Compatible IV Fluids for Esmolol Dilution
Esmolol can be diluted with dextrose 5% in water (D5W), normal saline (0.9% NaCl), or lactated Ringer's solution, among several other common IV fluids, but must never be mixed with sodium bicarbonate 5% or furosemide due to incompatibility. 1
FDA-Approved Compatible Solutions
The FDA label specifies that esmolol was tested at a final concentration of 10 mg/mL and found compatible and stable for at least 24 hours at room temperature or under refrigeration with the following solutions: 1
- Dextrose 5% Injection, USP 1
- Dextrose 5% in Lactated Ringer's Injection 1
- Dextrose 5% in Ringer's Injection 1
- Dextrose 5% and Sodium Chloride 0.45% Injection, USP 1
- Dextrose 5% and Sodium Chloride 0.9% Injection, USP 1
- Lactated Ringer's Injection, USP 1
- Potassium Chloride (40 mEq/liter) in Dextrose 5% Injection, USP 1
- Sodium Chloride 0.45% Injection, USP 1
- Sodium Chloride 0.9% Injection, USP 1
Critical Incompatibilities to Avoid
Never mix esmolol with sodium bicarbonate 5% solution due to limited stability, and never mix with furosemide due to precipitation. 2, 1 These incompatibilities can cause drug degradation or visible precipitation that renders the solution unsafe for administration. 2
Practical Administration Considerations
- Always inspect esmolol solutions visually for particulate matter and discoloration before administration. 2, 1
- Do not mix esmolol with incompatible solutions like sodium bicarbonate or furosemide in the same IV line. 2
- The standard dilution concentration is 10 mg/mL for continuous infusion, which differs from the 250 mg/mL concentration that should never be used for bolus dosing. 2
Common Clinical Pitfall
The most critical error is attempting to administer esmolol through an IV line containing sodium bicarbonate or furosemide, which will cause immediate incompatibility. 2, 1 Always flush the line with a compatible solution before and after esmolol administration if other medications are being given through the same access. 1