Weaning Schedule for Transitioning from Labetalol 100mg PO BID to Lisinopril
When transitioning from labetalol 100mg PO BID to lisinopril, gradually reduce labetalol over 2-3 days while simultaneously starting lisinopril at a low dose (2.5-5mg daily) and titrating up as needed. 1
Recommended Weaning Schedule
Step 1: Initial Transition (Days 1-2)
- Continue labetalol 100mg PO BID
- Start lisinopril 2.5mg PO once daily (morning) 2
- Monitor blood pressure every 6 hours 1
Step 2: Gradual Reduction (Days 3-4)
- Reduce labetalol to 50mg PO BID 3, 4
- Continue lisinopril 2.5mg PO once daily
- Monitor blood pressure every 6-8 hours 1
Step 3: Final Transition (Days 5-6)
- Reduce labetalol to 50mg PO once daily 3
- Increase lisinopril to 5mg PO once daily if blood pressure remains controlled 2
- Monitor blood pressure twice daily 1
Step 4: Complete Switch (Day 7)
- Discontinue labetalol
- Continue lisinopril 5mg PO once daily
- Titrate lisinopril dose as needed (up to 10mg daily or higher based on blood pressure response) 1
- Monitor blood pressure daily for the first week after complete transition 1
Important Considerations
Blood Pressure Targets
- Aim for a gradual reduction in blood pressure, avoiding drops greater than 10-15% in the first 24 hours 1
- Target systolic BP <220 mmHg and diastolic BP <120 mmHg for most patients 1
- For patients with end-organ damage (e.g., aortic dissection, acute MI, pulmonary edema), more aggressive BP control may be needed 1
Monitoring Parameters
- Check for signs of hypotension (dizziness, lightheadedness, syncope) 2
- Monitor renal function and potassium levels before and after transition 1
- Assess for adverse effects of lisinopril (cough, angioedema) 2
Contraindications and Cautions
- Avoid rapid discontinuation of labetalol to prevent rebound hypertension 3, 4
- Use lower initial doses of lisinopril (2.5mg) in elderly patients or those with renal impairment 2
- Be cautious with concomitant diuretics which may potentiate hypotensive effects 1
- Avoid this transition schedule in patients with heart failure, low cardiac output, or cardiogenic shock 1
Special Populations
- For patients with heart failure or post-MI left ventricular dysfunction, accelerate the transition to ACE inhibitor therapy while still ensuring gradual labetalol withdrawal 1
- For patients with renal impairment (creatinine clearance ≤30 ml/min), use lower doses of lisinopril and monitor renal function closely 2
This weaning schedule allows for a controlled transition between drug classes while maintaining blood pressure control and minimizing the risk of rebound hypertension or hypotension.