Key result
In the presence of dobutamine, the total clearance of esmolol was increased by 78% (432 vs 243 ml/kg.min) and its elimination half-life was decreased by 60% compared to esmolol alone.
Why the study?
The study investigated the pharmacokinetic and pharmacodynamic behavior of esmolol in the presence of dobutamine in healthy subjects of European ancestry.
Does dobutamine alter the pharmacokinetic and pharmacodynamic behavior of esmolol in healthy subjects?
RCT (n=16)
Double-blind
1:1
No
Does dobutamine alter the pharmacokinetic and pharmacodynamic behavior of esmolol in healthy subjects?
Dobutamine accelerates the elimination of esmolol and alters its pharmacodynamic effects on blood pressure, which may have implications for their concurrent use in clinical settings.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to possible esmolol-dobutamine interactions in acute settings; leaves open confirmation in critically ill patients.
Background and objective This study involved an investigation into the pharmacokinetic and pharmacodynamic behavior of esmolol in the presence of dobutamine in healthy subjects of European ancestry. Methods We conducted a single-center, prospective randomized study of 16 healthy subjects with each receiving an infusion of dobutamine sufficient to increase heart rate (HR) by 30 beats per minute (bpm) followed by a 60-minute infusion of 50 µg/kg/min esmolol. Pharmacokinetics, HR, and blood pressure were evaluated for 180 minutes. Results In the presence of dobutamine, esmolol elimination was substantially faster than without dobutamine, Esmolol infusion reduced dobutamine-induced elevation of HR reversibly whereas the dobutamine-induced systolic blood pressure (SBP) reduction did not recover after the termination of the esmolol infusion. No serious adverse events (AEs) were observed. Conclusions The accelerated elimination of esmolol was likely due to higher cleavage through tissue esterases induced by dobutamine-induced increased tissue passage cycles per time unit. The HR effect was characteristic of a beta-blocker, whereas the blood pressure effect was likely due to a mechanism other than direct beta-blockade. HR remained elevated after the infusion of esmolol and dobutamine, most likely due to persistent blood pressure reduction.
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Krumpl et al. (2020) conducted an RCT in Healthy volunteers (n=16). Esmolol with dobutamine vs. Esmolol without dobutamine (historical control) was evaluated on Total clearance of esmolol. In the presence of dobutamine, the total clearance of esmolol was increased by 78% (432 vs 243 ml/kg.min) and its elimination half-life was decreased by 60% compared to esmolol alone.
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