What is the dosage and management of hypertension with labetalol (labetalol) tablets?

Labetalol Tablet Dosing for Hypertension

For oral labetalol therapy, start with 100 mg twice daily and titrate upward in 100 mg increments every 2-3 days based on standing blood pressure, with most patients achieving control on 200-400 mg twice daily and a maximum dose of 2400 mg daily if needed. 1

Initial Dosing Strategy

• Begin with 100 mg twice daily, whether used as monotherapy or added to a diuretic regimen 1
• The full antihypertensive effect occurs within 1-3 hours of each dose, allowing you to assess response in the office setting 1
• Measure blood pressure approximately 12 hours after dosing at follow-up visits to determine if further titration is necessary 1

Titration Protocol

• Increase by 100 mg twice daily every 2-3 days using standing blood pressure as your guide 1
• Do not exceed 200 mg twice daily increments during titration 2
• The usual maintenance dose falls between 200-400 mg twice daily for most patients 1
• For severe hypertension, doses may range from 1200-2400 mg daily 1

Managing Side Effects During Titration

• If nausea or dizziness occurs with twice-daily dosing, switch to three times daily using the same total daily dose to improve tolerability 1
• This frequency adjustment facilitates further upward titration when needed 1

Special Population Adjustments

Elderly Patients

• Start with the standard 100 mg twice daily 1
• Most elderly patients achieve control on 100-200 mg twice daily, lower than the general population due to slower drug elimination 1
• Titrate more cautiously in this group 1

Pregnancy

• Labetalol is first-line for hypertension in pregnancy 3
• May require three or four times daily dosing during pregnancy due to accelerated drug metabolism, rather than the standard twice-daily regimen 3, 4
• Consider that labetalol may be less effective postpartum compared to calcium channel blockers and carries higher readmission risk 3

Combination Therapy Considerations

• When adding a diuretic, expect an additive effect that may necessitate downward dose adjustment of labetalol 1
• Optimal labetalol doses are typically lower in patients also receiving diuretics 1
• When transitioning from other antihypertensives, introduce labetalol as recommended while progressively decreasing the existing therapy 1

Absolute Contraindications (Any Dose)

• Second or third-degree heart block 2, 4
• Decompensated heart failure 2, 4
• Bradycardia 2, 4
• Reactive airways disease or COPD 2, 3, 4

Common Pitfalls to Avoid

• Do not use atenolol instead of labetalol during pregnancy due to fetal growth restriction risk 3
• Watch for postural hypotension, especially when combining with diuretics 2
• The maximum daily dose is 2400 mg, though most patients achieve adequate control with 800-1200 mg daily 4
• Labetalol may worsen heart failure even at lower doses 3