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labetalol

Brand: Trandate, Normodyne

⚠ BBW Prototype: carvedilol
Drug Class: beta-blocker
Drug Family: antihypertensive
Subclass: non-selective beta-blocker + alpha-1 blocker
Organ Systems: cardiovascular

Mechanism of Action

Combined alpha-1 and non-selective beta-blockade; 3:1 beta:alpha oral, 7:1 IV; rapid vasodilation with maintained cardiac output.

beta-1 receptorbeta-2 receptoralpha-1 receptor

Indications

  • hypertensive urgency/emergency (IV)
  • hypertension
  • hypertension in pregnancy
  • pheochromocytoma (after adequate alpha block)

Contraindications

  • asthma/COPD
  • cardiogenic shock
  • severe bradycardia
  • high-degree AV block
  • decompensated HF

Adverse Effects

Common

  • dizziness
  • fatigue
  • hypotension

Serious

  • bronchospasm
  • severe hypotension with IV
  • hepatotoxicity

Pharmacokinetics (ADME)

Absorption 25% oral bioavailability (first-pass)
Distribution moderate lipophilicity
Metabolism hepatic (conjugation)
Excretion renal
Half-life 5-8 hours
Onset 5-10 min IV; 20-120 min oral
Peak 2-4 hours oral
Duration 8-12 hours
Protein Binding 50%
Vd 3-16 L/kg

Drug Interactions

Drug / Agent Mechanism Severity
cimetidine increases labetalol bioavailability moderate
halothane additive hypotension moderate

Nursing Considerations

  1. IV used for hypertensive emergency — keep patient supine (orthostatic hypotension)
  2. Drug of choice for hypertension in pregnancy (IV)
  3. Monitor for bronchospasm in pulmonary disease
  4. IV infusion: titrate by 2 mg/min; maximum 300 mg total bolus
  5. Rare hepatotoxicity — monitor LFTs in long-term use

Clinical Pearls

  • Preferred IV agent for hypertensive emergency in pregnancy
  • Non-selective beta-blockade — avoid in asthma/COPD
  • Unique in maintaining cardiac output due to alpha-1 vasodilation

Safety Profile

Pregnancy safe
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Beta-blocker Hypertension Hypertension In Pregnancy Hypertensive Urgency/emergency (IV) Pheochromocytoma (after Adequate Alpha Block)
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