Recommended Diluent for Esmolol Drip
Esmolol should be diluted with Dextrose 5% in Water (D5W) or 0.9% Sodium Chloride (normal saline) for continuous infusion. 1
Compatible Diluent Solutions
The FDA-approved label specifies that esmolol is compatible with the following intravenous solutions and remains 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
- 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
- Sodium Chloride (0.45%) Injection, USP 1
Critical Incompatibilities to Avoid
Esmolol is NOT compatible with Sodium Bicarbonate (5%) solution due to limited stability, and it will precipitate when mixed with furosemide. 1 These combinations must be strictly avoided to prevent drug degradation and potential line occlusion.
Preparation for Specific Clinical Scenarios
For reversal of dobutamine-induced adverse effects during pharmacological stress testing, esmolol should be prepared as a 10 mg/mL dilution (not the 250 mg/mL concentration used for continuous infusion) at a dose of 0.5 mg/kg. 2 This lower concentration allows for more precise dosing in emergency situations.
Standard Concentration for Continuous Infusion
The concentration of continuous esmolol infusion should not exceed 2 mg/mL and must be diluted with D5W. 2 This concentration limit ensures safe administration and reduces the risk of infusion-related complications.
Pre-Administration Safety Check
Before administration, visually inspect the diluted esmolol solution for particulate matter and discoloration. 1 Any solution showing visible particles or color changes should be discarded and not administered to the patient.