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Intravenous Dilution Guidelines

Labetalol hydrochloride

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

Final concentrations: 1 mg/ml
Total volume= 200ml:
[200 mg] [160 ml] [Titrate]

Total volume= 300ml
[300 mg] [240 ml] [Titrate]

Total volume= 600ml:
[600 mg] [480 ml] [Titrate]

Stability / Miscellaneous

EXP: 1 DAY (RT)
Labetalol hydrochloride is an adrenergic receptor blocking agent that has both selective alpha1- and nonselective beta-adrenergic receptor blocking actions in a single substance.

Dosing (Adults)- quick summary: initially 20 mg IV push over 2 minutes. May repeat 20 to 80 mg q10 minutes (up to 300 mg total dose) until desired BP is reached or start continuous infusion: 2 mg/min (range: 1 to 3 mg/min)--titrate to blood pressure.

DOSAGE AND ADMINISTRATION
Labetalol hydrochloride injection is intended for intravenous use in hospitalized patients. DOSAGE MUST BE INDIVIDUALIZED depending upon the severity of hypertension and the response of the patient during dosing.

Patients should always be kept in a supine position during the period of intravenous drug administration. A substantial fall in blood pressure on standing should be expected in these patients. The patient’s ability to tolerate an upright position should be established before permitting any ambulation, such as using toilet facilities.

Either of two methods of administration of labetalol hydrochloride injection may be used: a) repeated intravenous injections, b) slow continuous infusion.

Repeated Intravenous Injection: Initially, labetalol hydrochloride injection should be given in a dose of 20 mg labetalol HCl (which corresponds to 0.25 mg/kg for an 80 kg patient) by slow intravenous injection over a 2-minute period.

Immediately before the injection and at 5 and 10 minutes after injection, supine blood pressure should be measured to evaluate response. Additional injections of 40 mg or 80 mg can be given at 10 minute intervals until a desired supine blood pressure is achieved or a total of 300 mg labetalol HCl has been injected. The maximum effect usually occurs within 5 minutes of each injection.

Slow Continuous Infusion: Labetalol hydrochloride injection is prepared for intravenous continuous infusion by diluting the drug with commonly used intravenous fluids (see below). Examples of methods of preparing the infusion solution are:

Labetalol hydrochloride injection 200 mg is added to 160 mL of a commonly used intravenous fluid such that the resultant 200 mL of solution contains 200 mg of labetalol hydrochloride, 1 mg/mL. The diluted solution should be administered at a rate of 2 mL/min to deliver 2 mg/min.

Alternatively, 200 mg of labetalol hydrochloride injection is added to 250 mL of a commonly used intravenous fluid. The resultant solution will contain 200 mg of labetalol hydrochloride, approximately 2 mg/3 mL. The diluted solution should be administered at a rate of 3 mL/min to deliver approximately 2 mg/min.

The rate of infusion of the diluted solution may be adjusted according to the blood pressure response, at the discretion of the physician. To facilitate a desired rate of infusion, the diluted solution can be infused using a controlled administration mechanism, e.g., graduated burette or mechanically driven infusion pump.

Since the half-life of labetalol is 5 to 8 hours, steady-state blood levels (in the face of a constant rate of infusion) would not be reached during the usual infusion time period. The infusion should be continued until a satisfactory response is obtained and should then be stopped and oral labetalol hydrochloride started. The effective intravenous dose is usually in the range of 50 to 200 mg. A total dose of up to 300 mg may be required in some patients.

Blood Pressure Monitoring: The blood pressure should be monitored during and after completion of the infusion or intravenous injections. Rapid or excessive falls in either systolic or diastolic blood pressure during intravenous treatment should be avoided. In patients with excessive systolic hypertension, the decrease in systolic pressure should be used as indicator of effectiveness in addition to the response of the diastolic pressure.

Initiation of Dosing with Labetalol Hydrochloride Tablets: Subsequent oral dosing with labetalol hydrochloride tablets should begin when it has been established that the supine diastolic blood pressure has begun to rise. The recommended initial dose is 200 mg, followed in 6 to 12 hours by an additional dose of 200 or 400 mg, depending on the blood pressure response. Thereafter, inpatient titration with labetalol hydrochloride tablets may proceed as follows:

Inpatient Titration Instructions
Regimen Daily Dose*
200 mg b.i.d. 400 mg
400 mg b.i.d. 800 mg
800 mg b.i.d. 1600 mg
1200 mg b.i.d. 2400 mg

* If needed, the total daily dose may be given in three divided doses.

While in the hospital, the dosage of labetalol hydrochloride tablets may be increased at 1 day intervals to achieve the desired blood pressure reduction.

For subsequent outpatient titration or maintenance dosing see Labetalol Hydrochloride Tablets Product Information DOSAGE AND ADMINISTRATION for additional recommendations.

Compatibility with commonly used intravenous fluids:
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Labetalol hydrochloride injection was tested for compatibility with commonly used intravenous fluids at final concentrations of 1.25 mg to 3.75 mg labetalol hydrochloride per mL of the mixture. Labetalol hydrochloride injection was found to be compatible with and stable (for 24 hours refrigerated or at room temperature) in mixtures with the following solutions:

Ringers Injection, USP
Lactated Ringers Injection, USP
5% Dextrose and Ringers Injection
5% Lactated Ringers and 5% Dextrose Injection
5% Dextrose Injection, USP
0.9% Sodium Chloride Injection, USP
5% Dextrose and 0.2% Sodium Chloride Injection, USP
2.5% Dextrose and 0.45% Sodium Chloride Injection, USP
5% Dextrose and 0.9% Sodium Chloride Injection, USP
5% Dextrose and 0.33% Sodium Chloride Injection, USP

Labetalol hydrochloride injection was NOT compatible with 5% Sodium Bicarbonate Injection, USP.

HOW SUPPLIED
Labetalol hydrochloride injection, 5 mg/mL, is supplied in:

4 mL (20 mg) Carpuject® Sterile Cartridge unit with Luer Lock, box of 1, List 2339.

20 mL (100 mg) multidose vial, box of 1, List 2267;

40 mL (200 mg) multidose vial, box of 1, List 2267.

Store between 2° and 30°C (36° and 86°F). Protect from freezing. Protect syringe from light.

Note: To prevent needle-stick injuries, needles and blunt cannulas should not be recapped, purposely bent, or broken by hand.


©Hospira 2004
EN-0776
HOSPIRA, INC., LAKE FOREST, IL 60045 USA

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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