Formulary
Labetalol hydrochloride: Indications, Dosing, Side Effects and Interactions
Labetalol hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Labetalol hydrochloride: Indications, Dosing, Side Effects and Interactions
Labetalol hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Controlled hypotension in anaesthesia**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): (consult product literature or local protocols).
**Hypertension of pregnancy**
- **Adult** (By Intravenous Infusion): Initially 20 mg/hour, then increased if necessary to 40 mg/hour after 30 minutes, then increased if necessary to 80 mg/hour after 30 minutes, then increased if necessary to 160 mg/hour after 30 minutes, adjusted according to response; Usual maximum 160 mg/hour.
- **Adult** (By Mouth): Use dose for hypertension.
**Hypertension following myocardial infarction**
- **Adult** (By Intravenous Infusion): 15 mg/hour, then increased to up to 120 mg/hour, dose to be increased gradually.
**Hypertensive emergencies**
- **Adult** (By Intravenous Injection): 50 mg, to be given over at least 1 minute, then 50 mg every 5 minutes if required until a satisfactory response occurs; maximum 200 mg per course.
- **Adult** (By Intravenous Infusion): Initially 2 mg/minute until a satisfactory response is achieved, then discontinue; usual dose 50-200 mg.
**Hypertension**
- **Adult** (By Mouth): Initially 100 mg twice daily, dose to be increased at intervals of 14 days; usual dose 200 mg twice daily, increased if necessary up to 800 mg daily in 2 divided doses, to be taken with food, higher doses to be given in 3-4 divided doses; maximum 2.4 g per day.
- **Elderly** (By Mouth): Initially 50 mg twice daily, dose to be increased at intervals of 14 days; usual dose 200 mg twice daily, increased if necessary up to 800 mg daily in 2 divided doses, to be taken with food, higher doses to be given in 3-4 divided doses; maximum 2.4 g per day.
- **Adult** (By Intravenous Injection): 50 mg, dose to be given over at least 1 minute, then 50 mg after 5 minutes if required; maximum 200 mg per course.
- **Adult** (By Intravenous Infusion): Initially 2 mg/minute until a satisfactory response is achieved, then discontinue; usual dose 50-200 mg.
**Hypertensive emergencies for labetalol hydrochloride**
- **Neonate** (By intravenous infusion): Initially 0.5 mg/kg/hour (max. per dose 4 mg/kg/hour), dose to be adjusted according to response at intervals of at least 15 minutes.
- **Child 1 month-11 years** (By intravenous infusion): Initially 0.5-1 mg/kg/hour (max. per dose 3 mg/kg/hour), dose to be adjusted according to response at intervals of at least 15 minutes.
- **Child 12-17 years** (By intravenous infusion): Initially 30-120 mg/hour, dose to be adjusted according to response at intervals of at least 15 minutes.
**Hypertension for labetalol hydrochloride**
- **Child 1 month-11 years** (By mouth): 1-2 mg/kg 3-4 times a day.
- **Child 12-17 years** (By mouth): Initially 50-100 mg twice daily, dose to be increased if required at intervals of 3-14 days; usual dose 200-400 mg twice daily, higher doses to be given in 3-4 divided doses; maximum 2.4 g per day.
- **Child 1 month-11 years** (By intravenous injection): 250-500 micrograms/kg (max. per dose 20 mg) for 1 dose.
- **Child 12-17 years** (By intravenous injection): 50 mg, dose to be given over at least 1 minute, then 50 mg after 5 minutes if required; maximum 200 mg per course.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm) Cautions For labetalol hydrochloride Liver damage
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For labetalol hydrochloride General side-effects: Common or very common Drug fever; ejaculation failure; hypersensitivity; urinary disorders Rare or very rare Hepatic disorders; systemic lupus erythematosus (SLE); toxic myopathy; tremor Frequency not known Cyanosis; hyperhidrosis; hyperkalaemia; interstitial lung disease; lethargy; lichenoid keratosis; muscle cramps; nasal congestion; peripheral oedema; postural hypotension; psychosis; thrombocytopenia Specific side-effects: Rare or very rare With oral use Peripheral vascular disease Frequency not known With intravenous use Fever; hypoglycaemia masked; intermittent claudication exacerbated; thyrotoxicosis masked With oral use Photosensitivity reaction
Interactions
**Other interactions (16):**
- Digitalis glycosides used in association with beta-blockers may increase atrio-ventricular conduction time.
- Clonidine Beta-blockers increase the risk of rebound hypertension.
- When clonidine is used in conjunction with non-selective beta-blockers, such as propranolol, treatment with clonidine should be continued for some time after treatment with the beta-blocker has been...
- Monoamine oxidase Inhibitors (except MOA-B inhibitors).
- Use with caution Class I antiarrhythmic agents (e.g.
- Insulin and oral antidiabetic drugs may intensify the blood sugar lowering effect, especially of non-selective beta-blockers.
Pregnancy
Hypertension of pregnancy for labetalol hydrochloride By intravenous infusion Adult Initially 20 mg/hour, then increased if necessary to 40 mg/hour after 30 minutes, then increased if necessary to 80 mg/hour after 30 minutes, then increased if necessary to 160 mg/hour after 30 minutes, adjusted according to response; Usual maximum 160 mg/hour. By mouth Adult Use dose for hypertension.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants. Breast feeding For labetalol hydrochloride Infants should be monitored as there is a risk of possible toxicity due to alpha-blockade (in addition to beta-blockade).
Hepatic impairment
Manufacturer advises caution (risk of slow metabolism). Dose adjustments Manufacturer advises consider dose reduction.
Renal impairment
Dose adjustments Manufacturer advises consider dose reduction.
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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