Labetalol (Trandate) 💊

Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure

💊 Labetalol may be used for hypertension in pregnancy, aortic dissection, stroke thrombolysis, phaeochromocytoma, or other hypertensive emergencies. ⚠️ Always take senior/expert advice before IV use.

📖 About

Always check the BNF link here for updated dosing and monitoring advice.

• Mixed α1- and β-adrenergic blocker.
• α-blockade → peripheral vasodilation (↓ afterload).
• β-blockade → reduces heart rate and myocardial oxygen demand.

⚙️ Mechanism of Action

• Blocks β-receptors in heart, vessels, lungs, pancreas, and liver.
• Blocks α1-receptors in vascular smooth muscle → vasodilation and BP reduction.
• Maintains cardiac output better than pure β-blockers in hypertensive crisis.

🎯 Hypertensive Emergency Targets

• 🔪 Aortic dissection: SBP < 110 mmHg (as tolerated).
• 🧠 Stroke thrombolysis: keep <185/110 mmHg before giving alteplase.
• 🧩 Hypertensive encephalopathy: aim SBP < 180 mmHg.

💊 Indications & Dosing

• 🩸 Chronic hypertension: Labetalol (Trandate) 100–200 mg PO twice daily with food (elderly: start 50 mg BD).
• 🚨 Hypertensive emergency: Labetalol (Trandate)
  • IV bolus: 20 mg slow IV over 1 min (may repeat up to 50 mg).
  • IV infusion: 0.5–2 mg/min (max 120 mg/hr). Stop once BP target achieved.
  • Max dose per course: 200 mg.

⛔ Contraindications

• Bradycardia (<60 bpm), systolic BP <100 mmHg.
• Asthma/bronchospasm 🫁.
• 2nd or 3rd-degree heart block.
• Uncontrolled / decompensated heart failure.
• Severe hypotension.
• Phaeochromocytoma (unless α-blockade established).
• Sick sinus syndrome.
• Significant peripheral vascular disease 🦵.
• ⚠️ Concomitant use with verapamil (risk of heart block/asystole).
• Caution in diabetes (masks hypoglycaemia, worsens control).

⚠️ Side Effects

• Postural hypotension, dizziness, weakness.
• Headache, fatigue, cold peripheries 🥶.
• Bronchospasm.
• Worsening diabetic control.
• Nightmares, insomnia 🌙.
• Worsening Raynaud’s, rash, vomiting.

📚 References

• BNF – Labetalol
• ESC Hypertension Guidelines.
• Oxford Handbook of Clinical Medicine.