[New ultra-short-acting beta-blockers: landiolol and esmolol--the effects on cardiovascular system]

Abstract

Esmolol and landiolol are ultra-short-acting intravenous beta-blockers. Both drugs have high cardioselectivity (beta1/beta2 selectivity of esmolol : 33, landiolol: 255) and short elimination half time (esmolol : 9 min, landiolol : 4 min). Since the duration of beta-adrenergic blockade is short and cardioselectivity is high compared with traditional intravenous beta-blocker propranolol, both drugs are titrated easily. Its use is particularly suited to critically ill patient and for perioperative period. In clinical settings, both drugs have been used for prevention of perioperative tachycardia after endotracheal intubation or surgical incision and treatment of supuraventricular arrhythmias. Esmolol also has been used for treatment of perioperative hypertension and for reducing cardiac work in patients with ischemic heart disease. Recently, it was reported that prophylactic administration of esmolol may prevent perioperative myocardial ischemia in high risk group. Landiolol is a newer drug compared with esmolol. There are not many clinical trials on landiolol. However, since landiolol has higher cardioselectivity and tends to have less cardiodepressant effect than esmolol, clinical indication of landiolol may be extended. Additional data from large studies are required to evaluate the clinical efficacy and safety of landiolol for a variety of diseases.