DT-Web

DB00187 - Esmolol


Identification
Name Esmolol
Accession Number DB00187 (APRD00954)
Type small molecule
Description Esmolol (trade name Brevibloc) is a cardioselective beta1 receptor blocker with rapid onset, a very short duration of action, and no significant intrinsic sympathomimetic or membrane stabilising activity at therapeutic dosages. Esmolol decreases the force and rate of heart contractions by blocking beta-adrenergic receptors of the sympathetic nervous system, which are found in the heart and other organs of the body. Esmolol prevents the action of two naturally occurring substances: epinephrine and norepinephrine.
Structure
MOL SDF PDB SMILES InChI
Categories (*)
Molecular Weight 295.374
Groups approved
Monoisotopic Weight 295.178358293
Pharmacology
Indication For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short term control of ventricular rate with a short-acting agent is desirable. Also used in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention.
Mechanism of action Similar to other beta-blockers, esmolol blocks the agonistic effect of the sympathetic neurotransmitters by competing for receptor binding sites. Because it predominantly blocks the beta-1 receptors in cardiac tissue, it is said to be cardioselective. In general, so-called cardioselective beta-blockers are relatively cardioselective; at lower doses they block beta-1 receptors only but begin to block beta-2 receptors as the dose increases. At therapeutic dosages, esmolol does not have intrinsic sympathomimetic activity (ISA) or membrane-stabilizing (quinidine-like) activity. Antiarrhythmic activity is due to blockade of adrenergic stimulation of cardiac pacemaker potentials. In the Vaughan Williams classification of antiarrhythmics, beta-blockers are considered to be class II agents.
Absorption Rapidly absorbed, steady-state blood levels for dosages from 50-300 µg/kg/min (0.05-0.3 mg/kg/mm) are obtained within five minutes.
Protein binding 55% bound to human plasma protein, while the acid metabolite is 10% bound.
Biotransformation Rapidly metabolized by hydrolysis of the ester linkage, chiefly by the esterases in the cytosol of red blood cells and not by plasma cholinesterases or red cell membrane acetylcholinesterase. Mainly in red blood cells to a free acid metabolite (with 1/1500 the activity of esmolol) and methanol.
Route of elimination Consistent with the high rate of blood-based metabolism of esmolol hydrochloride, less than 2% of the drug is excreted unchanged in the urine. The acid metabolite has an elimination half-life of about 3.7 hours and is excreted in the urine with a clearance approximately equivalent to the glomerular filtration rate. Excretion of the acid metabolite is significantly decreased in patients with renal disease, with the elimination half-life increased to about ten-fold that of normals, and plasma levels considerably elevated.
Toxicity Symptoms of overdose include cardiac arrest, bradycardia, hypotension, electromechanical dissociation and loss of consciousness.
Affected organisms
  • Humans and other mammals
Interactions
Drug Interactions
Drug Mechanism of interaction
Acetohexamide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Chlorpropamide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Clonidine Increased hypertension when clonidine stopped
Dihydroergotamine Ischemia with risk of gangrene
Dihydroergotoxine Ischemia with risk of gangrene
Disopyramide The beta-blocker, esmolol, may increase the adverse effects of disopyramide.
Epinephrine Hypertension, then bradycardia
Ergonovine Ischemia with risk of gangrene
Ergotamine Ischemia with risk of gangrene
Fenoterol Antagonism
Formoterol Antagonism
Gliclazide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Glipizide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Glisoxepide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Glyburide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Glycodiazine The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Ibuprofen Risk of inhibition of renal prostaglandins
Indomethacin Risk of inhibition of renal prostaglandins
Insulin Aspart The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Insulin Detemir The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Insulin Glargine The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Insulin Glulisine The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Insulin Lispro The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Isoproterenol Antagonism
Lidocaine The beta-blocker, esmolol, may increase the effect and toxicity of lidocaine.
Methysergide Ischemia with risk of gangrene
Orciprenaline Antagonism
Pipobroman Antagonism
Pirbuterol Antagonism
Piroxicam Risk of inhibition of renal prostaglandins
Prazosin Risk of hypotension at the beginning of therapy
Procaterol Antagonism
Repaglinide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Salbutamol Antagonism
Salmeterol Antagonism
Terazosin Increased risk of hypotension. Initiate concomitant therapy cautiously.
Terbutaline Antagonism
Tolazamide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Tolbutamide The beta-blocker, esmolol, may decrease symptoms of hypoglycemia.
Treprostinil Additive hypotensive effect. Monitor antihypertensive therapy during concomitant use.
Verapamil Increased effect of both drugs
Food Interactions Not Available

Targets


Beta-1 adrenergic receptor
Name Beta-1 adrenergic receptor
Gene Name ADRB1
Pharmacological action yes
Actions antagonist
References
  • Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. - Pubmed
  • Jahn P, Eckrich B, Schneidrowski B, Volz-Zang C, Schulte B, Mutschler E, Palm D: Beta 1-adrenoceptor subtype selective antagonism of esmolol and its major metabolite in vitro and in man. Investigations using tricresylphosphate as red blood cell carboxylesterase inhibitor. Arzneimittelforschung. 1995 May;45(5):536-41. - Pubmed
  • Volz-Zang C, Eckrich B, Jahn P, Schneidrowski B, Schulte B, Palm D: Esmolol, an ultrashort-acting, selective beta 1-adrenoceptor antagonist: pharmacodynamic and pharmacokinetic properties. Eur J Clin Pharmacol. 1994;46(5):399-404. - Pubmed
  • Kirshenbaum JM: Nonthrombolytic intervention in acute myocardial infarction. Am J Cardiol. 1989 Jul 18;64(4):25B-28B. - Pubmed
  • Jacobs JR, Maier GW, Rankin JS, Reves JG: Esmolol and left ventricular function in the awake dog. Anesthesiology. 1988 Mar;68(3):373-8. - Pubmed
  • Howie MB, Black HA, Zvara D, McSweeney TD, Martin DJ, Coffman JA: Esmolol reduces autonomic hypersensitivity and length of seizures induced by electroconvulsive therapy. Anesth Analg. 1990 Oct;71(4):384-8. - Pubmed
DTHybrid score 0.4658

Predictions


Id Partner name Gene Name Score
766 Beta-2 adrenergic receptor ADRB2 0.2313
1517 Beta-3 adrenergic receptor ADRB3 0.07
4119 Cytochrome P450 2D6 CYP2D6 0.0536
1588 Multidrug resistance protein 1 ABCB1 0.029
556 Alpha-1A adrenergic receptor ADRA1A 0.0283
320 5-hydroxytryptamine 1A receptor HTR1A 0.0264
4200 Cytochrome P450 1A2 CYP1A2 0.0179
318 Alpha-2A adrenergic receptor ADRA2A 0.0165
6144 Solute carrier family 22 member 2 SLC22A2 0.0157
101 Potassium voltage-gated channel subfamily H member 2 KCNH2 0.0153
4512 Cytochrome P450 3A4 CYP3A4 0.0152
885 5-hydroxytryptamine 1B receptor HTR1B 0.0147
4292 Acyl-[acyl-carrier-protein]--UDP-N-acetylglucosamine O-acyltransferase lpxA 0.0124
3076 Antigen 85-C fbpC 0.0122
632 Alpha-1B adrenergic receptor ADRA1B 0.012
3810 Catechol O-methyltransferase COMT 0.0109
629 Alpha-2B adrenergic receptor ADRA2B 0.0106
6024 Cytochrome P450 1A1 CYP1A1 0.0103
3941 Amine oxidase [flavin-containing] A MAOA 0.0102
540 Sodium-dependent noradrenaline transporter SLC6A2 0.0096
6016 Cytochrome P450 2C19 CYP2C19 0.0096
1181 Alpha-1-acid glycoprotein 1 ORM1 0.0093
6847 Lactase-phlorizin hydrolase LCT 0.0093
378 Alpha-2C adrenergic receptor ADRA2C 0.0088
1820 Beta-nerve growth factor NGF 0.0085
6145 Solute carrier family 22 member 1 SLC22A1 0.0085
4145 Phosphatidylinositol 3-kinase regulatory subunit beta PIK3R2 0.0077
4146 Phosphatidylinositol 3-kinase regulatory subunit gamma PIK3R3 0.0077
828 Phenylalanine-4-hydroxylase PAH 0.0077
3109 Phenylalanine-4-hydroxylase phhA 0.0077
789 Alpha-1D adrenergic receptor ADRA1D 0.0074
1281 Phosphatidylinositol 3-kinase regulatory subunit alpha PIK3R1 0.0065
824 Sodium-dependent serotonin transporter SLC6A4 0.0061
777 Tumor necrosis factor TNF 0.0058
713 Sodium-dependent dopamine transporter SLC6A3 0.0055
23 D(1A) dopamine receptor DRD1 0.0054
2300 Lysozyme E 0.0052
3633 Lysozyme R 0.0052
5597 Lysozyme 17 0.0052
1176 Mitogen-activated protein kinase 1 MAPK1 0.0043
118 Organic cation/carnitine transporter 2 SLC22A5 0.004
4757 Cytochrome P450 2C9 CYP2C9 0.0036
1374 Natriuretic peptides B NPPB 0.0032
1827 Gap junction alpha-1 protein GJA1 0.0032
1908 Vascular cell adhesion protein 1 VCAM1 0.0032
6164 POU domain, class 5, transcription factor 1 POU5F1 0.0031
131 Synaptic vesicular amine transporter SLC18A2 0.003
6107 Cytochrome P450 3A7 CYP3A7 0.0029
3876 Aromatic-L-amino-acid decarboxylase DDC 0.0028
4118 Cytochrome P450 3A5 CYP3A5 0.0027
4160 Voltage-dependent calcium channel subunit alpha-2/delta-2 CACNA2D2 0.0027
194 NADH dehydrogenase [ubiquinone] 1 subunit C2 NDUFC2 0.0026
6147 Solute carrier family 22 member 3 SLC22A3 0.0026
964 Voltage-dependent T-type calcium channel subunit alpha-1H CACNA1H 0.0025
3939 Amine oxidase [flavin-containing] B MAOB 0.0023
183 Vascular endothelial growth factor A VEGFA 0.0023
233 Potassium channel subfamily K member 2 KCNK2 0.0023
6151 Monocarboxylate transporter 10 SLC16A10 0.0021
4114 Voltage-dependent L-type calcium channel subunit beta-3 CACNB3 0.0019
4112 Voltage-dependent L-type calcium channel subunit beta-4 CACNB4 0.0019
1360 Sphingomyelin phosphodiesterase SMPD1 0.0019
6013 Cytochrome P450 2E1 CYP2E1 0.0019
502 5-hydroxytryptamine 2A receptor HTR2A 0.0019
492 Histamine H1 receptor HRH1 0.0018
4113 Voltage-dependent L-type calcium channel subunit alpha-1F CACNA1F 0.0018
333 Voltage-dependent L-type calcium channel subunit beta-1 CACNB1 0.0017
158 Sodium channel protein type 1 subunit alpha SCN1A 0.0017
3947 Xanthine dehydrogenase/oxidase XDH 0.0016
1256 5-hydroxytryptamine 6 receptor HTR6 0.0016
6025 UDP-glucuronosyltransferase 1-4 UGT1A4 0.0015
4110 Voltage-dependent L-type calcium channel subunit beta-2 CACNB2 0.0015
4115 Voltage-dependent L-type calcium channel subunit alpha-1D CACNA1D 0.0015
4111 Voltage-dependent L-type calcium channel subunit alpha-1S CACNA1S 0.0015
124 Histamine H2 receptor HRH2 0.0014
478 Voltage-dependent L-type calcium channel subunit alpha-1C CACNA1C 0.0014
716 5-hydroxytryptamine 7 receptor HTR7 0.0014
6432 Transporter snf 0.0014
4924 Cytochrome P450 2C8 CYP2C8 0.0014
436 5-hydroxytryptamine 2B receptor HTR2B 0.0013
432 D(4) dopamine receptor DRD4 0.0013
20 Prostaglandin G/H synthase 1 PTGS1 0.0012
638 D(3) dopamine receptor DRD3 0.0012
590 5-hydroxytryptamine 2C receptor HTR2C 0.0012
831 D(2) dopamine receptor DRD2 0.001
6106 Cytochrome P450 2C18 CYP2C18 0.001
274 Muscarinic acetylcholine receptor M5 CHRM5 0.001
833 Organic cation/carnitine transporter 1 SLC22A4 0.001
587 Serum albumin ALB 0.0009
450 Muscarinic acetylcholine receptor M4 CHRM4 0.0009
51 Muscarinic acetylcholine receptor M3 CHRM3 0.0008
617 Muscarinic acetylcholine receptor M2 CHRM2 0.0008
5718 Cytochrome P450 2A6 CYP2A6 0.0008
103 Muscarinic acetylcholine receptor M1 CHRM1 0.0008
6030 Cytochrome P450 2B6 CYP2B6 0.0007
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