Esmolol: a short-acting titratable beta-blocker in acute myocardial ischemia

Esmolol (Brevibloc) is a potent, titratable, cardioselective beta-blocker with a short elimination half-life (t1/2 = 9.2 min) and no intrinsic sympathomimetic activity. It was designed for use in critically ill patients who would benefit from the short duration of beta-adrenergic blockade. Esmolol's short duration of action allows for rapid onset and control of hemodynamic effects. Its safety and efficacy has been demonstrated in patients with acute myocardial ischemia. This review provides a brief summary of the pharmacology of esmolol, as well as experimental and clinical evidence on the use of esmolol in acute myocardial ischemia.