Does labetalol affect the baby after birth?
It is absolutely uncertain whether a labetalol dose in pregnancy can affect the baby after birth. There are some known side-effects of a labetalol dose in pregnancy, like low heart rate, low blood pressure, and low blood sugar. Sometimes, these effects are found in babies who were exposed to labetalol in their mother’s womb.
Does labetalol lower high blood pressure during pregnancy?
It is a well-known fact that labetalol is considered effective in lowering high blood pressure during pregnancy, but one must remain very careful about its probable side-effects as well. It slows the heart rate and improves blood flow, thus decreasing blood pressure. However, it does not cure it.
Does labetalol cross the blood-brain barrier?
Labetalol has been shown to cross the placental barrier in humans. Only negligible amounts of the drug crossed the blood-brain barrier in animal studies. Labetalol is approximately 50% protein bound. Neither hemodialysis nor peritoneal dialysis removes a significant amount of Labetalol from the systemic circulation (<1%).
Is labetalol an anti-hypertensive?
Similarly, labetalol is a common anti-hypertensive given in the post-anesthesia care unit, again due to its HR sparing effects and better control of blood pressure. [2] Labetalol is one of the most commonly used anti-hypertensives medications used for the treatment of hypertension during pregnancy.
Does labetalol affect fetus?
Labetalol and pregnancy You can take labetalol while you are pregnant. Labetalol can affect the baby's growth in the womb so you may be offered extra scans to check that your baby is growing OK. There's also a small chance that labetalol can affect a baby's blood sugar levels just after birth.
Why is labetalol safe in pregnancy?
Use of labetalol in pregnancy is common and there is no concern that it causes harm. Labetalol belongs to a family of medicines called beta blockers. Studies have not shown that beta blockers cause birth defects, stillbirth, or preterm birth.
Do beta blockers cross placenta?
β-Blockers are the most commonly used class of medication for treating cardiac conditions in pregnant women. Despite the common use of this class of medication, data that support its safety are limited. β-Blockers cross the placenta and potentially can cause physiological changes in the fetus.
How many mg of labetalol is safe during pregnancy?
Hypertension in Pregnancy: An initial dosage of 100 mg twice daily may be increased, if necessary at weekly intervals by 100 mg twice daily.
What is the safest beta blocker in pregnancy?
There is a general consensus that labetalol is safer than other β-blockers during pregnancy, and this drug is rapidly becoming the first-line choice in conditions, such as chronic hypertension during pregnancy.
How long does labetalol stay in your system?
Labetalol is metabolized by the liver resulting in an inactive glucuronide conjugate. It has an onset of action within 2 to 5 minutes, reaches its peak effects at 5 to 15 minutes, has an elimination half-life of 5.5 hours, and a duration of action up to four hours.
What pregnancy class is labetalol?
US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Are beta blockers Safe for Babies?
Beta blockers are commonly used in children to treat other problems including migraine, glaucoma, high blood pressure and some heart problems. Beta blockers have been used in paediatric health for more than fifty years and have an excellent safety record in young children.
Does labetalol cause low birth weight?
Most studies do not find that labetalol itself increases the chance for low birth weight (less than 5 pounds 8 ounces), preterm delivery (delivery before 37 weeks of pregnancy), or stillbirth.
How long does 100mg labetalol last?
The peak effects of single oral doses of labetalol hydrochloride occur within 2 to 4 hours. The duration of effect depends upon dose, lasting at least 8 hours following single oral doses of 100mg and more than 12 hours following single oral doses of 300 mg.
When should you not take labetalol?
You should not use labetalol if you are allergic to it, or if you have:asthma;"AV block" (2nd or 3rd degree);uncontrolled heart failure;very low blood pressure;slow heartbeats that have caused you to faint; or.if your heart cannot pump blood properly.
Is preeclampsia linked to autism?
Therefore, preeclampsia can increase risk for developing autistic disorders [3,19]. According to 2 meta-analyses, obesity is a risk factor for preeclampsia and ASD [25,26]. Therefore, increasing obesity prevalence has paralleled the increase in preeclampsia and ASD.
Does labetalol prevent preeclampsia?
Labetalol, a combined alpha and beta blocker, has been used for many years to safely treat hypertension in preeclamptic women, and is now known to reduce CPP in women with preeclampsia.
How does labetalol work in pre eclampsia?
Many preeclamptic women will not achieve blood pressure goals on this oral agent alone. Labetalol lowers blood pressure by blocking β- and α-adrenergic receptors. In addition, it can better preserve uteroplacental blood flow compared with other β-blockers.
How does labetalol work in the body?
Labetalol is used to treat high blood pressure. Labetalol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
What pregnancy category is labetalol?
US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. AU: Contraindicated during the first trimester of pregnancy.
How is Labetalol hydrochloride infused?
Labetalol hydrochloride injection is prepared for continuous intravenous infusion by diluting the vial contents with commonly used intravenous fluids (see below). Examples of two methods of preparing the infusion solution are:
What is the purpose of a labetalol hydrochloride injection?
Labetalol hydrochloride injection is indicated for control of blood pressure in severe hypertension.
How much is lbetalol excreted in milk?
Small amounts of Labetalol (approximately 0.004% of the maternal dose) are excreted in human milk. Caution should be exercised when Labetalol hydrochloride injection is administered to a nursing woman.
How long should you stay supine after a labetalol injection?
It is not a disclosure of all possible adverse or intended effects. During and immediately following (for up to 3 hours ) Labetalol hydrochloride injection, the patient should remain supine.
How long does it take for Labetalol to lower blood pressure?
Labetalol HCl administered as a continuous intravenous infusion, with a mean dose of 136 mg (27 mg to 300 mg) over a period of 2 to 3 hours (mean of 2 hours and 39 minutes), lowered the blood pressure by an average of 60/35 mmHg.
What is the formula for lbetalol hydrochloride?
Labetalol hydrochloride has the molecular formula C 19 H 24 N 2 O 3 • HCl and a molecular weight of 364.87. It has two asymmetric centers and therefore exists as a molecular complex of two diastereoisomeric pairs. Dilevalol, the R,R' stereoisomer, makes up 25% of racemic Labetalol.
Does Labetalol HCl lower blood pressure?
Both the alpha- and beta-blocking actions of orally administered Labetalol HCl contribute to a decrease in blood pressure in hypertensive patients.
What is intravenous labetalol used for?
Intravenous labetalol in the treatment of severe hypertension and hypertensive emergencies.
What is labetalol used for?
As labetalol is typically used to treat acute hypertension, whether it presents in the emergency department or an outpatient clinic, an interprofessional team approach and effective communication are essential for quality patient care. This interprofessional team can include specialists, other clinicians (MDs, DOs, PAs, NPs), nursing staff, and pharmacists. In the emergency department, swift intake and triage by the nurse or medical technician to identify a patient with dangerously elevated blood pressure and quickly but effectively convey the critical information to a physician or provider are necessary. If hospital admission is warranted, communicating the crucial details of the patient's presentation, medical history, and the treatment and current medical workup that have been completed are important, so time and resources are not wasted on repeating tests and exams. Utilizing an interprofessional team methodology that employs open communication between all team members and coordinated activity will improve patient outcomes and fewer adverse effects, particularly in hypertensive emergencies. [Level 5]
What is the best antihypertensive for pregnancy?
Labetalol is one of the most commonly used anti-hypertensives medications used for the treatment of hypertension during pregnancy. Hypertension during pregnancy is an increasingly common and a leading cause of maternal mortality and morbidity worldwide. Severe hypertension requires prompt treatment with rapid-acting antihypertensive agents such as labetalol to avoid stroke and placental abruption. Previously, intravenous hydralazine was utilized as a first-line drug for this purpose, although there is a growing experience with other agents, including intravenous labetalol and oral nifedipine. There appears to be a growing concern about the neonatal effects of hydralazine. Treatment aims to lower blood pressure during pregnancy into the mild range (less than 160/100 mm Hg), reduce the risk of stroke and other maternal cardiovascular complications. [3][4]
How long does it take for a lbetalol to work?
Labetalol is metabolized by the liver resulting in an inactive glucuronide conjugate. It has an onset of action within 2 to 5 minutes, reaches its peak effects at 5 to 15 minutes, has an elimination half-life of 5.5 hours, and a duration of action up to four hours.
Is labetalol safe for hypotension?
Overall, labetalol is usually well tolerated. Most adverse effects are typically mild and transient. As previously described above, symptomatic postural hypotension is a potential occurrence if patients are tilted or allowed to change positions from the supine or seated position to standing too quickly. This is especially important in the post-operative period (PACU or the ward) when managing a hypertensive patient with labetalol who can otherwise ambulate to the bathroom. Increased sweating, as well as flushing, have been reported with the use of labetalol. It seems the incidence of adverse reactions after administering labetalol seems to be dose-dependent. [6]
Is labetalol FDA approved?
The FDA-approved indication for labetalol is the treatment of arterial hypertension, which ranges from acute hypertensive crises (urgent/emergency) to stable chronic hypertension. Labetalol in clinical practice has several common off-label uses that include acute hypertension in pregnancy and hypertension associated with acute ischemic stroke, and intracranial hemorrhage, including subarachnoid hemorrhage. Today, labetalol is usually reserved for the acute management of hypertensive crises.
Can beta blockers cause claudication?
As with all beta-blockers, labetalol has negative inotropic effects and has the potential to cause acute left ventricular failure if given in sufficiently large enough doses to those patients who have impaired function of the left ventricle. All beta-blockers can exacerbate intermittent claudication and Raynaud phenomenon in patients with coexisting peripheral vascular disease. Another important consideration for anesthesia providers in the perioperative period is that non-selective beta-blockers that interact with beat receptors can result in bronchospasm in patients with a history of asthma or chronic obstructive pulmonary disease due to antagonism of beta receptors. Sudden withdrawal of beta-blockers can result in increased sensitivity to catecholamines. This upregulation can lead to tachyarrhythmias, acute hypertensive crises, and palpitations, although this is more common with chronic use. [7]
What Is Labetalol?
Labetalol is a drug used for treating high blood pressure. This medication is termed ‘beta-blocker’ – a group of drugs that can be given orally for long-term hypertension management and intravenously in severe hypertensive situations. Lowering blood pressure helps prevent heart attacks, strokes, and kidney problems. It relaxes the blood vessels and slows the heart rate, which results in improved blood flow, thus decreasing blood pressure.
How many weeks after taking labetalol can you have a miscarriage?
Miscarriage due to the use of a particular drug is very rare. There are no assessments on miscarriage after consuming labetalol.
What is it called when a baby is born without any signs of life?
Losing a baby is a terrible emotional blow. A baby who is born without any signs of life after 24 weeks of pregnancy is called a stillborn child. The mother ‘s health, age, lifestyle, and certain genetic factors are some of the reasons for it.
Is labetalol safe for pregnancy?
Pregnancy is a time when you need to stay in good health to keep all the complications at bay. It is a well-known fact that labetalol is considered effective in lowering high blood pressure during pregnancy, but one must remain very careful about its probable side-effects as well.
Is it important to weigh labetalol?
It is, therefore, important to weigh how necessary labetalol is to your health against any possible risk that you or your baby might be in. Ultimately, the decision to start, stop, continue or change any medicine should be made in consultation with your healthcare provider.
Can labetalol cause a stuffy nose?
A regular dosage of the medicine can, in some rare cases, cause an upset stomach. Some rare cases also experience a stuffy nose as a side-effect. Sometimes, it might cause tingling in the ...
Is lbetalol safe for hypertension?
Labetalol is safe as a medicine for hypertension. Nevertheless, one should be careful before taking the medicine and follow the instructions given by the doctor.
What are the factors that determine the placental transfer of anesthetics?
Placental transfer depends on three factors: (1) pKa, (2) maternal and fetal pH, and (3) degree of protein binding. Except for chloroprocaine, fetal acidosis produces higher fetal-to-maternal drug ratios because binding of hydrogen ions to ...
Can intravenous drugs cross the placenta?
Intravenous agents readily cross the placenta and can be detected in the fetal circulation. With the exception of benzodiazepines, fetal affects are limited by drug distribution, metabolism, and possibly placental uptake. Opiates readily cross the placenta, but their effects on neonates at delivery vary considerably.
How many pregnancies were exposed to methyldopa?
We identified 515 pregnancies exposed to methyldopa ( table 3 ). We found 61 children born SGA, 216 preterm births and four perinatal deaths among these pregnancies. We found a positive association between children born SGA and exposure to methyldopa, and between methyldopa exposure and increased risk of preterm birth. Exposure to methyldopa during pregnancy was not significantly associated with perinatal mortality ( table 3 ).
When is perinatal mortality defined?
Perinatal mortality was defined as either death occurring within the first 28 days of life or stillbirth. Before 2004, fetal deaths were recorded as stillbirths if they occurred after 28 weeks of gestation, but since then stillbirth is recorded for deaths after 22 gestational weeks. 20.
Is labetalol safe during pregnancy?
Our findings show that labetalol is not safer than other β-blockers during pregnancy.
Is there contradictory evidence regarding the consequences of blocker treatment during pregnancy?
There is contradictory evidence concerning the consequences of β-blocker treatment during pregnancy.
Can you adjust for treatment indication and severity of maternal disease?
Given the study design, we were not able to adjust for treatment indication and severity of maternal disease nor were we able to rule out confounding by indication, the underlying maternal disease, as a possible explanation for our findings.
Does a blocker increase the risk of birth?
Redeeming prescriptions of β-blockers was found to be significantly associated with increased risk of being born SGA, preterm birth and perinatal mortality.
What drugs cross the placenta?
All inhalational agents and most intravenous agents used by anesthesiologists will cross the placenta – inhalational agents cause very little fetal depression if used at < 1 MAC and delivery occurs within 10 mins of induction. Thiopental, propofol, benzodiazepines, and ketamine all cross the placenta, although only benzodiazepines are noted to produce significant fetal effects. Opiates all cross the placenta to some extent (amount is variable) – from a respiratory standpoint, newborns are most sensitive to maternal morphine. Fentanyl appears to be safe if given at < 1 ucg/kg. Epidural opiates produce minimal effects. Ephedrine, B-blockers, vasodilators, metoclopramide, and atropine cross the placenta, although glycopyrrolate (which also does not pass the blood-brain barrier) does not
How much blood does the uterus receive?
Uterine Blood Flow. The uterine arteries provide the uterus with ~ 700 cc/min of maternal blood. The placenta is supplied by two umbilical arteries from the fetus. The fetus receives oxygenated blood from the placenta through a single umbilical vein.
Why is a pregnant woman hypoosmotic?
While pregnant women are hypoosmotic due to decreased plasma protein concentrations , the fetus still has 50% less protein than its mother. The implications of this in terms of placental transfer are unclear, however it is certain that highly protein-bound drugs (ex. bupivacaine) are found in higher maternal (as opposed to fetal) concentrations
Do non-ionized drugs cross the placenta?
Non-ionized drugs tend to cross the placenta more easily than ionized drugs, however the fetus usually has a lower pH than the mother, leading to “ion trapping.”
Does MW 1000 cross the placenta?
Most drugs with MW < 500 Da cross the placenta, and most drugs with MW > 1000 Da do not cross the placenta (ex. heparin, protamine, insulin). Neither succinylcholine (highly ionized) or non-depolarizing NMBDs (high molecular weights) cross the placenta.
Does epinephrine prolong lidocaine?
Epinephrine has a differential effect on various anesthetics, substantially prolonging both lidocaine and mepivacaine and having a relatively minor effect (if any) on bupivacaine and ropivacaine.
Can maternal stress increase NE?
Data from pregnant sheep suggest that matern al stress can lead to increased native NE production and subsequently reduced uterine blood flow [Shnider SM et al. Anesthesiology 50: 524, 1979], suggesting that a regional technique may help preserve oxygen delivery to the fetus
Administration
Mechanism of action
Chemistry
- Labetalol hydrochloride (HCl) is a racemate chemically designated as 2-hydroxy-5-[1-hydroxy-2-[(1-methyl-3-phenylpropyl)amino]ethyl]benzamide monohydrochloride and it has the following structure: Labetalol HCl has the empirical formula C19H24N2O3HCl and a molecular weight of 364.9. It has two asymmetric centers and therefore exists as a molecular complex of two diaste…
Description
- Labetalol HCl is a white or off-white crystalline powder, soluble in water. Labetalol hydrochloride injection is a clear, colorless to light yellow, aqueous, sterile, isotonic solution for intravenous (IV) injection. It has a pH range of 3.0 to 4.5. Each mL contains 5 mg Labetalol hydrochloride USP, 45 mg anhydrous dextrose, 0.10 mg edetate disodium; 0.80 mg of methylparaben and 0.10 mg of p…
Effects
- Labetalol HCl produces dose-related falls in blood pressure without reflex tachycardia and without significant reduction in heart rate, presumably through a mixture of its alpha- and beta-blocking effects. Hemodynamic effects are variable, with small, nonsignificant changes in cardiac output seen in some studies but not others, and small decreases in total peripheral resistance. Elevate…
Signs and symptoms
- Due to the alpha1-receptor blocking activity of Labetalol HCl, blood pressure is lowered more in the standing than in the supine position, and symptoms of postural hypotension can occur. During dosing with intravenous Labetalol HCl, the contribution of the postural component should be considered when positioning the patient for treatment, and the p...
Pharmacology
- In a clinical pharmacologic study in severe hypertensives, an initial 0.25 mg/kg injection of Labetalol HCl administered to patients in the supine position decreased blood pressure by an average of 11/7 mmHg. Additional injections of 0.5 mg/kg at 15 minute intervals up to a total cumulative dose of 1.75 mg/kg of Labetalol HCl caused further dose-related decreases in blood …
Results
- Similar results were obtained in the treatment of patients with severe hypertension who required urgent blood pressure reduction with an initial dose of 20 mg (which corresponds to 0.25 mg/kg for an 80 kg patient) followed by additional doses of either 40 mg or 80 mg at 10 minute intervals to achieve the desired effect, or up to a cumulative dose of 300 mg.
Side effects
- Exacerbation of angina and, in some cases, myocardial infarction and ventricular dysrhythmias have been reported after abrupt discontinuation of therapy with beta-adrenergic blocking agents in patients with coronary artery disease. Abrupt withdrawal of these agents in patients without coronary artery disease has resulted in transient symptoms, including tremulousness, sweating, …
Medical uses
- Although beta-adrenergic receptor blockade is useful in the treatment of angina and hypertension, there are also situations in which sympathetic stimulation is vital. For example, in patients with severely damaged hearts, adequate ventricular function may depend on sympathetic drive. Beta-adrenergic blockade may worsen A-V block by preventing the necessary facilitating effects of sy…
Uses
- Labetalol hydrochloride injection is indicated for control of blood pressure in severe hypertension.
Contraindications
- Labetalol hydrochloride injection is contraindicated in bronchial asthma, overt cardiac failure, greater-than-first-degree heart block, cardiogenic shock, severe bradycardia, other conditions associated with severe and prolonged hypotension, and in patients with a history of hypersensitivity to any component of the product (see WARNINGS). Beta-blockers, even those w…
Treatment
- In patients with latent cardiac insufficiency, continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of impending cardiac failure, patients should be fully digitalized and/or be given a diuretic, and the response should be observed closely. If cardiac failure continues despite adequ…
Risks
- Several deaths have occurred when Labetalol hydrochloride injection was used during surgery (including when used in cases to control bleeding).
Interactions
- A synergism between Labetalol HCl and halothane anesthesia has been shown (see PRECAUTIONS: Drug Interactions). Drugs possessing beta-blocking properties can blunt the bronchodilator effect of beta-receptor agonist drugs in patients with bronchospasm; therefore, doses greater than the normal antiasthmatic dose of beta-agonist bronchodilator drugs may be …
Prevention
- Since Labetalol hydrochloride injection may be administered to patients already being treated with other medications, including other antihypertensive agents, careful monitoring of these patients is necessary to detect and treat promptly any undesired effect from concomitant administration.
Adverse effects
- In one survey, 2.3% of patients taking Labetalol HCl orally in combination with tricyclic antidepressants experienced tremor as compared to 0.7% reported to occur with Labetalol HCl alone. The contribution of each of the treatments to this adverse reaction is unknown, but the possibility of a drug interaction cannot be excluded.