Esmolol Hydrochloride

In a phase II open‑label trial, 40 septic shock patients with tachycardia were randomized to esmolol infusion or standard care. The primary endpoint — difference in norepinephrine equivalent dose at 6 hours — was not met (0.30 vs. 0.21 mcg/kg/min, P=0.15). Shock‑free days also did not differ. However, esmolol significantly lowered C‑reactive protein levels at 12 and 24 hours and reduced oxygen consumption in a subset of patients. The authors conclude that while esmolol did not improve vasopressor requirements, it was associated with decreased inflammation.

Fig. 1 Hourly esmolol dose during the duration of the study. (Cocchi MN, et al., 2022)

In a phase 3, double‑blind, multicenter trial (176 patients with diabetic foot ulcers), topical esmolol 14% gel plus standard of care (SoC) significantly increased wound closure at 12 weeks (60.3% vs. 41.7% with SoC alone; OR 2.13, P=0.03). Benefits persisted at 24 weeks (77.2% vs. 55.6%; OR 2.71, P=0.01). Median closure time was 85 days in the esmolol group but not estimable in controls. Adverse events were mostly not drug‑related. Topical esmolol is an effective addition to SoC for healing diabetic foot ulcers.

Fig. 2 Enrollment and Flow Chart of the Study Participants. (Rastogi A, et al., 2023)