What is the dosage of Labetalol (generic name: Labetalol) for treating hypertension?

From the Guidelines

Labetalol for hypertension should be initiated at a dose of 200-400 mg twice daily, with a maximum daily dose of 2400 mg divided into two or three doses, as recommended by the most recent guidelines 1. The dosing of labetalol is crucial in managing hypertension, and the guidelines provide a clear recommendation for its use.

• The initial dose of labetalol for hypertension is 200-400 mg twice daily, which can be adjusted based on the patient's response to the medication.
• The maximum daily dose of labetalol is 2400 mg, divided into two or three doses, to minimize the risk of adverse effects.
• Labetalol works as both an alpha and beta-blocker, providing rapid blood pressure reduction by decreasing peripheral vascular resistance while preventing reflex tachycardia through its beta-blocking effects.
• Monitor patients closely for hypotension, bradycardia, and bronchospasm during administration, especially in patients with asthma, COPD, heart failure, or heart block due to its beta-blocking properties. The most recent guidelines from the European Heart Journal 1 recommend the use of labetalol as a fourth-line treatment for resistant hypertension, with a preference for vasodilating beta-blockers such as labetalol, carvedilol, or nebivolol.
• The guidelines also emphasize the importance of combination therapy in managing hypertension, with the use of single-pill combinations preferred to improve adherence and reduce side effects.
• However, the guidelines note that the evidence for reduced cardiovascular disease outcomes with beta-blockers in combination therapy is based on observational studies, and further research is needed to confirm the benefits of upfront combination therapy. According to the ESC Council on Hypertension position document on the management of hypertensive emergencies 1, labetalol can be administered intravenously for the treatment of hypertensive emergencies, with an initial dose of 0.25-0.5 mg/kg i.v. bolus, followed by a continuous infusion of 2-4 mg/min until goal blood pressure is reached.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION DOSAGE MUST BE INDIVIDUALIZED. The recommended initial dosage is 100 mg twice daily whether used alone or added to a diuretic regimen. After 2 or 3 days, using standing blood pressure as an indicator, dosage may be titrated in increments of 100 mg b.i. d. every 2 or 3 days. The usual maintenance dosage of labetalol HCl is between 200 and 400 mg twice daily. Patients with severe hypertension may require from 1,200 to 2,400 mg per day, with or without thiazide diuretics Titration increments should not exceed 200 mg twice daily.

The dosage of labetalol for hypertension can be titrated in increments of 100 mg b.i.d. every 2 or 3 days, with a usual maintenance dosage of 200-400 mg twice daily. In cases of severe hypertension, the dosage may be increased to 1,200-2,400 mg per day. However, titration increments should not exceed 200 mg twice daily 2.

• Initial dosage: 100 mg twice daily
• Maintenance dosage: 200-400 mg twice daily
• Severe hypertension dosage: 1,200-2,400 mg per day
• Titration increments: 100 mg b.i.d. every 2 or 3 days, not to exceed 200 mg twice daily

From the Research

Labetalol Dosage for Hypertension

• The dosage of labetalol for hypertension can vary depending on the patient's response to the medication and the severity of their condition 3, 4.
• In a study published in the Archives of Internal Medicine, labetalol was titrated from 100 to 400 mg twice a day over a 6-week period to control blood pressure in elderly patients with isolated systolic hypertension 3.
• Another study published in The American Journal of Emergency Medicine found that oral labetalol doses of 300 mg, followed by 100 mg every 2 hours as needed, were effective in lowering blood pressure in patients with hypertensive urgencies 4.
• The maximum dose of labetalol per patient in this study was 500 mg.

Blood Pressure Lowering Efficacy of Labetalol

• A systematic review published in The Cochrane Database of Systematic Reviews found that labetalol lowered systolic and diastolic blood pressure by -10 mm Hg and -7 mm Hg, respectively, in patients with primary hypertension 5.
• However, the review noted that the effect of labetalol may be exaggerated due to high risk of bias, and that the evidence for its blood pressure lowering efficacy is of low quality 5.
• The review also found that labetalol had little or no effect on reducing pulse pressure, and that its blood pressure lowering effect was less than that of other classes of antihypertensive drugs, such as thiazides and drugs inhibiting the renin-angiotensin system 5.

Combination Therapy with Labetalol

• A review published in the American Family Physician recommended that combination antihypertensive therapy, including beta blockers like labetalol, be considered as a first-line treatment option for patients with hypertension 6.
• The review noted that combination therapy can provide a more effective and convenient treatment option for patients with hypertension, and can help to improve blood pressure control and reduce the risk of cardiovascular complications 6.
• Another review published in the Journal of Cardiovascular Pharmacology and Therapeutics discussed the use of calcium channel blockers in combination with other antihypertensive agents, including beta blockers like labetalol, to achieve better blood pressure control and reduce cardiovascular risk 7.