landiolol

Blocks stimulation of beta₁(myocardial)-adrenergic receptors. Does not usually affect beta₂(pulmonary, vascular, uterine)-adrenergic receptor sites.

Therapeutic effects:

Decreased ventricular rate (HR) in atrial fibrillation or atrial flutter.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Primarily metabolized by pseudocholinesterases and carboxylesterases in the plasma to an active metabolite.

Half-Life: Primarily excreted in urine as metabolites (8% as unchanged drug).

Time/Action Profile ⬆ ⬇

(↓ HR)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	10 min	minutes

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Severe sinus bradycardia, sick sinus syndrome, or >1st-degree heart block;
Decompensated HF;
Cardiogenic shock;
Pulmonary hypertension;
Moderate or severe hepatic impairment.

Use Cautiously in:

Hypovolemia (↑ risk of hypotension);
1st-degree heart block, sinus node dysfunction, or conduction disorders (↑ risk of bradycardia and heart block);
Reactive airway disease;
Diabetes mellitus (may ↑ risk mask signs of hypoglycemia);
Prinzmetal angina (↑ risk of angina);
Untreated pheochromocytoma (initiate only after alpha blocker therapy started);
Raynaud disease or peripheral vascular disease;
Renal impairment (↑ risk of hyperkalemia);
Mild hepatic impairment;
Metabolic acidosis (↑ risk of hyperkalemia renal tubular acidosis);
Hyperthyroidism (may mask symptoms);
History of severe allergic reactions (intensity of reactions may be ↑);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ sensitivity to beta blockers; initial dose ↓ recommended.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, HF, hypotension

Endo: hypoglycemia

F and E: hyperkalemia

Local: infusion site reactions

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

↑risk of bradycardia when used with digoxin, verapamil, diltiazem, clonidine, or ivabradine.
↑risk of depressed myocardial contractility when used with negative inotropes, including verapamil or diltiazem.
Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
May ↓ the beneficial beta₁-cardiovascular effects of dopamine or dobutamine.
Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension).

Route/Dosage ⬆ ⬇

IV (Adults ): Normal cardiac function: 9 mcg/kg/min infusion initially; then ↑ by 9 mcg/kg/min every 10 min to achieve adequate ventricular rate control (max dose = 36 mcg/kg/min). Impaired cardiac function: 1 mcg/kg/min infusion initially; then ↑ by 1 mcg/kg/min every 15 min to achieve adequate ventricular rate control (max dose = 36 mcg/kg/min).

Availability ⬆ ⬇

Lyophilized powder for injection: 280 mg/vial

Assessment ⬆ ⬇

Monitor BP, HR, and ECG, frequently during dose adjustment period and during therapy. The risk of hypotension is greatest within the 1st 30 min of starting infusion. Hold therapy for severe bradycardia or 2nd/3rd-degree heart block.
Monitor intake and output and daily weights. Assess routinely for signs and symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention). Hold therapy if cardiogenic shock or decompensated HF develops.
Monitor for bronchospasm in patients with asthma or COPD; titrate dose carefully and discontinue immediately if bronchospasm occurs.
Monitor for signs and symptoms of hypoglycemia (sweating, nausea, tachycardia). Tachycardia may be prevented by landiolol. If hypoglycemia occurs, seek emergency treatment.
Assess infusion site frequently during therapy. Concentrations >10 mg/mL may cause injection site reaction (redness, swelling, skin discoloration, and burning at the injection site). Do not use small veins or butterfly needles for administration. If venous irritation occurs, stop the infusion and resume at another site.

Lab Test Considerations:

Monitor serum electrolytes during therapy. May cause hyperkalemia.

Implementation ⬆ ⬇

High Alert: IV vasoactive medications are inherently dangerous. Before administering, have second practitioner independently check original order, dose calculations, and infusion pump settings.
High Alert: Do not confuse landiolol with labetolol. If both are available as floor stock, store in separate areas.

IV Administration:

Y-Site Compatibility: Do not administer other drugs through same IV line.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of landiolol. Advise patient to read Patient Information before starting therapy.
Advise patients to change positions slowly to minimize orthostatic hypotension.
Advise patient to call right away for chest pain, trouble breathing, nausea, unusual sweating, light-headedness, feeling faint, itchiness, numbness in hands or feet, or warmth/redness in upper body (face, neck, arms, chest).
Rep: Advise women of reproductive potential to notify health care professional if pregnant or breastfeeding. May cause fetal bradycardia. Monitor neonates exposed to landiolol during pregnancy and labor for hypotension, hypoglycemia, bradycardia, and respiratory depression, and manage accordingly. Monitor breastfed infants for bradycardia and symptoms of beta blockade, such as lethargy (hypoglycemia).

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇