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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

PubMedPrehospital emergency care2026-09-16

Medical Management of Aortic Emergencies in Critical Care Transport.

George Nicholas H NH, Guyette Francis X FX, Ramgopal Sriram S, Liang Nathan L NL et al.

Aortic emergencies (e.g., dissection or aneurysm; AE) are life-threatening events commonly encountered in critical care transport. Guidelines recommend beta-blockers to control heart rate (HR), with calcium channel blockers added for systolic blood pressure (SBP) control or as an alternative. There is little human data to support either strategy or to document adverse events. We aimed to determine the frequency with which medications commonly used to treat AE reach guideline-recommended hemodynamic targets and characterize adverse events during critical care transport (CCT). We performed an observational study design and retrospective cohort analysis of patients ≥18 years old with an AE undergoing CCT between 2003-2024. We included patients who received esmolol, nicardipine, labetalol, or combinations. We evaluated the primary outcome of target HR (60-80 bpm) or SBP (90-120 mmHg) with multivariable logistic regression controlling for age, sex, weight, year, and prior vasoactive medications. Secondary outcomes included hypotension (SBP <90 mmHg), bradycardia (HR <50 bpm), tachycardia (HR >100 bpm), and vasopressor support or cardiac arrest. We included 1,530 AE encounters, of which 792 (51.8%) received nicardipine, 236 (15.4%) esmolol, 194 (12.7%) labetalol, 163 (10.7%) esmolol and nicardipine, and 145 (9.5%) labetalol and nicardipine. Compared to esmolol alone, all other treatment strategies had a similar likelihood of achieving target HR or SBP goals. Patients receiving labetalol alone had the lowest incidence of hypotension (2.1% [0.1-4.1%]) and combined esmolol/nicardipine had the lowest incidence of tachycardia (11.0% [6.2-15.9%]). Esmolol compared to nicardipine alone had similar rates of tachycardia (19.1% [14.1-24.1%] versus 25.3% [22.2-28.3%], respectively), while esmolol had the highest incidence of hypotension (9.3% [5.6-13.0%]). We observed a similar odds of achieving HR and SBP targets regardless of medication used in a large sample of patients with aortic emergencies. While a combination of beta and calcium channel blockers may be optimal medical therapy, treatment with esmolol, labetalol, or nicardipine as single agents may be reasonable to achieve HR and SBP goals.

PMID 42748279
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PubMedThe journal of ECT2026-09-11

Effect of Electroconvulsive Therapy on Intracranial Pressure: An Evaluation Using Optic Nerve Sheath Diameter Measurements.

Fu Ping P, Nerella Resheek R, Rosenquist Peter B PB, Wan Morgan M et al.

Electroconvulsive therapy (ECT) stands as a widely acknowledged and effective treatment modality for a range of psychiatric disorders but requires careful patient selection and monitoring to ensure safety in the presence of risk factors given the pronounced physiologic response to the treatment and its attendant generalized anesthesia. Although there is substantial evidence indicating that ECT may trigger an increase in intracranial pressure (ICP) under specific patient circumstances, no studies demonstrate the degree of ICP changes associated with routine clinical ECT. Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) provides an indirect measure of intracranial pressure. We conducted serial ONSD assessments in 24 patients at four pivotal junctures during ECT treatment: pre-ECT administration, postanesthesia induction, immediate postictal seizure, and postanesthesia recovery. The ONSD measurements were analyzed with a two-way analysis of variance (ANOVA). We found no statistically significant discrepancies in ONSD measurements compared to baseline readings at any of the post-ECT time points. In addition, there was no difference in ONSD changes between patients who did or did not receive esmolol during treatment or underwent ECT with either unilateral or bilateral electrode placement. These findings strongly suggest that ECT does not induce substantial alterations in intracranial pressure, as determined through ONSD ultrasonography. Nevertheless, it is imperative to underscore the necessity for further research encompassing larger patient cohorts and those who may have baseline elevations of ICP.

PMID 42726646
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PubMedFrontiers in physiology2026-09-09

Ea/Ees and oscillatory power fraction capture complementary but distinct components of ventriculoarterial coupling: a porcine study.

Flade Hans Martin HM, Kirkeby-Garstad Idar I, Lyng Oddveig O, Tannvik Tomas Dybos TD et al.

Ventriculoarterial coupling (VAC), traditionally assessed using the invasive "gold standard" Ea/Ees ratio (arterial elastance to end-systolic elastance), is clinically important but requires approximations that are impractical at the bedside. Oscillatory power fraction (OPF), defined as the ratio of oscillatory to total hydraulic power and derived from synchronized aortic flow-pressure measurements, has been proposed as a pragmatic VAC surrogate. This study aimed to clarify the possible correlation between VAC and OPF in pharmacologically induced hemodynamic extremes. In 14 juvenile pigs challenged with vasoactive (phenylephrine, nitroprusside) and cardioactive drugs (dobutamine, esmolol) titrated toward protocolized targets (± 40% MAP, ± 50% dP/dt), we obtained a comprehensive dataset using intracardiac conductance catheters, intraaortic pressure probes, and ascending aortic flow probes. Linear mixed models with animal as a random effect compared baseline and drug-effect states. The coupling of the two responses was assessed from each animal's baseline-to-effect change, corrected for measurement error estimated from the replicate recordings. Ea/Ees changed by 10%-36% across the four interventions, whereas OPF changed by 1.5%-12%, and under phenylephrine and dobutamine, the change in OPF was negligible (|d| < 0.2, both p > 0.2) despite measurable changes in Ea/Ees. Esmolol was the only challenge under which both indices changed substantially in the same direction (Ea/Ees: + 35.4%, OPF: + 12.2%). Whether the magnitudes of the two responses were coupled could not be determined. Dobutamine markedly increased Ees, total power, and oscillatory power while preserving OPF despite a reduction in Ea/Ees, indicating improved VAC but stable pulsatile efficiency. Vasoactive drugs (phenylephrine, nitroprusside) substantially altered Ea/Ees without relevant OPF changes. Ea/Ees and OPF are not interchangeable. OPF responded far less strongly than Ea/Ees to the loading changes imposed here and did not resolve them under two of the four challenges. This is consistent with the two indices reflecting predominantly steady and pulsatile aspects of arterial load, although the present data do not demonstrate that separation directly. While OPF cannot replace Ea/Ees, power-derived indices offer practical adjuncts for characterizing ventriculoarterial interactions and the effects of selected drugs at the intensive care bedside.

PMID 42712720
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PubMedAnesthesiology research and practice2026-08-30

Intraoperative Hemodynamic Management and Cerebral Protection During Awake Craniotomy: Evidence-Based Approaches.

Maragh Marc Knezevic MK, Garcia Alanna Pagan AP, Oliinyk Yuliia Y, Acharjee Jayottri J et al.

Awake craniotomy is a standard neurosurgical technique that enables real-time assessment of brain functions during tumor resection, with high success rates. Although highly effective, the procedure is associated with hemodynamic disturbances, including blood pressure variability and impaired cerebral perfusion, compromising intraoperative safety. A focused literature search of PubMed, Embase, and Google Scholar was performed to identify relevant studies on intraoperative hemodynamic management during awake craniotomy. Findings were synthesized narratively to summarize current evidence, highlight emerging strategies, and identify knowledge gaps. Hypertension (8%-34%) was the most common disturbance, often triggered by painful surgical stimuli or emergence from sedation, with repeat craniotomy, impaired autoregulation, and glioma pathology as additional risk factors. Hypotension (10%-11%) was linked to perioperative stroke and mortality. Cerebral hypoperfusion contributed to poor outcomes, with stroke up to 23% and neurological morbidity in 68% of patients. Preventive strategies, such as scalp blocks, individualized blood pressure targets, and the use of dexmedetomidine and midazolam, improved intraoperative stability, while short-acting agents, including esmolol and labetalol, were preferred for rapid control. Advanced monitoring modalities, including arterial lines, near-infrared spectroscopy, and cerebral autoregulation indices, enhance safety and support accurate functional mapping. Hemodynamic instability during awake craniotomy influences outcomes. Current evidence supports multimodal prevention, tailored blood pressure control, and short-acting pharmacological agents; practice variation and the lack of randomized trials limit standardization. Looking ahead, advanced monitoring and emerging AI systems may provide new opportunities to enhance cerebral protection and optimize patient safety. This review summarizes evidence on intraoperative hemodynamic control in awake craniotomy, emphasizing strategies that enable maximal safe resection while preserving neurological function.

PMID 42668949
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PubMedWorld journal of methodology2026-08-21

Comparison of propofol alone vs propofol-phenylephrine combination for intraoperative hemodynamic stability in glioma surgery.

Thotungal Rhea R, Kaushal Ashutosh A, Agrawal Amit A, Jain Anuj A et al.

Propofol is widely used for induction in glioma surgery for its neuroprotective effects and favorable recovery profile. However, its dose-dependent hypotension is a major limitation in procedures requiring stable cerebral perfusion. To compare the efficacy of propofol vs propofol-phenylephrine (PPE) combination in maintaining hemodynamic stability in patients undergoing glioma surgery. Ninety American Society of Anesthesiologists I-II patients scheduled for elective glioma surgery were randomized to receive either propofol (group P) or a PPE admixture (group PPE). Induction was performed with slow titration of the study drug until loss of verbal response and Bispectral index < 60, followed by a continuous infusion (50 μg/kg/minute) until skin closure. Hemodynamic parameters [mean arterial pressure (MAP), systolic blood pressure, diastolic blood pressure, and heart rate] were recorded at baseline, during induction, immediately after intubation, and at predefined intraoperative time points. The incidence of hypotension, vasopressor and esmolol use, and brain relaxation scores were compared. Group PPE demonstrated significantly better preservation of MAP, systolic blood pressure, diastolic blood pressure, and heart rate throughout the peri-induction and intraoperative periods (P < 0.05). The mean maximum MAP reduction during induction was greater in group P compared with group PPE (19.7 mmHg vs 12.5 mmHg; P < 0.01). Hypotensive episodes were significantly more frequent in group P than in group PPE (84.4% vs 6.7%; P < 0.001). Rescue phenylephrine requirements were markedly lower in group PPE (P < 0.001). Esmolol use and brain relaxation scores were comparable between groups. Adding phenylephrine to propofol for induction and maintenance provides superior hemodynamic stability without compromising brain relaxation in glioma surgery.

PMID 42626261
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PubMedAcute and critical care2026-08-19

Esmolol in the management of refractory ventricular fibrillation: a systematic review and meta-analysis.

Lau Kathleen K, Chau Yau-Lam Alex YA, Cheng Ting-An TA, Lai Michael M et al.

Refractory ventricular fibrillation (rVF) presents a significant challenge in advanced cardiovascular life support (ACLS), with traditional antiarrhythmics showing limited success in improving long-term survival and neurological function. Esmolol, a beta-1 selective adrenergic receptor antagonist, might offer benefits due to its rapid onset and catecholamine-suppressing effects during cardiac arrest. This systematic review and meta-analysis (SRMA) evaluates the effectiveness of esmolol in improving the temporary return of spontaneous circulation (ROSC), sustained ROSC, survival to discharge, and survival to discharge with favorable neurological outcomes in rVF patients. This SRMA reviewed Medline (Ovid), Embase (Ovid), and Cochrane Central (Ovid) from their inception until October 2, 2025, for full-text clinical or observational studies assessing esmolol use alongside standard ACLS in adult rVF in both prehospital and in-hospital settings. The risk of bias was independently assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs; 95% CI) are reported. Analyses in which I² >50% used a random-effects model; otherwise, a common-effect model was used. Four studies (n=273) are included. Esmolol was associated with an increased temporary ROSC (RR, 1.80; 95% CI, 1.09-2.98), and although the links were not statistically significant, esmolol trended toward a benefit in sustained ROSC (RR, 1.25; 95% CI, 0.28-5.66), survival to discharge (RR, 1.08; 95% CI, 0.57-2.03), and survival to discharge with favorable neurological outcomes (RR, 2.08; 95% CI, 0.83-5.24). Esmolol was associated with improved temporary ROSC in rVF. The sensitivity analysis suggests potential benefits for sustained ROSC and neurological survival, but more data are needed. Further research is needed to clarify its role.

PMID 42613868
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