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What is Brevibloc and how does it work?
- Brevibloc Premixed (esmolol hydrochloride) Injection is a beta-blocker indicated for the rapid control of ventricular rate in patients with atrial fibrillation, or atrial flutter in perioperative, postoperative, or other emergent circumstances.
- Brevibloc is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention. Brevibloc is available in generic form.
- Supraventricular Tachycardia Or Noncompensatory Sinus Tachycardia Brevibloc (Esmolol Hydrochloride) injection is indicated 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.
- Brevibloc injection is also indicated in noncompensatory sinus tachycardia where, in the physician's judgment, the rapid heart rate requires specific intervention. Brevibloc injection is intended for short-term use.
- Intraoperative And Postoperative Tachycardia And/Or Hypertension Brevibloc (Esmolol Hydrochloride) injection is indicated for the short-term treatment of tachycardia and hypertension that occur during induction and tracheal intubation, during surgery, on emergence from anesthesia and in the postoperative period, when in the physician's judgment such specific intervention is considered indicated. Use of Brevibloc injection to prevent such events is not recommended.
What is the dosage for Brevibloc?
Dosing For The Treatment Of Supraventricular Tachycardia Or Noncompensatory Sinus Tachycardia
Brevibloc injection is administered by continuous intravenous infusion with or without a loading dose. Additional loading doses and/or titration of the maintenance infusion (step-wise dosing) may be necessary based on desired ventricular response.
Table 1 : Step-Wise Dosing
|1||Optional loading dose (500 mcg per kg over 1 minute), then 50 mcg per kg per min for 4 min|
|2||Optional loading dose if necessary, then 100 mcg per kg per min for 4 min|
|3||Optional loading dose if necessary, then 150 mcg per kg per min for 4 min|
|4||If necessary, increase dose to 200 mcg per kg per min|
In the absence of loading doses, continuous infusion of a single concentration of esmolol reaches pharmacokinetic and pharmacodynamic steady-state in about 30 minutes.
The effective maintenance dose for continuous and step-wise dosing is 50 to 200 mcg per kg per minute, although doses as low as 25 mcg per kg per minute have been adequate. Dosages greater than 200 mcg per kg per minute provide little added heart rate lowering effect, and the rate of adverse reactions increases.
Maintenance infusions may be continued for up to 48 hours.
Intraoperative And Postoperative Tachycardia And Hypertension
In this setting it is not always advisable to slowly titrate to a therapeutic effect. Therefore two dosing options are presented: immediate control and gradual control.
- Administer 1 mg per kg as a bolus dose over 30 seconds followed by an infusion of 150 mcg per kg per min if necessary.
- Adjust the infusion rate as required to maintain desired heart rate and blood pressure. Refer to Maximum Recommended Doses below
- Administer 500 mcg per kg as a bolus dose over 1 minute followed by a maintenance infusion of 50 mcg per kg per min for 4 minutes.
- Depending on the response obtained, continue dosing as outlined for supraventricular tachycardia. Refer to Maximum Recommended Doses below.
Maximum Recommended Doses
- For the treatment of tachycardia, maintenance infusion dosages greater than 200 mcg per kg per min are not recommended; dosages greater than 200 mcg per kg per min provide little additional heart rate-lowering effect, and the rate of adverse reactions increases.
- For the treatment of hypertension, higher maintenance infusion dosages (250-300 mcg per kg per min) may be required. The safety of doses above 300 mcg per kg per minute has not been studied.
Transition From Brevibloc Injection Therapy To Alternative Drugs
After patients achieve adequate control of the heart rate and a stable clinical status, transition to alternative antiarrhythmic drugs may be accomplished.
When transitioning from Brevibloc injection to alternative drugs, the physician should carefully consider the labeling instructions of the alternative drug selected and reduce the dosage of Brevibloc injection as follows:
- Thirty minutes following the first dose of the alternative drug, reduce the Brevibloc infusion rate by one-half (50%).
- After administration of the second dose of the alternative drug, monitor the patientâ€™s response and if satisfactory control is maintained for the first hour, discontinue the Brevibloc infusion.
What drugs interact with Brevibloc?
- Concomitant use of Brevibloc injection with other drugs that can lower blood pressure, reduce myocardial contractility, or interfere with sinus node function or electrical impulse propagation in the myocardium can exaggerate Brevibloc injection's effects on blood pressure, contractility, and impulse propagation.
- Severe interactions with such drugs can result in, for example, severe hypotension, cardiac failure, severe bradycardia, sinus pause, sinoatrial block, atrioventricular block, and/or cardiac arrest.
- In addition, with some drugs, beta blockade may precipitate increased withdrawal effects. (See clonidine, guanfacine, and moxonidine below.)
- Brevibloc injection should therefore be used only after careful individual assessment of the risks and expected benefits in patients receiving drugs that can cause these types of pharmacodynamic interactions, including but not limited to:
- Digitalis glycosides: Concomitant administration of digoxin and Brevibloc injection leads to an approximate 10% to 20% increase of digoxin blood levels at some time points.
- Digoxin does not affect Brevibloc injection pharmacokinetics. Both digoxin and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use increases the risk of bradycardia.
- Anticholinesterases: Brevibloc injection prolonged the duration of succinylcholine-induced neuromuscular blockade and moderately prolonged clinical duration and recovery index of mivacurium.
- Antihypertensive agents clonidine, guanfacine, or moxonidine: Beta blockers also increase the risk of clonidine-, guanfacine-, or moxonidine-withdrawal rebound hypertension. If, during concomitant use of a beta blocker, antihypertensive therapy needs to be interrupted or discontinued, discontinue the beta blocker first, and the discontinuation should be gradual.
- Calcium channel antagonists: In patients with depressed myocardial function, use of Brevibloc injection with cardiodepressant calcium channel antagonists (e.g., verapamil) can lead to fatal cardiac arrests.
- Sympathomimetic drugs: Sympathomimetic drugs having beta-adrenergic agonist activity will counteract effects of Brevibloc injection.
- Vasoconstrictive and positive inotropic agents: Because of the risk of reducing cardiac contractility in presence of high systemic vascular resistance, do not use Brevibloc injection to control tachycardia in patients receiving drugs that are vasoconstrictive and have positive inotropic effects, such as epinephrine, norepinephrine, and dopamine.
Is Brevibloc safe to take when pregnant or breastfeeding?
- There are no adequate and well-controlled studies in pregnant women. Brevibloc injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Brevibloc, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
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Brevibloc Premixed (esmolol hydrochloride) Injection is a beta-blocker indicated for the rapid control of ventricular rate in patients with atrial fibrillation, or atrial flutter in perioperative, postoperative, or other emergent circumstances. Brevibloc is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention.
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Related Disease Conditions
Atrial Flutter: ECG, Symptoms, and Treatments
Atrial flutter is a problem with the atria of the heart. In atrial flutter the atria of the heart rapidly and repeatedly beat due to an anomaly in the electrical system of the heart. It is a type of arrhythmia and can be dangerous because complications can develop easily. Signs and symptoms of atrial flutter include near fainting, palpitations, mild shortness of breath, and fatigue. While the exact cause of atrial flutter is not clearly understood, it's most likely related to your health, what medical conditions you certainly have, poor diet, lack of exercise, and drinking too much alcohol. Atrial flutter is diagnosed by physical examination, medical history, and a sawtooth ECG wave pattern.
Atrial Flutter vs. Atrial Fibrillation
Atrial flutter and atrial fibrillation (AFib) are two types of a heart problem called atrial tachycardia. Both of these conditions involve the heart's electrical activity, but they are not the same disease. Both diseases are serious and need medical treatment. Common symptoms of these diseases are similar and include: Fatigue Blurry vision Lightheadedness Palpitations Feeling like you may faint Serious symptoms of both conditions are similar and include: Fainting Sweating Severe shortness of breath Chest pain Atrial flutter and AFib are heart conditions that require medical diagnosis (ECG) and treatment by a doctor or other medical health-care professional.
Atrial Fibrillation (AFib) Treatment Drugs
Atrial fibrillation (AFib) is a heart rhythm disorder that causes irregular and often rapid heartbeat. The medications to treat AFib include beta-blockers, blood thinners, and heart rhythm drugs. Atrial fibrillation drugs can cause serious side effects like seizures, vision changes, shortness of breath, fainting, other abnormal heart rhythms, excessive bleeding while coughing or vomiting, blood in the stool, and bleeding into the brain.
Atrial Fibrillation (AFib)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm, which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Atrial Fibrillation vs. Ventricular Fibrillation (AFib vs VFib Symptoms, ECG Strips)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate. Atrial fibrillation (AFib) and ventricular fibrillation (VFib) are problems with the heart that cause abnormal heart rhythms. Causes of these heart conditions include, heart disease, drugs and medications, excessive alcohol consumption, high cholesterol, advancing age, a diet that contains high levels of animal meat (fat), high blood pressure, stress, stimulants like caffeine, nicotine. Ventricular fibrillation is the more serious of the conditions because if it isn't treated immediately the person will likely die. Symptoms of AFib are confusion, anxiety, fatigue, a fluttering in the chest, and the feeling that you may pass out or faint. Atrial fibrillation is treated with medications, cardioversion therapy, and surgery. If a person with ventricular fibrillation does not seek medical help immediately they will mostly likely suffer from sudden cardiac arrest or sudden death.
Atrial Fibrillation (AFib) Symptoms and Signs
Atrial fibrillation or AFib is a type of heart rhythm abnormality. Early warning signs and symptoms of atrial fibrillation include chest pain, palpitations, shortness of breath, and lightheadedness. Treatment for atrial fibrillation includes medical procedures, surgery, and medication.
What are the Most Common Causes of Atrial Fibrillation?
Atrial fibrillation (AF) is an abnormal heart rhythm characterized by an irregular and fast heartbeat. The upper chambers of the heart (atria) beat chaotically, and can cause pooling and clotting of blood in the atria, instead of it emptying into the lower chamber (ventricles). AF can lead to stroke, heart failure, blood clots, and heart-related complications. Atrial fibrillation is classified into three types: Paroxysmal atrial fibrillation, persistent atrial fibrillation, and long-standing persistent atrial fibrillation.
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