Brevibloc

Before taking this medicine

Brevibloc (esmolol hydrochloride) must not be used in people with: • A severely slow heart rate, second- or third-degree heart block, or sick sinus syndrome. • Decompensated heart failure, where the heart cannot pump adequately, or cardiogenic shock. • Pulmonary hypertension. • A known allergy to esmolol or any inactive ingredient. Cross-sensitivity between beta blockers is possible. It must not be given close in time to intravenous calcium-channel blockers that depress heart function, such as verapamil, while either medicine’s effects on the heart are still present. Fatal cardiac arrests have occurred with this combination. Brevibloc can cause dangerously low blood pressure, a slow heart rate, heart failure and cardiac arrest. Blood pressure, heart rate and heart rhythm require close monitoring. Extra caution is needed with low blood pressure, low blood volume, first-degree heart block or other heart conduction problems. People with reactive airway disease should generally not receive beta blockers because they can cause airway narrowing. Caution is also needed with diabetes, fasting or vomiting: Brevibloc may hide warning signs of low blood sugar and increase the risk of severe or prolonged episodes, particularly in children and people with diabetes. Severe low blood sugar requires emergency treatment. Other conditions requiring caution include Prinzmetal’s angina, poor circulation such as Raynaud’s disease, kidney impairment, high potassium levels, metabolic acidosis and an overactive thyroid. Blood electrolytes should be monitored during treatment. In people with pheochromocytoma, Brevibloc must be used with an alpha blocker, and only after the alpha blocker has been started. Abrupt withdrawal of beta blockers can worsen angina or cause a heart attack or abnormal heart rhythm in people with coronary artery disease. It may also trigger a thyroid crisis in people with an overactive thyroid, so monitoring is needed when treatment is stopped. People at risk of severe allergic reactions may react more strongly to allergens and may respond less well to epinephrine treatment. Infusion-site reactions can include inflammation, blistering and tissue damage, particularly if the medicine leaks outside the vein. During pregnancy, Brevibloc should be used only if the potential benefit justifies the risk to the fetus. Use in late pregnancy or during labor or delivery has been associated with a slow fetal heart rate. It is not known whether esmolol passes into human milk; a decision is needed about whether to stop breastfeeding or stop the medicine. Safety and effectiveness in children have not been established. Older adults require cautious treatment selection because reduced heart or kidney function, other illnesses and other medicines are more common.