LABETALOL (Trandate)

Name:	LABETALOL (Trandate^R)
Classification:	combined alpha and beta receptor blocker; antihypertensive decreases blood pressure (alpha blockade) decreases HR, contractility, myocardial oxygen requirements (beta blockade)
Dose:	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 OR infusion of 0.5 - 1.0 mg/kg/hr titrated to effect
Administration:	Bolus dose: 5-20 mg IV direct over a 2 minute period bolus should be diluted to a concentration of 1 mg/mL IV Infusion: 500 mg/250 mL in dextrose 5%, sodium chloride 0.9% or Ringer's Lactate
Adverse Effects:	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:	caution in left ventricular dysfunction, bronchospastic disease, pheochromocytoma (additional alpha blockade required), hepatic dysfunction
Drug Interactions:	labetalol + nitroglycerin = additive hypotensive effect labetalol + beta₂ agonists = decreased bronchodilation
Monitoring Therapy:	continuous heart rate and ECG rhythm blood pressure cardiac output if monitored lactate
Adult Critical Care Protocol:	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).