ESMOLOL HYDROCHLORIDE IS GIVEN INTRAVENOUSLY AT A CONCENTRATION USUALLY NOT EXCEEDING 10 MG/ML.
FOR THE RAPID TEMPORARY CONTROL OF VENTRICULAR RATE IN PATIENTS WITH SUPRAVENTRICULAR ARRHYTHMIAS, A LOADING DOSE OF 500 MICROGRAMS/KG GIVEN OVER 1 MINUTE IS FOLLOWED BY AN INITIAL MAINTENANCE INFUSION OF 50 MICROGRAMS/KG PER MINUTE FOR 4 MINUTES. IF THE RESPONSE IS SATISFACTORY THIS MAINTENANCE INFUSION SHOULD BE CONTINUED AT 50 MICROGRAMS/KG PER MINUTE. IF A SUITABLE RESPONSE IS NOT OBTAINED WITHIN THE INITIAL 5 MINUTES A FURTHER LOADING DOSE OF 500 MICROGRAMS/KG OVER 1 MINUTE MAY BE GIVEN AND THE MAINTENANCE INFUSION MAY BE INCREASED TO 100 MICROGRAMS/KG PER MINUTE FOR 4 MINUTES. THIS PROCEDURE MAY BE REPEATED UNTIL A SATISFACTORY RESPONSE IS OBTAINED, INCREASING THE MAINTENANCE INFUSION EACH TIME BY 50 MICROGRAMS/KG PER MINUTE TO A MAXIMUM OF 200 MICROGRAMS/KG PER MINUTE. LITTLE ADDITIONAL BENEFIT IS OBTAINED FROM FURTHER INCREASES IN MAINTENANCE DOSAGE. ONCE A SATISFACTORY RESPONSE IS OBTAINED INFUSION MAY BE CONTINUED, IF NECESSARY, FOR UP TO 48 HOURS.
WHEN TRANSFERRING A PATIENT TO ANOTHER ANTIARRHYTHMIC DRUG, THE INFUSION RATE OF ESMOLOL HYDROCHLORIDE IS REDUCED BY 50% THIRTY MINUTES AFTER STARTING THE ALTERNATIVE DRUG, AND MAY BE DISCONTINUED ONE HOUR AFTER THE SECOND DOSE OF THAT DRUG.
IN THE CONTROL OF PERIOPERATIVE HYPERTENSION AND/OR TACHYCARDIA, ESMOLOL HYDROCHLORIDE MAY BE GIVEN INTRAVENOUSLY AS FOLLOWS: DURING ANAESTHESIA, A LOADING DOSE OF 80 MG OVER 15 TO 30 SECONDS FOLLOWED BY AN INFUSION OF 150 MICROGRAMS/KG PER MINUTE, INCREASED AS NECESSARY UP TO 300 MICROGRAMS/KG PER MINUTE; ON WAKING FROM ANAESTHESIA, AN INFUSION OF 500 MICROGRAMS/KG PER MINUTE FOR 4 MINUTES, FOLLOWED BY AN INFUSION OF 300 MICROGRAMS/KG PER MINUTE AS REQUIRED; POSTOPERATIVELY, A STEPPED DOSAGE SCHEDULE, AS DESCRIBED UNDER CONTROL OF SUPRAVENTRICULAR ARRHYTHMIAS ABOVE, ALTHOUGH MAINTENANCE INFUSIONS MAY BE INCREASED UP TO 300 MICROGRAMS/KG PER MINUTE AS NECESSARY.