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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

PubMedFrontiers in neuroscience2026-11-10

Effect of ultrasound-guided stellate ganglion block on intraoperative hemodynamics in laparoscopic partial adrenalectomy: a randomized clinical trial.

Nie Jingyi J, Wang Huang H, Zhang Wenjing W, Wang Hui H et al.

This study aimed to evaluate the effect of ultrasound-guided stellate ganglion block (SGB) on intraoperative hemodynamic parameters in patients undergoing laparoscopic partial adrenalectomy. A total of 72 patients with adrenal tumors scheduled for laparoscopic partial adrenalectomy were enrolled and randomly assigned in a 1:1 ratio to either the stellate ganglion block (SGB) group or the control group. The primary outcome was the incidence of intraoperative hypertension, defined as a systolic blood pressure (SBP) ≥180 mmHg or an increase of ≥30% in mean arterial pressure (MAP) from baseline. Secondary outcomes included MAP and heart rate (HR) measured at nine predefined perioperative time points, intraoperative vasoactive drug consumption, and the incidence of perioperative adverse events. The incidence of intraoperative hypertension was significantly lower in the SGB group than in the control group (14.3% vs. 37.1%, p = 0.029). Compared with the control group, patients in the SGB group exhibited significantly lower MAP and HR at eight time points ranging from immediately after tracheal intubation until the end of surgery (p < 0.05). The intraoperative consumption of phentolamine was significantly lower in the SGB group than in the control group [0 (0-4) mg vs. 0 (0-0) mg; p = 0.008]. In contrast, the consumption of norepinephrine was significantly higher in the SGB group [0 (0-0) mg vs. 0 (0-8) mg; p = 0.004]. No statistically significant differences were observed between the two groups in the consumption of esmolol and atropine, or in the incidence of perioperative adverse events. Ultrasound-guided SGB lowers intraoperative hypertension incidence and phentolamine demand in laparoscopic partial adrenalectomy. Although the SGB group observed a slight increase in the intraoperative dose of norepinephrine, no perioperative adverse events occurred. There was also no significant difference in the incidence of adverse reactions between the two groups.

PMID 43005334
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PubMedBMC anesthesiology2026-10-30

What triggers intraoperative blood pressure/heart rate surges and postoperative hypertonia during unilateral biportal endoscopy?

Sun Peipei P, Ma Tingting T, Ju Jing J, Pan Min M et al.

Unilateral biportal endoscopy (UBE) is an increasingly utilized minimally invasive technique for lumbar degenerative disease. Dural tear is a recognized complication (incidence 1.9-5.8%), typically associated with cerebrospinal fluid leakage and intracranial hypotension. However, the unique irrigation dynamics of UBE - an open two-portal system permitting high-flow continuous irrigation - may produce a distinctly different pathophysiology when an occult dural defect is present. The anesthesiology literature contains few descriptions of the acute intraoperative hemodynamic manifestations of this phenomenon. A 49-year-old woman (ASA physical status I) underwent UBE for L4-L5 and L5-S1 disc herniation under total intravenous anesthesia. The procedure was complicated by intraoperative wrong-level surgery (L4-L5 misidentified as L5-S1), necessitating complete portal withdrawal, re-localization, and re-establishment of the surgical field, which prolonged the operation to 4 h 23 min with a cumulative irrigation volume of 51,000 mL. Approximately 2.5 h after incision, progressive, treatment-refractory tachycardia (70 → 117 beats/min) and hypertension (up to 183/102 mmHg) developed; esmolol and urapidil produced minimal antihypertensive effect despite concurrent augmentation of anesthetic depth. On postoperative review, the scrub nurse recalled observing a suspected dural tear approximately 10 min before the hemodynamic escalation, which had not been communicated intraoperatively. Following extubation, the patient exhibited impaired consciousness, persistent tachypnea (40-50 breaths/min), and generalized hypertonia with decerebrate posturing. Multidisciplinary evaluation excluded epileptic seizure, metabolic encephalopathy, malignant hyperthermia, and intraoperative awareness. Suspected acute intracranial hypertension secondary to massive irrigation fluid entry into the subarachnoid space via the unrecognized dural defect was considered the most likely diagnosis. The patient was reintubated and managed in the intensive care unit with osmotic diuresis (furosemide, mannitol), corticosteroids, and sedation. Consciousness recovered the following morning, limb hypertonia resolved by postoperative day 11, and the patient was discharged on day 14 without neurological deficit. This case suggests that an occult dural tear during UBE with large-volume irrigation may produce a paradoxical hemodynamic profile of progressive, therapy-resistant hypertension and tachycardia - contrasting with the bradycardia and hypotension classically associated with intracranial hypotension from cerebrospinal fluid leaks. The triad of (i) progressive, treatment-refractory hypertension and tachycardia, (ii) prolonged UBE duration (> 2 h), and (iii) large-volume irrigation (> 20 L) may represent a high-risk pattern warranting immediate intraoperative communication between anesthesia and surgical teams and consideration of intracranial pressure-directed interventions. This observation is hypothesis-generating and requires validation in larger studies.

PMID 42958471
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PubMedCardiovascular therapeutics2026-10-12

Esmolol Alleviates Sepsis-Associated Myocardial Injury by Acting on the APAF1 and JAK2/STAT3 Inflammatory Pathways.

Zhao Lei L, Dong Hua H, Dong Shimin S

The aim of this study is to explore the protective effect of esmolol against sepsis-associated myocardial injury (SAMI) and its underlying molecular mechanisms. SAMI-related differentially expressed genes were identified from the Gene Expression Omnibus database (GSE267388). Potential targets of esmolol were predicted using PharmMapper. Overlapping genes were used for enrichment and molecular docking analyses. H9C2 cells were treated with LPS to establish an injury model, followed by esmolol treatment. Cell viability, apoptosis, oxidative stress, and mitochondrial function were also assessed. The expressions of apoptotic protease activating factor 1 (APAF1) and JAK2/STAT3 pathway molecules were detected using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blotting. A rat model of sepsis was used to verify cardiac function, inflammation, oxidative stress, and related protein expression. Six core targets were screened, and esmolol showed the strongest binding to APAF1. Esmolol increased cell viability; reduced apoptosis, ROS, and MDA; restored mitochondrial membrane potential; downregulated APAF1, Bax, cleaved-caspase-9/3; and suppressed JAK2/STAT3 phosphorylation. Esmolol reversed APAF1 overexpression-induced injury. In vivo, esmolol alleviated myocardial pathological injury, decreased the concentrations of myocardial markers and inflammatory factors, and inhibited the APAF1 and JAK2/STAT3 pathways. Esmolol protects against SAMI by dual inhibition of the APAF1 mitochondrial apoptotic and JAK2/STAT3 inflammatory pathways, with APAF1 likely serving as a key downstream target of esmolol.

PMID 42861774
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PubMedAmerican journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists2026-10-12

Labetalol-induced hyperkalemia in acute aortic dissection: A rare but clinically relevant adverse effect.

Butt Faizan F, Khan Zoha Z, Badua Paul M PM

Hyperkalemia is a potentially life-threatening electrolyte abnormality often associated with renin-angiotensin-aldosterone system (RAAS) inhibitors, renal dysfunction, or potassium-sparing agents. Non-selective beta-blockers, including labetalol, may also precipitate hyperkalemia through beta-2 (β-2)-adrenergic blockade, although this adverse effect is underrecognized, particularly in patients without underlying renal disease. A 59-year-old man with hypertension, diabetes, asthma, and polysubstance use disorder presented with severe chest pain and hypertensive emergency (243/132 mmHg). Imaging revealed aortic dilatation and confirmed acute type B aortic dissection. After initial medical management with intravenous (IV) esmolol and nicardipine, oral labetalol was initiated and escalated to 600 mg for anti-impulse therapy. The patient developed persistent, non-hemolyzed hyperkalemia (5.2 to 5.8 mmol/L) temporally correlating with labetalol dose escalation, despite preserved renal function (serum creatinine 1.4 to 1.8 mg/dL) and absence of RAAS inhibitors or heparin exposure. Conservative management failed, and the patient underwent thoracic endovascular aortic repair (TEVAR) with thoracic branch endoprosthesis (TBE). Post-operatively, labetalol was discontinued and replaced with carvedilol. Serum potassium (K+) normalized within 48 hours and remained without further K+ lowering agents. Naranjo Adverse Drug Reaction Probability Scale assessment yielded a score of 7, indicating a probable adverse drug reaction. Labetalol may induce clinically significant hyperkalemia independent of renal impairment or typical precipitating medications. This case highlights the importance of monitoring K+ in patients receiving labetalol for acute aortic syndromes and supports carvedilol as a potentially safer non-selective beta-blocker alternative with respect to K+ homeostasis.

PMID 42862110
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PubMedInternational journal of biological macromolecules2026-09-30

Electrospun silk sericin-poly(lactic acid) coaxial nanofiber scaffold for esmolol and ferulic acid co-delivery in expedited diabetic wound healing.

Pandey Giriraj G, Kolipaka Tejaswini T, Yadav Deepankar D, Arya Dilip Kumar DK et al.

Diabetic foot ulcers (DFUs) are chronic, infection-prone wounds that heal poorly due to impaired angiogenesis, persistent inflammation, and elevated oxidative stress, creating a substantial clinical and economic burden and highlighting the need for advanced extracellular matrix-mimicking dressings. Therefore, we have developed a ferulic acid (FA)-esmolol (ESM)-loaded coaxial nanofibrous (NFs) scaffold using silk sericin (SS) as the shell and poly(lactic acid) (PLA) as the core via electrospinning for DFU management. The optimized scaffold showed a uniform, bead-free morphology with increased fiber diameter (370 ± 95 nm) compared to blank NFs (201 ± 52 nm) and a confirmed core-shell architecture. The FA-ESM NFs demonstrated high porosity (81.04 ± 4.39%) and an optimal water vapor transmission rate (WVTR) (2077 g/m2/day), supporting a moist wound environment. Water retention (409.39 ± 12.41%) and controlled biodegradation (~98% over 21 days) indicated excellent exudate handling and sustained structural integrity. Mechanical analysis showed suitable tensile strength (1.20 MPa) and elongation (112.80%). Drug release followed the Korsmeyer-Peppas model (R2 ≈ 0.975/0.9811; n = 0.699/0.883), indicating anomalous to case II transport. The scaffold exhibited significant antioxidant activity, >80% cell viability, and hemocompatibility. It significantly enhanced cell migration within 48 h and modulated biomarkers (↓MMP-9, ↓TNF-α, ↑VEGF; p < 0.01). Strong antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa, along with significantly accelerated wound closure in diabetic models within 16 days (p < 0.0001), further validates its therapeutic efficacy. Overall, the scaffold demonstrates promising anti-inflammatory, antioxidant, and pro-angiogenic properties and potentially effective dressing for DFU management.

PMID 42815666
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PubMedFrontiers in medicine2026-09-29

Prediction of moderate-to-severe postoperative thirst in general anesthesia patients based on automated machine learning and clinical nursing translation.

Zhan Yi Y, Yang Siting S, Wang Haoran H

To develop an Automated Machine Learning (AutoML)-based model for screening Moderate-to-Severe Postoperative Thirst (MSPOT) risk at surgery-to-PACU handover and a prototype clinical decision support system. This retrospective single-center cohort included 928 patients undergoing general anesthesia (training set: n = 650; held-out internal test set: n = 278). An Improved Wave Optics Optimizer (IWOO) framework integrated feature selection and hyperparameter optimization using demographic, preoperative, and intraoperative variables. Prediction was performed at anesthesia-to-PACU handover, after final intraoperative data became available and before routine postoperative NRS thirst assessment. Performance was evaluated using ROC-AUC, PR-AUC, calibration analysis, Brier score, and decision curve analysis (DCA). SHAP was used to summarize feature contributions. In the held-out internal test set, the AutoML model achieved a ROC-AUC of 0.9053, PR-AUC of 0.9080, and Brier score of 0.129, outperforming conventional models. DCA showed greater net benefit across thresholds of 1%-95%. In same-center temporal validation, discrimination remained acceptable (ROC-AUC: 0.8807; PR-AUC: 0.8778), but calibration deteriorated (Brier score: 0.1924; intercept: -1.2250; slope: 0.5811), indicating average risk overestimation and overly extreme probabilities. Six predictors were identified: esmolol use, intraoperative blood loss, operation time, ASA classification, ERAS, and intraoperative fluid volume. The AutoML model showed strong discrimination and transparent feature attribution. The prototype illustrates its potential use at PACU handover to prioritize early assessment and comfort-oriented thirst management. However, temporal miscalibration indicates that individualized probabilities are not ready for clinical decision-making without recalibration and subsequent prospective validation.

PMID 42807403
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