MEDICATION	DOSAGES & INTERVALS OF ADMINISTRATION	ROUTE & FINAL DILUTION	DILUTION INSTRUCTIONS	STABILITY	RATE OF INFUSION & COMMENTS
ESMOLOL HCl (Neo) (Brevibloc) Mechanism of action: Class II antiarrythmic; Beta-adrenergic blocker. Esmolol is a very short acting beta-1 selective (cardioselective)  adrenergic receptor  blocker.  It inhibits beta-1 receptors principally in cardiac muscle increasing the refractory period of the AV node, resulting in interruption of the re-entry circuit.  Cardioselectivity is not absolute and at higher doses inhibition of beta-2 adrenergic receptors in the bronchial and vascular musculature occurs. 10 mg/mL in sodium chloride premixed 250 mL bag Isosmotic solution Osmolarity: 312 mOsmol/L pH: 4.5 to 5.5 NOTE: The foil overwrap of the premixed bags is used as a moisture barrier only. Opened bags do not require protection from light. Ref: 2, 8, 14, 98 Last update: 2025-04-03	Supraventricular Tachycardia This medication is only to be commenced in consultation with the electrophysiology service when being used for arrhythmias. Loading dose: 100 to 500 mcg/kg administered over 1 to 2 min Maintenance Infusion: Initial dose:  50 to 100 mcg/kg/minute and titrate by 50 – 100 mcg/kg/min every 5 to 10 min until a 10% reduction in heart rate or mean arterial pressure occurs Mean dose required in studies 550 mcg/kg/minute (range 300 to 1000 mcg/kg/minute). Because of its short half-life, blood levels of esmolol can be rapidly altered by increasing or decreasing the infusion rate and rapidly eliminated by discontinuing the infusion.	IV 10 mg/mL	Supplied by Pharmacy	72 hours room temperature.	Administration: Infuse loading dose over 1 to 2 minutes **Continuous Critical Infusion** 1.     Do not interrupt. 2.     Never bolus solutions/medications into same lumen. 3.     Use pressure sensing disc tubing. COMMENTS: Limited data available in neonates, infants and children. Monitoring: Monitor heart rate, blood pressure, ECG, and respiratory rate continuously. If no arterial line (cuff only), monitor blood pressure Q15 minutes for 30 minutes after each dose increase. **Continuous Critical Infusion** 1.     Do not interrupt. 2.     Never bolus solutions/medications into same lumen. 3.     Use pressure sensing disc tubing. Standard Prescription: esmolol __  mcg IV x 1 loading dose esmolol __ mcg/kg/min continuous IV infusion