Pharmacokinetics of Esmolol in Hepatic Disease

Buchi, Kenneth N.; Rollins, Douglas E.; Tolman, Keith G.; Achari, Ramanuj; Drissel, Debra; Hulse, James D.

doi:10.1002/j.1552-4604.1987.tb05583.x

Cited by 23 publications

(5 citation statements)

References 5 publications

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“…[25] This study substantiated a previous report that the liver plays a minimal role, if any, in the metabolism of esmoloJ.l 20 1 Nine patients with Laennec's cirrhosis and 3 healthy volunteers received intravenous esmolol, 200 Ilg/kg/min, for 4 hours by continuous infusion.…”

Section: Hepatic Dysfunctionsupporting

confidence: 85%

Esmolol

Wiest

1995

Clinical Pharmacokinetics

102

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Esmolol is an ultra short-acting intravenous cardioselective beta-antagonist. It has an extremely short elimination half-life (mean: 9 minutes; range: 4 to 16 minutes) and a total body clearance [285 ml/min/kg (17.1 L/h/kg)] approaching 3 times cardiac output and 14 times hepatic blood flow. The alpha-distribution half-life is approximately 2 minutes. When esmolol is administered as a bolus followed by a continuous infusion, onset of activity occurs within 2 minutes, with 90% of steady-state beta-blockade occurring within 5 minutes. Full recovery from beta-blockade is observed 18 to 30 minutes after terminating the infusion. Esmolol blood concentrations are undetectable 20 to 30 minutes postinfusion. The elimination of esmolol is independent of renal or hepatic function as it is metabolised by red blood cell cytosol esterases to an acid metabolite and methanol. The acid metabolite, which is renally eliminated, has 1500-fold less activity than esmolol. Methanol concentrations remain within the range of normal endogenous levels. Clinically, esmolol is used for the following: (i) situations where a brief duration of adrenergic blockade is required, such as tracheal intubation and stressful surgical stimuli; and (ii) critically ill or unstable patients in whom the dosage of esmolol is easily titrated to response and adverse effects are rapidly managed by termination of the infusion. In adults, bolus doses of 100 to 200mg are effective in attenuating the adrenergic responses associated with tracheal intubation and surgical stimuli. For the control of supraventricular arrhythmias, acute postoperative hypertension and acute ischaemic heart disease, doses of < 300 micrograms/kg/min, administered by continuous intravenous infusion, are used. The principal adverse effect of esmolol is hypotension (incidence of 0 to 50%), which is frequently accompanied with diaphoresis. The incidence of hypotension appears to increase with doses exceeding 150 micrograms/kg/min and in patients with low baseline blood pressure. Hypotension infrequently requires any intervention other than decreasing the dose or discontinuing the infusion. Symptoms generally resolve within 30 minutes after discontinuing the drug. In surgical and critical care settings where clinical conditions are rapidly changing, the pharmacokinetic profile of esmolol allows the drug to provide rapid pharmacological control and minimises the potential for serious adverse effects.

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Section: Hepatic Dysfunctionsupporting

confidence: 85%

Esmolol

Wiest

1995

Clinical Pharmacokinetics

102

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“…No dose adjustments are necessary for atenolol, nadolol, esmolol, sotalol, and acebutalol. [38][39][40] Diuretics Loop diuretics, such as furosemide, bumetanide, and torsemide, are used for volume management in HF…”

Section: Angiotensin-converting Enzyme (Ace) Inhibitorsmentioning

confidence: 99%

Liver Abnormalities in Cardiac Diseases and Heart Failure

Alvarez¹,

Mukherjee²

2011

Int J Angiol

182

147

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Heart failure (HF) is characterized by the inability of systemic perfusion to meet the body's metabolic demands and is usually caused by cardiac pump dysfunction and may occasionally present with symptoms of a noncardiac disorder such as hepatic dysfunction. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion due to increased central venous pressure may cause elevations of liver enzymes and both direct and indirect serum bilirubin. Impaired perfusion from decreased cardiac output may be associated with acute hepatocellular necrosis with marked elevations in serum aminotransferases. Cardiogenic ischemic hepatitis (''shock liver'') may ensue following an episode of profound hypotension in patients with acute HF. We discuss pathophysiology and identification of liver abnormalities that are commonly seen in patients with HF.

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“…Propranolol should be administered cautiously in patients with hepatic impairment. No dose adjustments are necessary for atenolol, nadolol, esmolol, sotalol, or acebutolol [112][113][114][115][116] . Diuretics: Loop diuretics, such as furosemide, bumetanide, and torsemide, are used for volume management in HF because of their superior natriuretic effects compared with other classes of diuretics.…”

Section: Congestive Hepatopathymentioning

confidence: 99%

Hepato-cardiac disorders

Fouad¹,

Yehia²

2014

WJH

111

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Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato�cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. �ifferential diagnoses of liver injury are extremely important in a cardiologist's clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic conges� tive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplanta� tion may lead to the improvement of all cardiac chang� es and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases

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Pharmacokinetics of Esmolol in Hepatic Disease

Cited by 23 publications

References 5 publications

Esmolol

Esmolol

Liver Abnormalities in Cardiac Diseases and Heart Failure

Hepato-cardiac disorders

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