Page 139 - 2026 SMOG

LABETALOL (TRANDATE)
Class/Mechanism of Action
• Beta Blocker with Alpha Blocking Activity
Blocks alpha and beta /beta adrenergic receptor sites.
1
2
˚ Onset—IV: 2–5min
Indications
• Labeled Indications
˚ Treatment of severe hypertension and hypertensive emergencies
• Off-Label Indications
˚ Preeclampsia and severe hypertension in pregnancy, hypertension during acute ischemic
stroke, and pediatric hypertension
Contraindications
• Hypersensitivity to Labetalol or any component of the formulation
• Bradycardia <60 bpm, Heart block >1st degree
• Uncompensated heart failure, Cardiogenic shock
• Asthma, COPD
• Administration of non-dihydropyridine calcium channel blockers (verapamil)
Adverse Reactions/Precautions
• Symptomatic hypotension with or without syncope. Monitor EKG closely
• Use with extreme caution in patients with compensated heart failure and bradycardia
• Patients with bronchospastic diseases (reactive airway) should not use beta blockers
• May worsen, prolong, or cause hypoglycemia. Could also mask hypoglycemic symptoms
• Pregnancy: Yes, close fetal monitoring is recommended.
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Hypertension Crisis (Hypertensive Hypertension Emergencies
Emergency/Urgency) (Sys: >185/Dia: >110) • IV
• IV ˚ Intermittent Bolus: 0.2–1mg/kg have been
˚ Intermittent Bolus: 1–20mg over 1–2min. reported (max dose: 40mg/dose)
Followed by 20–80mg q10min until
Continuous Infusion: 0.25–3mg/kg/hr;
target BP is reached. Consider continuous ˚ administration requires the use of an
infusion if unable to target infusion pump
˚ Continuous Infusion: Initial loading Note: Not a first-line medication for children;
dose: 10–20mg over 2min, followed by
0.5–2mg/min (may require titration up to use with caution
10mg/min)
Note: The goal is to lower MAP by no more than
25%. Reduce MAP gradually by 10–20% over the
first hr, then by 5–15% over the next 23hr.

2026 Standard Medical Operating Guidelines (SMOG) • 131