What is the recommended dosing for labetalol (labetalol) in the management of hypertension?

Labetalol Dosing for Hypertension Management

For hypertension management, labetalol should be initiated at 100 mg twice daily orally, with titration in increments of 100 mg twice daily every 2-3 days, to a usual maintenance dose of 200-400 mg twice daily, with a maximum daily dose of 2400 mg. 1

Oral Dosing Protocol

Initial Therapy

• Starting dose: 100 mg twice daily (whether used alone or with a diuretic) 1
• Titration: Increase by 100 mg twice daily every 2-3 days based on standing blood pressure 1
• Usual maintenance dose: 200-400 mg twice daily 1

Dose Adjustments

• Severe hypertension: May require 1,200-2,400 mg per day 1
• If side effects occur with twice-daily dosing: Same total daily dose can be administered three times daily to improve tolerability 1
• Maximum titration increment: 200 mg twice daily 1
• When adding a diuretic: Expect additive effect, may require labetalol dosage adjustment 1

Elderly Patients

• Initial dose: Same as general population (100 mg twice daily) 1
• Maintenance dose: Usually lower (100-200 mg twice daily) due to slower elimination 1

Intravenous Dosing for Hypertensive Emergencies

Bolus Administration

• Initial dose: 0.3-1.0 mg/kg (maximum 20 mg) slow IV injection 2, 3
• Repeat: Every 10 minutes as needed 2
• Maximum cumulative dose: 300 mg 2, 3

Continuous Infusion

• Infusion rate: 0.4-1.0 mg/kg/h IV infusion up to 3 mg/kg/h 2, 3
• Titrate to target blood pressure 3

Blood Pressure Monitoring and Targets

• Full antihypertensive effect: Usually seen within 1-3 hours of initial dose or dose increment 1
• For IV administration: Monitor blood pressure every 15 minutes for first 2 hours, then every 30 minutes for 6 hours, then hourly 3
• Target reduction: Aim for gradual reduction of 10-15% in the first hour rather than rapid normalization 3

Special Considerations

Contraindications

• Reactive airways disease or chronic obstructive pulmonary disease 2
• Second or third-degree heart block 2
• Bradycardia 2
• Decompensated heart failure 2, 3
• Concurrent beta-blocker therapy 3

Common Side Effects

• Postural hypotension (especially 2-4 hours after dosing) 3, 4
• Dizziness 3
• Gastrointestinal disturbances 3
• Fatigue 3
• Headache 3

Pregnancy

• Labetalol is effective and well-tolerated in pregnant women with hypertension 3

Transition from IV to Oral Therapy

• Can transition after 24 hours if hemodynamic goals achieved 3
• Initial oral dose after IV therapy: 200 mg 3

Clinical Pearls

• Labetalol has both alpha and beta blocking properties, making it especially useful in hyperadrenergic states 2
• When transferring from other antihypertensive drugs, introduce labetalol as recommended and progressively decrease existing therapy 1
• For very resistant hypertension, combination therapy may be necessary 3
• Excessive or rapid falls in blood pressure should be avoided 3