What are the implications of a patient stopping Labetalol (Normodyne, Trandate) for 4 days with subsequent stable blood pressure?

From the Guidelines

The patient should consult with their healthcare provider before continuing to stay off labetalol to assess the risk of rebound hypertension and determine the best course of action for their blood pressure management. While it's positive that the blood pressure has remained stable for 4 days after self-discontinuation, abruptly stopping beta-blockers like labetalol can potentially lead to rebound hypertension or other cardiovascular complications 1. The patient should schedule an appointment with their doctor to evaluate their current blood pressure readings, discuss why they stopped the medication, and determine if they truly no longer need it or if an alternative treatment plan is appropriate. Some key points to consider in the management of hypertension include:

• The use of combination therapy with multiple blood pressure-lowering medications, which can have additive or synergistic effects and lead to greater blood pressure reduction 1
• The importance of monitoring blood pressure regularly to ensure it remains controlled, especially after stopping or changing medications
• The potential benefits and risks of different medication classes, including beta-blockers like labetalol, and the need for individualized treatment plans If the doctor agrees that discontinuation is appropriate, they may recommend monitoring blood pressure at home regularly for several weeks to ensure it remains controlled. Beta-blockers work by blocking the effects of adrenaline on beta receptors, reducing heart rate and blood pressure, so the body may need time to adjust to functioning without this medication 1. Even if blood pressure appears stable now, underlying hypertension may return without proper management and follow-up.

From the FDA Drug Label

Exacerbation of Ischemic Heart Disease Following Abrupt Withdrawal: Angina pectoris has not been reported upon labetalol HCl discontinuation. However, hypersensitivity to catecholamines has been observed in patients withdrawn from beta-blocker therapy; exacerbation of angina and, in some cases, myocardial infarction have occurred after abrupt discontinuation of such therapy When discontinuing chronically administered TRANDATE Tablets, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored The patient stopped taking labetalol for 4 days and BP is stable now, but according to the label, it is recommended to gradually reduce the dosage over a period of 1 to 2 weeks when discontinuing the medication, especially in patients with ischemic heart disease. Since the patient stopped the medication abruptly, close monitoring is necessary to watch for potential exacerbation of ischemic heart disease or other complications 2. Key considerations include:

• Monitoring for signs of ischemic heart disease
• Watching for potential rebound effects
• Considering the risk of myocardial infarction or angina exacerbation It is essential to closely monitor the patient's condition and be prepared to reinstitute therapy if necessary 2.

From the Research

Patient's Decision to Stop Taking Labetalol

• The patient stopped taking labetalol for 4 days and their blood pressure (BP) is now stable.
• There is no direct evidence in the provided studies to suggest that stopping labetalol for a short period would have a significant impact on BP stability.

Blood Pressure Lowering Efficacy of Labetalol

• A study published in 2015 3 found that labetalol lowered BP by -10 mm Hg (95% CI -14 to -7)/-7 mm Hg (95% CI -9 to -5) in patients with primary hypertension.
• However, the effect of labetalol is likely to be exaggerated due to high risk of bias in the study.

Comparison with Other Antihypertensive Medications

• A study published in 2019 4 found that different combinations of antihypertensive therapy, including lisinopril, losartan, and valsartan, were equally effective in reducing BP and improving arterial stiffness in patients with essential hypertension.
• Another study published in 2025 5 found that labetalol, methyldopa, and nifedipine were equally effective in reducing the incidence of severe hypertension in pregnant women with hypertensive disorders.

Timing of Antihypertensive Medication Administration

• A study published in 2025 6 found that administering antihypertensive medications at bedtime instead of in the morning did not reduce cardiovascular risk or affect the risks and benefits of blood pressure-lowering medication.