Drug Database
ES

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

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
Read full article →
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
Read full article →
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
Read full article →
PubMedFrontiers in medicine2026-07-14

Transesophageal echocardiography-guided anesthetic management of a patient with dilated cardiomyopathy, severe heart failure, and septic shock: a case report.

Chen Lixin L, Li Jianbin J, Gao Mintai M, Zhu Danjun D et al.

Perioperative management of severe dilated cardiomyopathy (DCM) with markedly reduced left ventricular ejection fraction (LVEF) is particularly complex, especially when complicated by septic shock, as standard resuscitative measures may trigger acute cardiac decompensation. This report describes a 41-year-old male with undiagnosed severe DCM (LVEF 16% by transthoracic echocardiography) and left ventricular thrombus, who presented with Aeromonas hydrophila-induced necrotizing fasciitis that rapidly progressed to septic shock and multiple organ dysfunction. The severity of septic manifestations obscured the underlying occult cardiomyopathy, underscoring the critical role of cardiac biomarkers and echocardiography in facilitating early diagnosis. Intraoperative transesophageal echocardiography (TEE) proved pivotal for the real-time, physiology-guided titration of a multi-agent pharmacological regimen (norepinephrine, dobutamine, esmolol) and for guiding positional adjustments, thereby balancing the conflicting hemodynamic demands of septic vasoplegia and end-stage heart failure during emergent limb-saving surgery.

PMID 42445149
Read full article →
PubMedCardiology in the young2026-07-03

A scoping review of the evidence supporting antiarrhythmic use after paediatric cardiac surgery.

Sullenger Rebecca D RD, Kohlmann Taylor T, Kilborn Alison G AG, Commander Sarah Jane SJ et al.

Arrhythmias after paediatric cardiac surgery occur frequently and contribute to postoperative morbidity and mortality. There is limited literature assessing the safety and efficacy of common antiarrhythmics administered in this population. We systematically searched PubMed and EMBASE for literature on antiarrhythmic use in children <18 years of age after cardiac surgery from 2000 to 2024. Two reviewers independently screened abstracts and then reviewed full-text manuscripts to determine eligibility. We identified 28 studies of 3,752 patients across 11 different antiarrhythmics: flecainide, procainamide, esmolol, landiolol, propranolol, amiodarone, sotalol, dexmedetomidine, digoxin, ivabradine, and magnesium. Most studies were small, with 17 enrolling fewer than 100 children. Only eight studies were randomised, 16 were retrospective, 12 were prospective, and one was multicenter. Safety and efficacy endpoints varied widely, limiting our ability to combine data for meta-analysis. Overall, evidence supporting the use of these drugs in children after cardiac surgery was limited. Although antiarrhythmics are commonly used in children after cardiac surgery, randomised trials with standardised endpoints to guide choice of therapy are lacking. Pragmatic trials to generate real-world data should be considered to further evaluate the safety and efficacy of various antiarrhythmics in this population.

PMID 42394265
Read full article →
PubMedCureus2026-07-01

Efficacy of Esmolol Versus Nitroglycerin in Maintaining the Quality of Bloodless Surgical Fields in Middle Ear Surgery: A Randomized Controlled Trial.

K Mithra M, Sahu Lingaraj L, Kumari Anjali A, Nayak Laba K LK et al.

Background Middle ear surgeries such as tympanoplasty and mastoidectomy demand a bloodless operative field because even minimal bleeding under high-magnification microscopy can significantly impair visualization, prolong operative time, and increase the risk of iatrogenic injury. Controlled hypotension is widely accepted for minimizing bleeding; however, the optimal pharmacological agent in otological surgery remains debated. Esmolol, a cardio-selective beta-1 blocker, reduces heart rate (HR) and cardiac output without vasodilation, whereas nitroglycerin (NTG) frequently induces reflex tachycardia that may paradoxically increase microvascular bleeding. Objective To compare the efficacy of intravenous esmolol versus nitroglycerin in achieving and maintaining a bloodless surgical field in middle ear surgery under general anesthesia, with primary evaluation of Surgical Site Comfort (SSC) score, surgical and microscope duration, and secondary evaluation of intraoperative HR, mean arterial pressure (MAP), pre and post op hemodynamic variables. Methods A prospective, randomized, double-blind, parallel-group controlled trial was conducted at Kalinga Institute of Medical Sciences, Bhubaneswar. One hundred ASA I-II adult patients undergoing elective middle ear surgery were randomized to esmolol (Group A, n=50) or nitroglycerin (Group B, n=50) targeting MAP 60-65 mmHg. The surgical field was assessed using the six-point Fromme-Boezaart scale every five minutes. HR and MAP were recorded throughout. SSC scores were analyzed using the Mann-Whitney U test; continuous variables by Welch's independent t-test. Results Both groups were demographically comparable. SSC scores were significantly lower (better field) in the esmolol group from 5 minutes onward (p < 0.001 at all subsequent time points). Group A reached SSC score 1 (slight bleeding, not a surgical nuisance) by 60 minutes; Group B never reached this level. Surgical duration was shorter in Group A (79.9 ± 15.7 vs. 103.5 ± 15.3 min, p < 0.0001), as was microscope use time (48.2 ± 10.1 vs. 75.7 ± 14.8 min, p < 0.0001). Intraoperative HR was consistently lower in Group A (p < 0.001); MAP was comparable between groups for most of the operative period. No clinically significant adverse events were recorded in either group. Conclusion Esmolol is superior to nitroglycerin in achieving a bloodless surgical field in middle ear surgery under general anesthesia. By providing effective HR control alongside adequate MAP reduction, esmolol achieves earlier and more sustained field clarity, significantly shortening surgical and microscope use time without adverse hemodynamic effects.

PMID 42382881
Read full article →

+1626 more articles available with a free account

Sign up free to view all articles →

Ask about esmolol hydrochoride