How to Dilute Esmolol for Intravenous Administration
Esmolol hydrochloride injection is supplied as a ready-to-use solution at 10 mg/mL concentration and does not require dilution for standard administration via continuous infusion. 1
Ready-to-Use Formulation
- The commercially available esmolol hydrochloride injection at 10 mg/mL can be administered directly without further dilution for maintenance infusions. 1
- This concentration is appropriate for hand-held syringe administration of loading doses while preparing the maintenance infusion. 1
Compatible Diluents (If Dilution Needed)
If dilution is required for specific clinical scenarios, esmolol is compatible with the following intravenous solutions at a final concentration of 10 mg/mL, remaining stable for at least 24 hours at controlled room temperature or under refrigeration: 1
- Dextrose 5% Injection, USP 1
- Sodium Chloride 0.9% Injection, USP 1
- Sodium Chloride 0.45% Injection, USP 1
- Dextrose 5% and Sodium Chloride 0.9% Injection, USP 1
- Dextrose 5% and Sodium Chloride 0.45% Injection, USP 1
- Lactated Ringer's Injection, USP 1
- Dextrose 5% in Lactated Ringer's Injection 1
- Dextrose 5% in Ringer's Injection 1
- Potassium Chloride (40 mEq/liter) in Dextrose 5% Injection, USP 1
Critical Incompatibilities
- Esmolol is NOT compatible with Sodium Bicarbonate 5% solution due to limited stability. 1
- Do not mix with furosemide, as this causes precipitation. 1
Stability Considerations
- Esmolol solutions at 10 mg/mL remain stable in compatible IV fluids for at least 168 hours when stored at 5°C or 23-27°C. 2
- When stored at 40°C, stability is maintained for at least 48 hours in most solutions, except when mixed with 5% sodium bicarbonate (stable only 24 hours). 2
- Container type (glass versus polyvinyl chloride) does not affect stability. 2
Practical Administration Points
- Always inspect the solution visually for particulate matter and discoloration before administration. 1
- The maximum recommended concentration for infusion is 10 mg/mL. 3, 1
- For loading doses, administer 500 mcg/kg (0.5 mg/kg) over 1 minute, which can be given via hand-held syringe from the ready-to-use vial. 4, 1
- Maintenance infusions should be administered through a separate intravenous line from other medications to avoid incompatibility issues. 3
Common Pitfall to Avoid
Do not attempt to dilute esmolol with sodium bicarbonate solutions or mix with furosemide in the same line, as this will result in drug degradation or precipitation. 1 If a patient requires both medications, use separate IV access sites.