What are the types of intravenous (IV) beta blockers?

From the Guidelines

The types of intravenous (IV) beta blockers are Esmolol, Metoprolol, and Propranolol.

Key Characteristics of IV Beta Blockers

• Esmolol: a beta-1 selective agent with a short half-life, administered at a dose of 50 to 300 mcg per kg per min 1
• Metoprolol: a beta-1 selective agent, given in 5-mg increments by slow intravenous administration, repeated every 5 min for a total initial dose of 15 mg 1
• Propranolol: a non-selective beta blocker, administered as an initial dose of 0.5 to 1.0 mg, followed in 1 to 2 h by 40 to 80 mg by mouth every 6 to 8 h 1

Important Considerations

• IV beta blockers should be used with caution in patients with certain conditions, such as heart failure, hypotension, and hemodynamic instability 1
• The choice of beta blocker should be based on pharmacokinetic and side effect criteria, as well as physician familiarity 1
• Monitoring during IV beta-blocker therapy should include frequent checks of heart rate and blood pressure, as well as continuous ECG monitoring and auscultation for rales and bronchospasm 1

From the FDA Drug Label

Metoprolol Tartrate Injection, USP, is a selective beta 1-adrenoreceptor blocking agent, available in 5 mL vials for intravenous administration. Esmolol hydrochloride injection, for intravenous administration, is a beta adrenergic receptor blocker with a very short duration of action

The types of intravenous (IV) beta blockers mentioned are:

• Selective beta 1-adrenoreceptor blocking agent: metoprolol
• Beta adrenergic receptor blocker: esmolol 2 3 3

From the Research

Types of Intravenous (IV) Beta Blockers

• Ultra-short-acting intravenous beta-blockers:
  • Esmolol: a titratable short-acting intravenous beta blocker with a very rapid onset and offset of action 4, 5
  • Landiolol: a newer ultra-short-acting intravenous beta-blocker with higher cardioselectivity and less cardiodepressant effect than esmolol 4
• Short-acting intravenous beta-blockers:
  • Propranolol: a traditional intravenous beta-blocker with lower cardioselectivity compared to esmolol and landiolol 4
• Other intravenous beta-blockers:
  • Sotalol: an antiarrhythmic beta-blocker that can be used intravenously 6
  • Timolol: a beta-blocker that has been studied for secondary prevention of myocardial infarction, but can also be used intravenously 6

Characteristics of IV Beta Blockers

• Esmolol and landiolol have high cardioselectivity and short elimination half-time, making them suitable for critically ill patients and perioperative periods 4
• Esmolol has a rapid onset and offset of action, and its effects dissipate rapidly after discontinuation 5
• Intravenous beta-blockers can be used to reduce ventricular rate in patients with supraventricular tachyarrhythmias, and to reduce heart rate in patients with acute myocardial infarction and/or unstable angina 5, 7