Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- Should always be administered while patient is in the supine or left lateral position
- Raising the patient into the upright position within three hours of intravenous labetalol administration should be avoided, since excessive postural hypotension may occur
- Q pulse document -'WAC Group Guideline and Pathway on the Management of Hypertensive Disorders in Pregnancy'(CLN-LW-0032) should be consulted for most up to date information on the use of labetalol in this indication (ref 1)
- For Y-site compatibility see below
Available preparations
Trandate 100mg per 20ml ampoule
Labetalol 100mg per 20ml ampoule
Reconstitution
Already in solution
Draw up using a 5 micron filter needle
Infusion fluids
Glucose 5% (or see further information)
Methods of intravenous administration
Continuous intravenous infusion (administer using an electronically controlled infusion device)
- Dilute 200mg (40ml) injection solution with 160ml infusion fluid (1mg per ml)
- Ideally administer via central line. If essential, can be given via a large peripheral vein (ref 4)
- Fluid restriction: use undiluted (ref 2,3) via central line (ref 2) - unlicensed, anecdotal evidence base
Bolus intravenous injection (emergency situations such as hypertensive encephalopathy)
- Administer each 50mg over at least one minute (over five minutes if used in severe hypertension in pregnancy (ref 1))
- May be repeated every five minutes to a usual maximum total dose of 200mg (may be repeated at 10 minute intervals if used in severe hypertension in pregnancy (ref 1))
- Administer via central line or large peripheral vein (ref 4)
Dose in adults
Hypertension of pregnancy
- Commence an intravenous infusion at a rate of 20mg per hour
- This dose may be doubled every thirty minutes until a satisfactory reduction in blood pressure has been obtained or a dose of 160mg per hour is reached
- Occasionally higher doses may be necessary
Hypertensive episodes following acute myocardial infarction
- Commence an intravenous infusion at 15mg per hour
- Gradually increase to a maximum of 120mg per hour, depending on blood pressure control
In hypertension due to other causes
- Commence an intravenous infusion at about 2mg per minute, until a satisfactory response is obtained
- The infusion should then be stopped
- The effective dose is usually in the range of 50 to 200mg, depending on the severity of the hypertension
- For most patients it is unnecessary to administer more than 200mg, but larger doses may be required, especially in patients with phaechromocytoma
Acute Stroke
- See Local guidelines - Acute Stroke Thrombolysis and thrombectomy Integrated Care Pathway
Monitoring
- Monitor blood pressure, heart rate and respiratory function throughout the infusion
- Monitor LFTs as severe hepatocellular damage has been reported
- Monitor infusion site every 30 minutes (ref 3)
Further information
- Labetalol may also be diluted in glucose infusion fluids containing sodium chloride e.g. Sodium chloride 0.18%/Glucose 4%, or in Sodium chloride 0.9% (ref 4)
Storage
Store below 250C
References
SPC March 2023
1'WAC Group Guideline and Pathway on the Management of Hypertensive Disorders in Pregnancy -Drug Treatment guidelines for severe hypertension in pregnancy"(CLN-LW-0032) Q-Pulse document
2. "Critical Care Group: Minimum infusion volumes for fluid restricted critically ill patients: 4th edition 2012 UKCPA
3. Injectable Drugs Guide accessed via Medicinescomplete 07/03/2024
4: Medusa IV guides, downloaded 07/03/2024
5. BNF accessed online 07/03/2024
Therapeutic classification
Beta adrenoreceptor blocking agent with alpha blocking activity
