diff --git a/.ci/tav.json b/.ci/tav.json
index 3812344527e..769e83108ab 100644
--- a/.ci/tav.json
+++ b/.ci/tav.json
@@ -1,44 +1,45 @@
 {
-  "versions": [ 21, 20, 18, 16, 14 ],
+  "// versions": "Skip >=18.19.0 until IITM double-import issue is resolved.",
+  "versions": [ "21", "20", "18.18.2", "16", "14" ],
   "// modules": [
-    "List of instrumented modules with the min Node version supported.",
-    "minVersion for each module should be kept in sync with .tav.yml"
+    "List of instrumented modules with the minimum Node major version supported.",
+    "minMajorVersion for each module should be kept in sync with .tav.yml"
   ],
   "modules": [
-    { "name": "@apollo/server", "minVersion": 14 },
-    { "name": "@aws-sdk/client-dynamodb", "minVersion": 14 },
-    { "name": "@aws-sdk/client-s3", "minVersion": 14 },
-    { "name": "@aws-sdk/client-sns", "minVersion": 14 },
-    { "name": "@aws-sdk/client-sqs", "minVersion": 14 },
-    { "name": "@elastic/elasticsearch", "minVersion": 10 },
-    { "name": "@hapi/hapi", "minVersion": 8 },
-    { "name": "@opentelemetry/api", "minVersion": 14 },
-    { "name": "apollo-server-express", "minVersion": 8 },
-    { "name": "aws-sdk", "minVersion": 8 },
-    { "name": "cassandra-driver", "minVersion": 16 },
-    { "name": "elasticsearch", "minVersion": 8 },
-    { "name": "express", "minVersion": 8 },
-    { "name": "express-queue", "minVersion": 8 },
-    { "name": "fastify", "minVersion": 8 },
-    { "name": "finalhandler", "minVersion": 8 },
-    { "name": "generic-pool", "minVersion": 8 },
-    { "name": "graphql", "minVersion": 8 },
-    { "name": "ioredis", "minVersion": 8 },
-    { "name": "knex", "minVersion": 8 },
-    { "name": "memcached", "minVersion": 8 },
-    { "name": "mongodb", "minVersion": 8 },
-    { "name": "mongodb-core", "minVersion": 8 },
-    { "name": "mysql", "minVersion": 8 },
-    { "name": "mysql2", "minVersion": 8 },
-    { "name": "next", "minVersion": 14 },
-    { "name": "pg", "minVersion": 8 },
-    { "name": "redis", "minVersion": 8 },
-    { "name": "restify", "minVersion": 14 },
-    { "name": "tedious", "minVersion": 8 },
-    { "name": "undici", "minVersion": 8 },
-    { "name": "ws", "minVersion": 8 },
-    { "name": "@koa/router,koa-router", "minVersion": 8 },
-    { "name": "handlebars,pug", "minVersion": 8 },
-    { "name": "bluebird,got", "minVersion": 8 }
+    { "name": "@apollo/server", "minMajorVersion": 14 },
+    { "name": "@aws-sdk/client-dynamodb", "minMajorVersion": 14 },
+    { "name": "@aws-sdk/client-s3", "minMajorVersion": 14 },
+    { "name": "@aws-sdk/client-sns", "minMajorVersion": 14 },
+    { "name": "@aws-sdk/client-sqs", "minMajorVersion": 14 },
+    { "name": "@elastic/elasticsearch", "minMajorVersion": 10 },
+    { "name": "@hapi/hapi", "minMajorVersion": 8 },
+    { "name": "@opentelemetry/api", "minMajorVersion": 14 },
+    { "name": "apollo-server-express", "minMajorVersion": 8 },
+    { "name": "aws-sdk", "minMajorVersion": 8 },
+    { "name": "cassandra-driver", "minMajorVersion": 16 },
+    { "name": "elasticsearch", "minMajorVersion": 8 },
+    { "name": "express", "minMajorVersion": 8 },
+    { "name": "express-queue", "minMajorVersion": 8 },
+    { "name": "fastify", "minMajorVersion": 8 },
+    { "name": "finalhandler", "minMajorVersion": 8 },
+    { "name": "generic-pool", "minMajorVersion": 8 },
+    { "name": "graphql", "minMajorVersion": 8 },
+    { "name": "ioredis", "minMajorVersion": 8 },
+    { "name": "knex", "minMajorVersion": 8 },
+    { "name": "memcached", "minMajorVersion": 8 },
+    { "name": "mongodb", "minMajorVersion": 8 },
+    { "name": "mongodb-core", "minMajorVersion": 8 },
+    { "name": "mysql", "minMajorVersion": 8 },
+    { "name": "mysql2", "minMajorVersion": 8 },
+    { "name": "next", "minMajorVersion": 14 },
+    { "name": "pg", "minMajorVersion": 8 },
+    { "name": "redis", "minMajorVersion": 8 },
+    { "name": "restify", "minMajorVersion": 14 },
+    { "name": "tedious", "minMajorVersion": 8 },
+    { "name": "undici", "minMajorVersion": 8 },
+    { "name": "ws", "minMajorVersion": 8 },
+    { "name": "@koa/router,koa-router", "minMajorVersion": 8 },
+    { "name": "handlebars,pug", "minMajorVersion": 8 },
+    { "name": "bluebird,got", "minMajorVersion": 8 }
   ]
 }
diff --git a/.github/workflows/tav-command.yml b/.github/workflows/tav-command.yml
index 780be326bb1..ea6fb43adb7 100644
--- a/.github/workflows/tav-command.yml
+++ b/.github/workflows/tav-command.yml
@@ -66,7 +66,8 @@ jobs:
               const permutations = []
               for (const mod of mods) {
                 for (const nv of vers) {
-                  if (mod.minVersion && nv >= mod.minVersion) {
+                  const nvMajor = Number(nv.split('.')[0]);
+                  if (mod.minMajorVersion && nvMajor >= mod.minMajorVersion) {
                     permutations.push(`${mod.name} ${nv}`)
                   }
                 }
diff --git a/.github/workflows/tav.yml b/.github/workflows/tav.yml
index b1e15b2d4e7..0bcb52399df 100644
--- a/.github/workflows/tav.yml
+++ b/.github/workflows/tav.yml
@@ -45,7 +45,8 @@ jobs:
             const permutations = []
             for (const mod of matrix.modules) {
               for (const nv of matrix.versions) {
-                if (mod.minVersion && nv >= mod.minVersion) {
+                const nvMajor = Number(nv.split('.')[0])
+                if (mod.minMajorVersion && nvMajor >= mod.minMajorVersion) {
                   permutations.push(`${mod.name} ${nv}`)
                 }
               }
diff --git a/.github/workflows/test.yml b/.github/workflows/test.yml
index f93a75bf0d1..8ac3339afe6 100644
--- a/.github/workflows/test.yml
+++ b/.github/workflows/test.yml
@@ -130,7 +130,7 @@ jobs:
           - '21.0'
           - '20'
           - '20.0'
-          - '18'
+          - '18.18.2' # Skip >=18.19.0 until IITM double-import issue is resolved.
           - '18.0'
           - '16'
           - '16.0'
diff --git a/CHANGELOG.asciidoc b/CHANGELOG.asciidoc
index 0976728e22c..d6525474c30 100644
--- a/CHANGELOG.asciidoc
+++ b/CHANGELOG.asciidoc
@@ -37,6 +37,11 @@ See the <<upgrade-to-v4>> guide.
 [[release-notes-4.3.0]]
 ==== 4.3.0 - 2023/12/05
 
+*Known issue*: Using the APM agent's <<esm>> with Node v18.19.0 is currently
+not supported. Earlier versions of Node.js v18 and Node.js v20 and later
+*are* supported. See <https://github.com/elastic/apm-agent-nodejs/issues/3784>
+for details.
+
 [float]
 ===== Features
 
diff --git a/dev-utils/lint-tav-json.js b/dev-utils/lint-tav-json.js
index f990cccb279..ddd7bf2681c 100755
--- a/dev-utils/lint-tav-json.js
+++ b/dev-utils/lint-tav-json.js
@@ -59,7 +59,8 @@ function main(argv) {
       moduleNamesFromJson.add(moduleName);
     });
     for (const nv of tavJson.versions) {
-      if (mod.minVersion && nv >= mod.minVersion) {
+      const nvMajor = Number(nv.split('.')[0]);
+      if (mod.minMajorVersion && nvMajor >= mod.minMajorVersion) {
         matrix.push(`${mod.name} ${nv}`);
       }
     }