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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

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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PubMedAmerican journal of cardiovascular drugs : drugs, devices, and other interventions2026-09-21

Beta-Blockers for the Treatment of Arrhythmias: Which Drug for Which Arrhythmia? A State-of-the-Art Narrative Review.

Muresan Lucian L, Cismaru Gabriel G, Popa Stefan Lucian SL, Rosu Radu R et al.

Beta-blockers are among the most widely prescribed drugs in the management of both supraventricular and ventricular arrhythmias, and they are frequently regarded as a homogeneous pharmacological class. They are not. The agents in current use differ substantially in beta1-receptor selectivity, lipophilicity, half-life, route of administration, intrinsic sympathomimetic activity, and ancillary properties, and arrhythmias themselves differ in mechanism, adrenergic dependence, anatomical origin, and structural substrate. This narrative review examines whether these pharmacological differences translate into clinically meaningful differences in efficacy and utility, asking not only whether a beta-blocker should be used but which one should be used. Evidence was drawn from a targeted search of PubMed, Web of Science, Scopus, Ovid, Embase, and the Cochrane Library, with priority given to randomized controlled trials, meta-analyses, large registries, and contemporary society guidelines, and was synthesized qualitatively by arrhythmia type. A class effect is apparent for many indications, particularly rate control in atrial fibrillation and atrial flutter, where metoprolol, bisoprolol, and carvedilol perform broadly similarly and the choice is driven mainly by comorbidity and tolerability. Drug-specific differences emerge in three settings. In adrenergically mediated inherited syndromes, namely catecholaminergic polymorphic ventricular tachycardia and long QT syndrome, nonselective agents and especially nadolol are clearly superior to beta1-selective agents, and the same principle appears to extend to ventricular electrical storm, in which propranolol has outperformed metoprolol in a randomized comparison. In acute care, pharmacokinetics dominate, and the ultra-short-acting agents esmolol and landiolol permit a degree of titration that longer-acting drugs cannot match. In patients with heart failure and reduced ejection fraction, carvedilol, metoprolol succinate, and bisoprolol should be preferred irrespective of arrhythmia subtype because of their established mortality benefit. Conversely, beta1-selective agents, including the highly selective agent nebivolol, improve tolerability in bronchospastic disease, although this reflects respiratory tolerability rather than any demonstrated antiarrhythmic advantage, and beta-blockers have little role in Brugada syndrome or in bradycardia-dependent acquired torsades de pointes. Beta-blockers should therefore not be treated as interchangeable. Selection should integrate arrhythmic mechanism, structural substrate, and patient characteristics, and head-to-head trials remain conspicuously scarce.

PMID 42766102
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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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