LABETALOL (Trandate)

combined alpha and  beta receptor blocker; antihypertensive 

• decreases blood pressure (alpha blockade)
• decreases HR, contractility, myocardial oxygen requirements (beta blockade)

• Bolus:
  • 5-20 mg IV direct initially; additional doses of 40-80 mg may be given at 10 minute intervals
• Infusion:
  • 2 mg/min with the rate of infusion adjusted to supine BP

• Bolus dose:
  • 5-20 mg IV direct over a 2 minute period
  • bolus should be diluted to a concentration of 1 mg/ml

Urgent initiation of a labetalol infusion (required to start in 30 minutes or less) prepared by RN with final concentration: 200mg/100mL (2mg/mL).

Preparation Instructions (to ensure standardized concentration): 

1. Remove 40mL of diluent from a 100mL bag.
2. Draw up the contents of two x 100mg/20mL vials of labetalol (total 200mg)
3.  Add the total of 200mg (40mL) to the prepared bag of D5W to produce a final concentration of 2mg/mL (200mg/100mL).
4.  Any “kits” kept in Pyxis will be updated to supply 2x20mL vial of labetalol and 1x100mL bag of diluent. Current ward stock in CCTC remains 100 mg in 20 mL vials. 

Standard sized infusions prepared by pharmacy: 
To avoid interruptions in therapy, a STAT medication request for the standard size infusion bag (500mg/250mL) to be prepared by the pharmacy team should be completed in tandem. The stability of a pharmacy prepared bag is 24h.

• bradycardia
• decreased contractility, cardiac output
• ventricular arrhythmias (including PVCs)
• excessive drops in BP - especially orthostatic hypotension (patients should be kept supine for 3 hours after administration)
• parasthesia (mild, transient tingling of scalp or skin)
• dyspnea, bronchospasm
• pain at injection site

• caution in left ventricular dysfunction, bronchospastic disease, pheochromocytoma (additional alpha blockade required), hepatic dysfunction

• labetalol + nitroglycerin = additive hypotensive effect
• labetalol + beta₂ agonists = decreased bronchodilation

• continuous heart rate and ECG rhythm
• blood pressure
• cardiac output if monitored
• lactate

• May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
• May be titrated by a nurse in Adult Critical Care
• Administration by central venous line preferred
• Patient requires placement of an arterial line to monitor BP.
• Continuous infusions must be administered by infusion device and the pump library must be enabled.
• Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).