에스몰롤
Esmolol
Esmolol hydrochloride
다른 이름: Brevibloc · Miniblock · ASL-8052 · Esmolol HCl · Esmololum · Esmolol hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Ultra-short acting beta blockade (ventricular arrhythmias) - Normal cardiac function | An initial loading dose of 0.25-0.5 mg/kg (250-500 micrograms/kg) administered IV as slow bolus over 1-2 minutes, then followed by a constant rate infusion of 10-200 micrograms/kg/minute; or Start CRI at 10-200 micrograms/kg/minute without the bolus loading dose. | IV | CRI | — | 🌎 NA |
| Ultra-short acting beta blockade - Severe dilated cardiomyopathy or severe mitral regurgitation | Start CRI at 10-20 micrograms/kg/min and titrate upward every 10 minutes to an effective endpoint. | IV | CRI | — | 🌎 NA |
| SVTs | 0.05-0.1 mg/kg (50-100 micrograms/kg) IV bolus over 2 minutes; repeat every 5 minutes to a maximum of 0.5 mg/kg (500 micrograms/kg). | IV | q5m | — | 🌎 NA |
| Arrhythmia conversion | Give in incremental IV bolus doses of 0.05-0.1 mg/kg every 5 minutes up to a maximum dose of 0.5 mg/kg. | IV | q5m | — | 🌎 NA |
- Ultra-short acting beta blockade (ventricular arrhythmias) - Normal cardiac function: If no loading dose, maximal effect should occur in 10-20 minutes.
- Ultra-short acting beta blockade - Severe dilated cardiomyopathy or severe mitral regurgitation: Do not give loading dose.
- Arrhythmia conversion: Because esmolol's effects are short-lived, if arrhythmia conversion does not occur, other negative inotropes (e.g., diltiazem, or verapamil) can be safely used 30 minutes after esmolol.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| HCM (to determine if beta-blockers will reduce dynamic left-ventricular outflow tract obstruction) | An initial loading dose of 0.25-0.5 mg/kg (250-500 micrograms/kg) administered IV as slow bolus over 1-2 minutes, then followed by a constant rate infusion of 10-200 micrograms/kg/minute. | IV | CRI | — | 🌎 NA |
| Critical Arrhythmias | Loading dose of 200-500 micrograms/kg IV over 1 minute; followed by a constant rate IV infusion of 25-200 micrograms/kg/minute | IV | CRI | — | 🌎 NA |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
에스몰롤은 초단기 작용을 하는 심장 선택성 베타-1 아드레날린 수용체 길항제입니다.
수의학에서는 주로 심방세동, 심방조동, 동성 빈맥과 같은 상심실성 빈맥(SVT)의 급성 및 단기 관리를 위한 정맥 주입용으로 사용됩니다. 또한 환자를 장기 작용 경구용 베타 차단제로 전환하기 전에 베타 차단제 요법이 효과적이고 내약성이 있는지 확인하기 위한 진단용 시험 약물로도 매우 유용합니다. 이는 특히 비대성 심근병증(HCM)이 있는 고양이에서 베타 차단이 동적 좌심실 유출로 폐쇄를 감소시키는지 평가하는 데 유용합니다.
임상 요점: 에스몰롤은 적혈구 에스테라아제에 의해 빠르게 대사되기 때문에 주입을 중단한 후 10~20분 이내에 효과가 사라지며, 중증 환자의 시험적 치료에 있어 매우 안전합니다.
작용 기전
Esmolol competitively blocks beta-1 adrenergic receptors in the myocardium with minimal to no effect on beta-2 receptors at clinical doses.
- Negative Chronotropy: Decreases heart rate by slowing sinoatrial (SA) node firing and increasing sinus cycle length.
- Negative Dromotropy: Slows conduction velocity through the atrioventricular (AV) node and prolongs sinus node recovery time.
- Negative Inotropy: Decreases myocardial contractility, which reduces myocardial oxygen demand.
Unlike propranolol, esmolol lacks intrinsic sympathomimetic activity (ISA) and does not possess membrane-stabilizing (quinidine-like) or bronchoconstrictive effects.
안전성·주의사항
금기사항
- Overt cardiac failure
- 2nd or 3rd degree AV block
- Sinus bradycardia
- Cardiogenic shock
- Second or third-degree AV block
- Uncompensated congestive heart failure
- Hypotension
부작용
- Hypotension
- Bradycardia
- Heart block
- Exacerbation of congestive heart failure
- Bronchospasm (at high doses where beta-1 selectivity is lost)
주의
Use with caution (weigh benefit vs. risk) in patients with congestive heart failure (CHF), bronchoconstrictive lung disease, or diabetes mellitus. Esmolol may mask certain clinical signs of developing hypoglycemia (such as increased heart rate or blood pressure).
약물 상호작용
Esmolol may increase serum digoxin levels up to 20%, but these drugs have been used together safely and effectively.
Concurrent use is not recommended due to potential risk of hypertension.
May increase steady-state esmolol serum concentrations up to 50%; titrate esmolol dosage carefully.
May see additive effects (hypotension, bradycardia) if used with esmolol.
If systemic vascular resistance is high, there is an increased risk for blocked cardiac contractility; esmolol is not recommended to control SVTs in patients receiving these drugs.
In humans, particularly with severe cardiomyopathy, cardiac arrest has occurred (rarely).
Additive negative inotropic and chronotropic effects; risk of severe bradycardia and hypotension
Increased risk of severe bradycardia
Mutual antagonism
Additive negative inotropic and chronotropic effects, increasing risk of severe bradycardia and hypotension.
모니터링
- Continuous Electrocardiogram (ECG)
- Direct or indirect blood pressure
- Heart rate and rhythm
- Clinical signs of heart failure
약동학
반감기
흡수
Steady-state blood levels occur in about 5 minutes if a loading dose was given or about 30 minutes if no load was given.
분포
Rapidly and widely distributed but not appreciably to the CNS, spleen or testes. The distribution half-life is about 2 minutes. It is unknown whether the drug crosses the placenta or enters milk.
대사
Rapidly metabolized in the blood by esterases to a practically inactive metabolite.
배설
Renal or hepatic dysfunction do not appreciably alter elimination characteristics.
과다투여
The IV LD50 in dogs is approximately 32 mg/kg.
- 2 mg/kg/min for 1 hour: No adverse effects.
- 3 mg/kg/min for 1 hour: Produced ataxia and salivation.
- 4 mg/kg/min for 1 hour: Caused muscular rigidity, tremors, seizures, ptosis, vomiting, hyperpnea, vocalizations, and prostration.
Management: These effects all resolved within 90 minutes of the end of infusion. Because of the short duration of action of the drug, discontinuation or dosage reduction may be all that is required; otherwise, symptomatic and supportive treatment may be initiated.
제품
제형
- Injection
- Injectable: 10 mg/ml solution
인용의약품
- Esmolol HCl Injection: 10 mg/mL regular & preservative free in 10 mL vials
- Esmolol HCl Injection: 20 mg/mL preservative free in 5 mL vials & 100 mL bags
- Esmolol HCl Injection: 250 mg/mL in 10 mL ampules
- Brevibloc 10 mg/ml solution for injection
규제 현황
POM (Prescription Only Medicine). Human-approved drug used under the cascade.
POM (Prescription Only Medicine). Human-approved drug used under the cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
The concentrate for injection should be stored at room temperature; do not freeze and protect from excessive heat. After diluted to a concentration of 10 mg/mL esmolol HCl is stable (at refrigeration temperatures or room temperature) for at least 24 hours in commonly used IV solutions.
보호자 정보
에스몰롤은 동물병원 환경에서만 투여되는 응급용 초단기 작용 약물입니다.
- 지속적인 모니터링: 반려동물이 이 약물을 투여받는 동안 심전도(ECG) 및 혈압 장비를 통해 면밀히 모니터링됩니다.
- 목적: 위험한 심장 박동을 빠르게 안정시키거나, 반려동물의 심장 상태가 장기 작용 경구용 베타 차단제에 잘 반응하는지 확인하기 위한 '테스트' 목적으로 자주 사용됩니다.
- 안전성: 몇 분 안에 혈류에서 제거되기 때문에, 저혈압이나 느린 심박수와 같은 부작용이 발생하더라도 주입을 중단하면 일반적으로 매우 빠르게 사라집니다.
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