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esmolol hydrochoride

✓ Approved

HQ Specialty Pharma · ADRB1 · Small Molecule

What is esmolol hydrochoride?

esmolol hydrochoride is a small molecule developed by HQ Specialty Pharma. It is approved for therapeutic indications via injectable (others) or intravenous (iv).

Drug Profile

CompanyHQ Specialty Pharma
Drug ClassSmall Molecule
Molecular TargetADRB1
RouteInjectable (Others), Intravenous (IV)
StatusApproved
Sources: ClinicalTrials.gov, HQ Specialty Pharma

Mechanism of Action

Molecular Targets

esmolol hydrochoride acts on 1 molecular target:

ADRB1adrenoceptor beta 1 (B1AR, RHR)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

esmolol hydrochoride is developed for 3 unique indications across 2 therapeutic areas.

Therapeutic AreaConditionPhase
Cardiac disordersAtrial fibrillation✓ Approved
Vascular disordersHypertension✓ Approved
Cardiac disordersSupraventricular tachycardia✓ Approved

Related Research Articles

PubMedMedicine2026-07-25

Effects of nicardipine and esmolol on regional renal oxygenation and hemodynamics during controlled hypotension in rhinoplasty: A prospective, randomized clinical trial.

Cintan Kamil K, Yüzkat Nureddin N, Demir Canser Yilmaz CY, Tunçdemir Yunus Emre YE

Achieving a bloodless surgical field during rhinoplasty is critical, yet the physiological impact of controlled hypotension (CH) on renal oxygenation remains a concern. This study evaluated the effects of nicardipine and esmolol on regional renal oxygenation and hemodynamics during controlled hypotension in patients undergoing rhinoplasty. After ethics approval and trial registration (ClinicalTrials.gov: NCT05430724), 80 adults with ASA I-II status undergoing elective rhinoplasty at a single university hospital were enrolled. Patients were assigned to group N (nicardipine, n = 40) or group E (esmolol, n = 40). Target mean arterial pressure (MAP) was 55 to 65 mm Hg. The primary outcomes were regional renal oxygenation (rSO2) measured using near-infrared spectroscopy and hemodynamics. Secondary outcomes included opioid requirements, renal function tests, and assessor-blinded surgical satisfaction. All 80 randomized patients completed the trial and were included in the final analysis. Repeated-measures analysis showed significant time-dependent changes in MAP and renal rSO2 values, with significant time × group interactions for MAP, right renal rSO2, and left renal rSO2. No prespecified renal desaturation events, defined as a ≥20% decrease from baseline rSO2, occurred in either group. Additional opioid use was significantly higher in group N (P = .001), whereas surgical satisfaction was more favorable in group E (P = .001). Postoperative creatinine and urea values remained within normal limits in both groups. In this short-duration rhinoplasty model, esmolol was associated with more favorable hemodynamic control, reduced opioid requirement, and higher surgical satisfaction compared with nicardipine. Although nicardipine was associated with higher regional renal rSO2 values, this finding should be interpreted as an exploratory physiological observation rather than evidence of functional renal protection. No external funding was received for this trial.

PMID 42499028
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PubMedCurrent medical science2026-07-23

Perioperative Esmolol Is Associated with Early Opioid Sparing in Patients with Ischemic Heart Disease: Evidence from a Retrospective Cohort and an Incisional Pain Rat Model.

Xin Yue-Yang YY, Yang Ning N, Chen Hao H, Zhan Gao-Feng GF et al.

Previous studies have confirmed the opioid-sparing and analgesic properties of perioperative esmolol, yet relevant clinical evidence specifically focusing on patients with ischemic heart disease (IHD) remains scarce, and the spinal nociceptive mechanism underlying esmolol-induced pain relief has not been fully elucidated. This study aimed to investigate the association between perioperative esmolol administration and early postoperative opioid demand in IHD patients undergoing elective non-cardiac surgery, and further explore the role of spinal 5-hydroxytryptamine (5-HT)/5-HT2B signaling in incisional pain using a female rat plantar incision model. For the clinical retrospective cohort, eligible IHD patients were divided into esmolol-exposed and non-exposed groups balanced via 1:1 propensity score matching. The primary outcome was cumulative 24-h postoperative opioid consumption converted to intravenous morphine equivalents (IME); secondary endpoints included early Numeric Rating Scale (NRS) pain scores, opioid-related adverse events and perioperative cardiovascular safety indicators. In animal experiments, intrathecal esmolol or selective 5-HT2B antagonist RS127445 was delivered to the female rats with plantar incision, followed by detection of mechanical withdrawal thresholds and spinal 5-HT/5-HT2B expression. After matching, 52 patients were included in each group. Perioperative esmolol was associated with a 3.0 mg reduction in 24 h IME (mean difference [MD] = -3.0, 95% CI [-4.9, -1.1], P = 0.002), alongside lower post-anesthesia care unit (PACU) opioid consumption (MD = -2.3, 95% CI [-4.2, - 0.3], P = 0.022) and decreased resting NRS scores in PACU (MD = -0.8, 95% CI [-1.3, -0.2], P = 0.006) and at postoperative 6 h (MD = -0.6, 95% CI [-1.1, -0.02], P = 0.043); no intergroup difference in NRS was observed at 24 h (P = 0.379). All opioid-related adverse events showed comparable incidence between groups (all P > 0.05). Intraoperative heart rate was significantly lower in the esmolol group (MD = -4.4 beats/min, 95% CI [-7.8, -1.0], P = 0.012), while intraoperative mean arterial pressure (MAP) and major cardiovascular complications exhibited no between-group differences (all P > 0.05). In rats, the results revealed transiently elevated paw withdrawal mechanical thresholds after intrathecal esmolol (P < 0.05 at 5 and 10 min), accompanied by suppressed surgery-induced upregulation of spinal 5-HT and 5-HT2B protein (P < 0.05). Intrathecal RS127445 also significantly alleviated mechanical hypersensitivity at 1 h post-administration (P < 0.01), with loss of efficacy at 2 h (P > 0.05). Perioperative esmolol is associated with early opioid-sparing and mild relief of acute postoperative pain in IHD patients receiving elective non-cardiac surgery, without increasing cardiovascular risks, whereas this regimen fails to reduce opioid-associated side effects. Preclinical data suggest that spinal 5-HT/5-HT2B signaling contributes to incision-induced mechanical hyperalgesia and may mediate the transient analgesic effect of esmolol.

PMID 42490018
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PubMedJournal of medical Internet research2026-07-20

Clinical Evaluation of an AI-Assisted Decision Support System for General Anesthesia Management Based on Data From 6 Centers: Comparative Study.

Chen Dongxu D, Xue Qingsheng Q, Wang Geng G, Mu Shanshan S et al.

AI is rapidly transforming medical practice, with emerging applications in perioperative care and anesthesiology. However, the clinical implementation of AI-assisted decision-making systems in anesthetic management remains challenging and requires comprehensive evaluation. This study aimed to assess the performance and clinical applicability of an AI-assisted decision support system (ZW-AA-001) for general anesthesia management by comparing its decisions with those of experienced anesthesiologists across 6 medical centers. A multicenter retrospective study was conducted using perioperative data from 1008 patients who underwent elective noncardiac surgeries under total intravenous anesthesia. The AI system's recommendations for anesthetic and hemodynamic medication adjustments were compared with anesthesiologists' decisions. Key outcomes included decision concordance rates, temporal performance, and consistency across centers. Advanced statistical methods, including prevalence-adjusted and bias-adjusted κ (PABAK) and Gwet's first-order agreement coefficient (AC1), were used to evaluate agreement metrics. The study included 1008 patients, with a median age of 50 (IQR 37-59) years and female predominance (619/1008, 61.4%). During anesthesia maintenance, the AI system demonstrated moderate overall decision agreement with anesthesiologists (73.3%, 95% CI 72.4%-74.3%). Analysis of center-specific data revealed generally consistent performance across all 6 centers. For propofol management, high concordance was observed in dosage adjustment decisions (91.1%, 95% CI 90.4%-91.8%), though fair agreement was found in adjustment direction (68.6%, 95% CI 67.3%-69.8%). The AI system showed significantly faster decision-making time compared to anesthesiologists for the adjustment of propofol (pseudomedian difference -77.5, 95% CI -79.5 to -75.5 seconds; P<.001). Although esmolol-related decisions showed a numerically higher concordance of 71.4%, this was not statistically significant (PABAK=0.429; P=.21; AC1=0.622; P=.09). Decisions for atropine, ephedrine, and urapidil demonstrated substantially lower agreement (17.4%-29.8%). The AI system recommended hemodynamic interventions more frequently than anesthesiologists across all medications. The AI-assisted decision support system demonstrated varying levels of concordance with anesthesiologists in managing surgery, with the highest agreement observed in propofol administration. However, the system's lower agreement in hemodynamic medication management highlights the need for further optimization and validation. These findings underscore the potential of AI systems to enhance anesthetic decision-making, improve efficiency, and address workforce challenges in anesthesiology. Future research should focus on expanding the system's capabilities, validating its performance in prospective clinical trials, and ensuring its integration into diverse clinical settings.

PMID 42475676
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PubMedJournal of intensive care2026-07-15

Low-dose esmolol attenuates sepsis-induced myocardial injury: association with improved autophagic homeostasis and PI3K/Akt signaling.

Zhang Xianfen X, Fu Qizhi Q, Zhang Hengzhe H, Song Haosen H et al.

Sepsis-induced myocardial injury (SIMI) contributes substantially to sepsis mortality. We investigated whether low-dose esmolol is associated with improved autophagy-related homeostasis and restored PI3K/Akt phosphorylation in SIMI. Human peripheral blood transcriptomic datasets (GSE28750, GSE232753, GSE134347, and GSE185263) and a rat septic myocardial dataset (GSE125042) were analyzed. Sprague-Dawley rats underwent cecal ligation and puncture (CLP) and received low-dose (5 mg·kg⁻1·h⁻1) or high-dose (15 mg·kg⁻1·h⁻1) esmolol infusion starting at 4h post-CLP. Autophagy was modulated with rapamycin, 3-methyladenine (3-MA), or chloroquine (CQ). Conscious hemodynamic monitoring, serial echocardiography, survival analysis, sepsis severity scoring, cardiac troponin I (cTnI) measurement, chamber-specific transmission electron microscopy, LC3/p62 co-localization, and TFEB subcellular localization were assessed. The unified endpoint was 18 h post-CLP. Bioinformatics analyses identified Akt1 and mTOR as hub genes and highlighted PI3K/Akt signaling as a candidate pathway associated with SIMI and esmolol response. Low AKT1 expression was associated with poorer survival in septic patients and showed moderate prognostic performance (AUC = 0.750). Rat myocardial transcriptomic data showed no transcriptional suppression of PI3K/mTOR components during sepsis. Sepsis suppressed PI3K/Akt phosphorylation, with p62 and LC3-II accumulation and TFEB cytoplasmic retention. Low-dose esmolol reduced tachycardia by 15-20% without hypotension, preserved left ventricular ejection fraction, lowered cTnI (1.36 to 0.14 ng/mL) and sepsis scores (18.50 to 8.50), and improved 144 h survival (P = 0.005). High-dose esmolol caused persistent hypotension and lacked survival benefit. Low-dose esmolol partially restored PI3K/Akt phosphorylation and enhanced TFEB nuclear translocation, reduced LC3/p62 co-localization, and ameliorated chamber-specific ultrastructural damage-mitochondrial swelling in the atrium and myofibrillar disarray in the ventricle-with findings suggestive of improved autophagosome-lysosome processing. CQ aggravated myocardial injury and autophagy-marker accumulation; low-dose esmolol partially attenuated CQ-induced deterioration. Direct quantitative measurement of autophagic flux and isoform-specific functional assays targeting PI3K were not conducted in the present study. Low-dose esmolol was associated with restored PI3K/Akt phosphorylation, enhanced TFEB nuclear translocation, and improved autophagy-related homeostasis in a rat SIMI model. We propose a working model in which low-dose esmolol may coordinate PI3K/Akt signaling and TFEB-mediated lysosomal adaptation to alleviate septic myocardial injury. The causal relationship cannot be definitively validated in the absence of direct flux monitoring, pathway-specific loss-of-function experiments, and isoform-specific evidence. These findings provide preclinical support for further evaluating low-dose esmolol as a candidate adjunct therapy for septic cardiomyopathy.

PMID 42449445
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PubMedSystematic reviews2026-07-14

Evaluating the efficacy of esmolol in septic shock: a systematic review and meta-analysis.

Al-Nafai Retaj R, Aljahdali Ghaid G, Alrebish Lama L, Albeladi Maisa M et al.

Persistent tachycardia in septic shock is associated with adverse outcomes, yet optimal management remains uncertain. Esmolol, a short-acting β1-selective blocker, has been investigated as a strategy to control heart rate and attenuate excessive sympathetic activation. This systematic review and meta-analysis evaluated the efficacy of esmolol in adult patients with septic shock. A comprehensive search of PubMed/MEDLINE, Cochrane Central, and Google Scholar was conducted from database inception to March 28, 2025. Reference lists and clinical trial registries were also screened. Randomized controlled trials comparing esmolol plus standard care with standard care alone in adults with septic shock were included. The primary outcome was 28-day mortality. Secondary outcomes included heart rate, mean arterial pressure (MAP), and lactate. Three randomized controlled trials involving 314 patients were included. Esmolol was associated with a significant reduction in 28-day mortality (OR 0.33, 95% CI 0.20-0.53; I2 = 0%). Heart rate was significantly reduced at both 24 h (day 1) (MD - 8.50 bpm, 95% CI - 10.82 to - 6.17) and 48 h (day 2) (MD - 16.60 bpm, 95% CI - 20.03 to - 13.17). No statistically significant difference in MAP was observed between groups (MD 0.10 mmHg, 95% CI - 3.46 to 3.66; I2 = 53%). Although the included studies did not report clinically meaningful differences in lactate levels, differences in outcome reporting precluded quantitative synthesis. Esmolol therapy may improve heart rate control and reduce 28-day mortality in carefully selected patients with septic shock without adversely affecting MAP. However, these findings should be interpreted cautiously because they are based on a limited number of randomized trials and are subject to clinical heterogeneity and potential risk of bias. Larger, high-quality randomized controlled trials are needed to confirm these findings and define the optimal use of esmolol in septic shock. The review protocol was registered with PROSPERO (CRD42024584599).

PMID 42444017
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PubMedCureus2026-07-14

Comparative Efficacy of Esmolol, Labetalol, and Lignocaine in Attenuating Hemodynamic Responses to Laryngoscopy and Intubation: A Randomized Double-Blind Study.

Sahoo Rojalin R, Sahoo Suryasnata S, Patra Ananta Narayan AN, Shubhadarshini Swatee Shatarupa SS

Background Laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation resulting in tachycardia and hypertension. These hemodynamic changes may be harmful, particularly in patients with limited cardiovascular reserve. Various pharmacological agents have been used to attenuate this response, but an ideal agent remains debatable. Aim To compare the efficacy of intravenous esmolol, labetalol, and lignocaine in attenuating peri-intubation hemodynamic responses, assessed using heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product during laryngoscopy and endotracheal intubation Materials and methods Patients were randomly allocated into three equal groups (n = 25 each). Group ES received intravenous esmolol 1 mg/kg, Group LB received intravenous labetalol 0.25 mg/kg, and Group LG received intravenous lignocaine 1.5 mg/kg, administered two minutes prior to laryngoscopy and endotracheal intubation. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product were recorded at baseline, after drug administration, at intubation, and at one, three, five, seven, and 10 minutes following intubation. Data were analyzed using repeated-measures ANOVA, one-way ANOVA, chi-square test, and Tukey post hoc analysis, with p < 0.05 considered statistically significant. Results Baseline demographic parameters and hemodynamic variables were comparable among the three groups. All three drugs attenuated the hemodynamic response to laryngoscopy and intubation to varying extents. Labetalol demonstrated the most effective attenuation of heart rate, systolic blood pressure, mean arterial pressure, and rate pressure product at intubation and throughout the post-intubation period (p < 0.001). Esmolol showed better attenuation compared to lignocaine but was less effective than labetalol. Lignocaine was the least effective agent. No significant adverse effects were observed in any group. Conclusion Intravenous labetalol is more effective than esmolol and lignocaine in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation, with better overall cardiovascular stability and safety.

PMID 42445626
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