Pharmacokinetics in children

The study by Tabbutt et al. seems to show that the clearance in neonates and infants is higher than in children aged > 1 year, at 281 and 126 ml/min/kg respectively.
In children aged 3-16 years with supraventricular arrhythmias, a terminal half-life averaging 6.9 min (range 5.2 to 10.9 min) and a volume of distribution averaging 283 ml/kg have been described.

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Dyspnoea, cold extremities, provocation of congestive heart failure or hypoglycaemia (without symptoms: take care with diabetes patients) and nightmares.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Great caution is needed in concomitant use of verapamil (Isoptin) because of the risk of severe arrhythmia. Be aware of the possibility of brief blood pressure drops.
In children weighing < 15 kg, recovery after the medication is stopped takes longer – about 15 min. Drops in blood pressure of 10-15% can occur in young children.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

• CARDIOVASCULAR SYSTEM
• BETA BLOCKING AGENTS

BETA BLOCKING AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

References

1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
2. Tabbutt S, et al, The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and children: a multicenter, double-blind, randomized trial, J Thorac Cardiovasc Surg, 2008, Aug;136(2), 321-8
3. Adamson PC, et al, The pharmacokinetics of esmolol in pediatric subjects with supraventricular arrhythmias., Pediatr Cardiol, 2006, Jul-Aug;27(4), 420-7
4. Wiest DB, et al, Esmolol for the management of pediatric hypertension after cardiac operations, J Thorac Cardiovasc Surg, 1998, Apr;115(4), 890-7
5. Cuneo BF, et al, Pharmacodynamics and pharmacokinetics of esmolol, a short-acting beta-blocking agent, in children, Pediatr Cardiol, 1994, Nov-Dec;15(6), 296-301
6. Trippel DL, et al, Cardiovascular and antiarrhythmic effects of esmolol in children, J Pediatr, 1991, Jul;119(1 Pt 1), 142-7
7. Wiest DB, et al, Pharmacokinetics of esmolol in children, Clin Pharmacol Ther, 1991, Jun;49(6), 618-23
8. Lurbe E, et al, Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension, J Hypertens, 2009, Sep;27(9),, 1719-42

Changes

Therapeutic Drug Monitoring

Overdose