diff --git a/packages/node/src/sdk/index.ts b/packages/node/src/sdk/index.ts
index 2ac62a2b5b91..46c709299f67 100644
--- a/packages/node/src/sdk/index.ts
+++ b/packages/node/src/sdk/index.ts
@@ -131,7 +131,7 @@ function _init(
   }
 
   if (!isCjs() && options.registerEsmLoaderHooks !== false) {
-    maybeInitializeEsmLoader();
+    maybeInitializeEsmLoader(options.registerEsmLoaderHooks === true ? undefined : options.registerEsmLoaderHooks);
   }
 
   setOpenTelemetryContextAsyncContextStrategy();
diff --git a/packages/node/src/sdk/initOtel.ts b/packages/node/src/sdk/initOtel.ts
index 47c8879ae3e9..947486ba26cb 100644
--- a/packages/node/src/sdk/initOtel.ts
+++ b/packages/node/src/sdk/initOtel.ts
@@ -13,6 +13,7 @@ import { GLOBAL_OBJ, consoleSandbox, logger } from '@sentry/utils';
 
 import { getOpenTelemetryInstrumentationToPreload } from '../integrations/tracing';
 import { SentryContextManager } from '../otel/contextManager';
+import type { EsmLoaderHookOptions } from '../types';
 import { isCjs } from '../utils/commonjs';
 import type { NodeClient } from './client';
 
@@ -31,7 +32,7 @@ export function initOpenTelemetry(client: NodeClient): void {
 }
 
 /** Initialize the ESM loader. */
-export function maybeInitializeEsmLoader(): void {
+export function maybeInitializeEsmLoader(esmHookConfig?: EsmLoaderHookOptions): void {
   const [nodeMajor = 0, nodeMinor = 0] = process.versions.node.split('.').map(Number);
 
   // Register hook was added in v20.6.0 and v18.19.0
@@ -43,7 +44,7 @@ export function maybeInitializeEsmLoader(): void {
     if (!GLOBAL_OBJ._sentryEsmLoaderHookRegistered && importMetaUrl) {
       try {
         // @ts-expect-error register is available in these versions
-        moduleModule.register('@opentelemetry/instrumentation/hook.mjs', importMetaUrl);
+        moduleModule.register('import-in-the-middle/hook.mjs', importMetaUrl, { data: esmHookConfig });
         GLOBAL_OBJ._sentryEsmLoaderHookRegistered = true;
       } catch (error) {
         logger.warn('Failed to register ESM hook', error);
diff --git a/packages/node/src/types.ts b/packages/node/src/types.ts
index 882114a013f9..9cf3047e6c0a 100644
--- a/packages/node/src/types.ts
+++ b/packages/node/src/types.ts
@@ -4,6 +4,11 @@ import type { ClientOptions, Options, SamplingContext, Scope, Span, TracePropaga
 
 import type { NodeTransportOptions } from './transports';
 
+export interface EsmLoaderHookOptions {
+  include?: string[];
+  exclude?: string[];
+}
+
 export interface BaseNodeOptions {
   /**
    * List of strings/regex controlling to which outgoing requests
@@ -87,13 +92,22 @@ export interface BaseNodeOptions {
 
   /**
    * Whether to register ESM loader hooks to automatically instrument libraries.
-   * This is necessary to auto instrument libraries that are loaded via ESM imports, but might it can cause issues
+   * This is necessary to auto instrument libraries that are loaded via ESM imports, but it can cause issues
    * with certain libraries. If you run into problems running your app with this enabled,
    * please raise an issue in https://github.com/getsentry/sentry-javascript.
    *
+   * You can optionally exclude specific modules or only include specific modules from being instrumented by providing
+   * an object with `include` or `exclude` properties.
+   *
+   * ```js
+   * registerEsmLoaderHooks: {
+   *   exclude: ['openai'],
+   * }
+   * ```
+   *
    * Defaults to `true`.
    */
-  registerEsmLoaderHooks?: boolean;
+  registerEsmLoaderHooks?: boolean | EsmLoaderHookOptions;
 
   /** Callback that is executed when a fatal global error occurs. */
   onFatalError?(this: void, error: Error): void;