Landiolol, sold under the brand names Onoact, Rapibloc®, Sibboran® and Rapiblyk® among others, is a medication used for the treatment of supraventricular tachycardia, atrial fibrillation, and atrial flutter in perioperative, postoperative or other circumstances where short-term control of the ventricular rate with a short-acting agent is desirable. With the exception of the USA, landiolol is also indicated for non-compensatory sinus tachycardia where, in the physician's judgment, the rapid heart rate requires specific intervention. It is a β-adrenergic blocker; an ultra short-acting, β1-super-selective intravenous adrenergic antagonist, which decreases the heart rate effectively with fewer negative effects on blood pressure or myocardial contractility. In comparison to other β blockers, landiolol has the shortest elimination half-life (3 to 4 minutes), ultra-rapid onset of effect (heart rate begins to decrease immediately after completion of administration), and predictable effectiveness with inactive metabolites (heart rate returns to baseline levels at 30 min after completion of landiolol hydrochloride administration). The pure S-enantiomerstructure of landiolol is believed to develop less hypotensive side effects in comparison to other β-blockers. This has a positive impact on the treatment of patients when reduction of heart rate without decrease in arterial blood pressure is desired. It is used as landiolol hydrochloride. Landiolol was approved for medical use in Japan in 2022, [10][11], Europe in 2016, Canada in November 2023, it has been approved in Bahrain, Kuwait, Qatar and Oman since October 2024, in the United States in November 2024 [12] and in Australia in June 2025.
Medical use Landiolol is indicated as an antiarrhythmic agent to treat
Supraventricular tachycardia and for the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other circumstances where short-term control of the ventricular rate with a short acting agent is desirable. Non-compensatory sinus tachycardia where, in the physician's judgment the rapid heart rate requires specific intervention. Landiolol has been approved for the treatment of ventricular fibrillation or ventricular tachycardia in Japan. In the United States, since August 2026, landiolol is indicated not only for the short-term reduction of ventricular rate in adults with supraventricular tachycardia including atrial fibrillation and atrial flutter but also for pediatric patients with supraventricular tachycardia. Landiolol can be used as first-line treatment for acute ventricular rate control in patients with atrial fibrillation (Level I recommendation - 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): Developed by the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)). The 2024 ESC Guidelines for the management of AF recommend that “in selected patients who are hemodynamically unstable or with severely impaired LVEF, intravenous amiodarone, landiolol, or digoxin can be used.” They further state that “The ultra-short acting and highly selective beta- blocker landiolol can safely control rapid AF in patients with low ejection fraction and acutely decompensated heart failure, with a limited impact on myocardial contractility or blood pressure”.
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