Esmolol Dosing for an 80 kg Patient with Tachycardia or Hypertension
For an 80 kg patient with tachycardia or hypertension, the recommended esmolol dosing is a loading dose of 40-80 mg (0.5-1 mg/kg) IV bolus over 1 minute, followed by a continuous infusion of 50-300 mcg/kg/min, titrated to clinical response. 1
Dosage Calculation for 80 kg Patient
- Loading dose: 40-80 mg IV bolus (0.5-1 mg/kg × 80 kg)
- Initial infusion: 4-24 mg/min (50-300 mcg/kg/min × 80 kg)
- Titration: Increase in 50 mcg/kg/min increments (4 mg/min for 80 kg) every 5-10 minutes until desired effect
Clinical Scenarios and Specific Dosing
For Supraventricular Tachycardia
- Start with loading dose of 80 mg (1 mg/kg) IV over 1 minute
- Begin infusion at 50 mcg/kg/min (4 mg/min)
- Titrate up in 50 mcg/kg/min increments every 5 minutes to maximum 200 mcg/kg/min (16 mg/min) 1
- Most patients respond at approximately 100 mcg/kg/min (8 mg/min) 2
For Hypertensive Emergency
- Loading dose of 40-80 mg (0.5-1 mg/kg) IV over 1 minute
- Begin infusion at 50 mcg/kg/min (4 mg/min)
- Titrate up to maximum 300 mcg/kg/min (24 mg/min) as needed 1
- Reduce dose once target blood pressure is achieved
Monitoring and Dose Adjustments
- Monitor heart rate and blood pressure continuously
- Assess response after each dose adjustment
- Allow 5 minutes to reach 90% of steady-state beta-blockade 3
- Reduce infusion rate immediately if hypotension occurs (systolic BP <90 mmHg)
- Full recovery from beta-blockade occurs 18-30 minutes after stopping infusion 3
Important Considerations
Contraindications
- Second or third-degree AV block (without pacemaker)
- Systolic heart failure
- Cardiogenic shock
- Severe bradycardia
- Asthma or bronchospastic disease 1
Adverse Effects
- Hypotension (occurs in 20-50% of patients, more common at doses >150 mcg/kg/min) 3, 4
- Bradycardia
- Diaphoresis (often accompanies hypotension)
Clinical Pearls
- Esmolol's ultra-short half-life (9 minutes) makes it ideal for critical situations where rapid titration and reversal may be needed 3
- Hypotension typically resolves within 30 minutes of decreasing or stopping the infusion 3
- Concomitant digoxin use may reduce the incidence of hypotension 2
- Chinese patients may require lower maintenance doses (approximately 73 mcg/kg/min) 5
- For patients undergoing cardiac procedures, a bolus of 80 mg followed by 12 mg/min infusion has been shown effective 6
By following this dosing regimen, rapid control of heart rate or blood pressure can be achieved while minimizing the risk of prolonged adverse effects due to esmolol's ultra-short duration of action.