Adult Dosing
Severe hypertension
- Initial: 20 mg slow IV over 2 minutes; may repeat injections of 40-80 mg q10 minutes. [Max total IV dose: 300 mg]
- Alt: 2 mg/minute IV slow continuous infusion until satisfactory response
- Convert to oral route as follows: 200 mg PO x 1; then 200-400 mg PO q6-12 hrs depending on blood pressure response
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Hypertension [Non-FDA Approved]
- 0.4-1 mg/kg/hr, to a max. dose of 3 mg/kg/hr; May initiate with a 0.2-1 mg/kg bolus; Max bolus: 20 mg
[Outline]
- Therapy may cause hepatic necrosis and death after both short- and long-term treatment. Therefore periodically perform hepatic laboratory tests. Suspend therapy if the patient has laboratory evidence of liver injury or jaundice
- Therapy may cause depressed myocardial contractility and precipitation of more severe cardiac failure. Therefore administer cautiously in patients with a history of heart failure who are well compensated. Avoid use in CHF patients
- Abrupt cessation of therapy may cause exacerbations of angina pectoris and myocardial infarction in patients with coronary artery disease
- It should not be used in nonallergic bronchospasm (e.g., Chronic Bronchitis and Emphysema) patients
- Use caution when administering labetalol to patients with pheochromocytoma to avoid paradoxical hypertensive responses
- Adjust the dose of antidiabetic drugs as therapy reduces the release of insulin in response to hyperglycemia
- Avoid use during major surgery as several deaths have occurred when labetalol hydrochloride injection was used during surgery
- Caution must be observed when reducing severely elevated blood pressure
- Patients receiving IV labetalol infusion must be kept in the supine position during the infusion and for 3 hours after infusion, closely monitoring blood pressure
- Do not discontinue abruptly. Abrupt discontinuation may precipitate angina, MI, arrhythmias, or rebound hypertension; discontinue by tapering over 1-2 weeks
- Use with caution in patients with impaired hepatic function since metabolism of the drug may be diminished
- Significant declines in cardiac output with little change in systemic vascular resistance may occur in patients with low cardiac indices and elevated systemic vascular resistance. Avoid use in such patients
- High dosages up to 3 g/day as an infusion for up to 2 to 3 days may cause hypotension or bradycardia
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Hypotension
- Diabetes mellitus
- PVD
- Respiratory difficulties
- Bronchospastic disease
- Thyrotoxicosis
- Pheochromocytoma
- Myasthenia gravis
Pregnancy Category:C
Breastfeeding: Labetolol is excreted in breast milk in small amounts. Amounts ingested by the infant are small and would not be expected to cause any adverse effects in full-term breastfed infants; use alternate agents in preterm infants. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 9 February 2011). Manufacturer advises caution.
