Brevibloc (Esmolol) Drug Information: Overdosage and Contraindications

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May 25, 2012

Brevibloc

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Brevibloc

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OVERDOSE

Acute Toxicity

Overdoses of BREVIBLOC (Esmolol Hydrochloride) can cause cardiac arrest. In addition, overdoses can produce bradycardia, hypotension, electromechanical dissociation and loss of consciousness. Cases of massive accidental overdoses of BREVIBLOC (esmolol) have occurred due to dilution errors. Use of BREVIBLOC (esmolol) PREMIXED INJECTION and BREVIBLOC (esmolol) DOUBLE STRENGTH PREMIXED INJECTION may reduce the potential for dilution errors. Some of these overdoses have been fatal while others resulted in permanent disability. Bolus doses in the range of 625 mg to 2.5 g (12.5-50 mg/kg) have been fatal. Patients have recovered completely from overdoses as high as 1.75 g given over one minute or doses of 7.5 g given over one hour for cardiovascular surgery. The patients who survived appear to be those whose circulation could be supported until the effects of BREVIBLOC (esmolol) resolved.

Because of its approximately 9-minute elimination half-life, the first step in the management of toxicity should be to discontinue the BREVIBLOC (esmolol) infusion. Then, based on the observed clinical effects, the following general measures should also be considered.

Bradycardia: Intravenous administration of atropine or another anticholinergic drug.

Bronchospasm: Intravenous administration of a beta₂ stimulating agent and/or a theophylline derivative.

Cardiac Failure: Intravenous administration of a diuretic and/or digitalis glycoside. In shock resulting from inadequate cardiac contractility, intravenous administration of dopamine, dobutamine, isoproterenol, or amrinone may be considered.

Symptomatic Hypotension: Intravenous administration of fluids and/or pressor agents.

CONTRAINDICATIONS

BREVIBLOC (Esmolol Hydrochloride) is contraindicated in patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock or overt heart failure (see WARNINGS).

Last reviewed on RxList: 12/3/2007
This monograph has been modified to include the generic and brand name in many instances.