Acute Toxicity: Overdose of Esmolol HCl can cause cardiac arrest. In addition, overdoses can produce bradycardia, hypotension, electromechanical dissociation and loss of consciousness. Cases of massive accidental overdoses of Esmolol HCl have occurred due to dilution errors. Some of these overdose have been fatal while others resulted in permanent disability. Bolus doses in the range of 625 milligrams to 2.5 grams (12.5-50 milligrams/kg) have been fatal. Patients have recovered completely from overdoses as high as 1.75 grams given over one minute or doses of 7.5 grams given over one hour for cardiovascular surgery. The patients who survived appear to be those whose circulation could be supported until the effects of Esmolol HCl resolved.
Because of its approximately 9-minute elimination half-life, the first step in the management of toxicity should be to discontinue the Esmolol HCl infusion. Then based on the observed the 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, isoproterenal, or amrinone may be considered.
Symptomatic Hypotension: Intravenous administration of fluids and/or pressor agents.