How is labetalol used to treat high blood pressure. What are the common side effects of labetalol. How should labetalol be taken and stored. What precautions should be followed when using labetalol. When should you seek medical attention while taking labetalol.

Understanding Labetalol: A Powerful Beta-Blocker for Hypertension

Labetalol, pronounced as (la bet’ a lole), is a medication that belongs to the class of drugs known as beta-blockers. Its primary use is in the treatment of high blood pressure, also known as hypertension. This powerful medication works by relaxing blood vessels and slowing heart rate, which together improve blood flow and decrease blood pressure.

High blood pressure is a widespread condition that, if left untreated, can lead to severe health complications. These may include damage to vital organs such as the brain, heart, blood vessels, and kidneys. The consequences of untreated hypertension can be dire, potentially resulting in heart disease, heart attacks, heart failure, stroke, kidney failure, loss of vision, and various other health issues.

How does labetalol work to lower blood pressure?

Labetalol functions by blocking both alpha and beta receptors in the body. This dual action results in:

• Relaxation of blood vessels, reducing resistance to blood flow
• Slowing of the heart rate, decreasing the workload on the heart
• Reduction in the force of heart contractions, further lowering blood pressure

This combined effect makes labetalol particularly effective in managing hypertension.

Dosage and Administration of Labetalol

Labetalol is typically available as an oral tablet. The usual dosing schedule is two to three times daily, although this can vary based on individual patient needs and doctor recommendations. To ensure consistent blood levels and optimal effectiveness, it’s crucial to take labetalol at approximately the same times each day.

What is the typical dosage for labetalol?

The dosage of labetalol can vary depending on several factors, including:

1. The severity of hypertension
2. Patient’s age and overall health
3. Response to initial treatment
4. Presence of other medical conditions

It’s essential to follow your doctor’s prescription carefully and not adjust the dosage without consulting them first.

Remember that labetalol is a long-term treatment for hypertension. It controls high blood pressure but does not cure it. Therefore, it’s crucial to continue taking the medication even if you feel well. Abruptly stopping labetalol can lead to serious heart problems, including angina (chest pain) or heart attack.

Other Medical Uses of Labetalol

While primarily prescribed for hypertension, labetalol has found applications in treating other medical conditions as well. These additional uses showcase the versatility of this medication in managing various cardiovascular issues.

Can labetalol be used to treat conditions other than hypertension?

Yes, labetalol has been found effective in treating:

• Angina (chest pain): Labetalol can help reduce the frequency and severity of angina attacks by decreasing the heart’s workload.
• Tetanus: In some cases, labetalol is used as part of the treatment regimen for patients with tetanus, helping to manage associated cardiovascular symptoms.

It’s important to note that these are off-label uses, and the decision to prescribe labetalol for these conditions is made by healthcare professionals based on individual patient needs and circumstances.

Precautions and Considerations When Taking Labetalol

Before starting labetalol treatment, it’s crucial to inform your healthcare provider about your complete medical history and any medications you’re currently taking. This information helps prevent potential drug interactions and ensures the safe use of labetalol.

What should you tell your doctor before taking labetalol?

Be sure to inform your healthcare provider about:

• Any allergies to labetalol, other medications, or ingredients in labetalol tablets
• All prescription and over-the-counter medications, vitamins, nutritional supplements, and herbal products you’re taking
• Any history of heart, kidney, or liver disease
• Asthma or other lung diseases
• Severe allergies
• Diabetes
• Pheochromocytoma (a tumor that develops on a gland near the kidneys)
• Pregnancy, plans to become pregnant, or if you’re breastfeeding

This comprehensive information allows your doctor to make informed decisions about your treatment and adjust dosages if necessary.

Potential Side Effects of Labetalol

Like all medications, labetalol can cause side effects. While not everyone experiences these effects, it’s important to be aware of potential reactions and know when to seek medical attention.

What are the common side effects of labetalol?

Common side effects of labetalol may include:

• Dizziness
• Tingling scalp or skin
• Lightheadedness
• Excessive tiredness
• Headache
• Upset stomach
• Stuffy nose

These side effects are usually mild and often subside as your body adjusts to the medication. However, if these symptoms persist or worsen, it’s advisable to consult your healthcare provider.

Are there any serious side effects to watch out for?

While rare, some side effects of labetalol can be serious and require immediate medical attention. These include:

• Shortness of breath or wheezing
• Swelling of the feet and lower legs
• Sudden weight gain
• Chest pain

If you experience any of these symptoms, contact your doctor immediately or seek emergency medical care.

Proper Storage and Handling of Labetalol

Proper storage of labetalol is crucial to maintain its effectiveness and ensure safety. Following the right storage guidelines can help prevent accidental ingestion and maintain the medication’s potency.

How should labetalol be stored?

To properly store labetalol:

• Keep the medication in its original container
• Ensure the container is tightly closed
• Store at room temperature, away from excess heat and moisture
• Keep out of reach of children
• Do not store in the bathroom, where humidity levels can be high

Proper storage not only maintains the medication’s effectiveness but also prevents accidental ingestion, especially by children.

Lifestyle Modifications to Complement Labetalol Treatment

While labetalol is an effective medication for managing high blood pressure, it’s most effective when combined with healthy lifestyle choices. These modifications can enhance the medication’s effects and contribute to overall cardiovascular health.

What lifestyle changes can help manage high blood pressure alongside labetalol?

To maximize the benefits of labetalol treatment, consider implementing the following lifestyle changes:

1. Adopt a low-fat, low-salt diet: Reducing sodium and saturated fat intake can help lower blood pressure
2. Maintain a healthy weight: Excess weight puts additional strain on your heart and blood vessels
3. Exercise regularly: Aim for at least 30 minutes of moderate physical activity most days of the week
4. Quit smoking: Smoking increases blood pressure and damages blood vessels
5. Limit alcohol consumption: Excessive alcohol intake can raise blood pressure
6. Manage stress: Chronic stress can contribute to hypertension, so find effective stress-management techniques

These lifestyle modifications, when combined with labetalol treatment, can significantly improve blood pressure control and overall cardiovascular health.

Monitoring and Follow-up While on Labetalol

Regular monitoring is crucial when taking labetalol to ensure the medication is working effectively and to catch any potential side effects early. Your healthcare provider will likely schedule follow-up appointments to assess your progress and make any necessary adjustments to your treatment plan.

How often should blood pressure be checked while taking labetalol?

The frequency of blood pressure checks can vary depending on individual circumstances, but generally:

• Initially, your doctor may recommend more frequent checks, possibly weekly
• Once your blood pressure stabilizes, checks may be reduced to once every few weeks or monthly
• Home blood pressure monitoring can be beneficial, with results shared with your healthcare provider
• Regular follow-up appointments with your doctor are crucial for comprehensive evaluations

Remember, consistent monitoring helps ensure that labetalol is effectively managing your blood pressure and allows for timely adjustments to your treatment plan if needed.

In conclusion, labetalol is a powerful and effective medication for managing hypertension and certain other cardiovascular conditions. While it can significantly improve blood pressure control, it’s most effective when combined with healthy lifestyle choices and regular medical follow-ups. Always follow your healthcare provider’s instructions carefully, be aware of potential side effects, and don’t hesitate to ask questions or report concerns about your treatment. With proper use and monitoring, labetalol can be an invaluable tool in maintaining cardiovascular health and preventing the serious complications associated with uncontrolled high blood pressure.

Labetalol: MedlinePlus Drug Information

pronounced as (la bet’ a lole)

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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.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Labetalol comes as a tablet to take by mouth. It usually is taken two or three times a day. To help you remember to take labetalol, take it around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take labetalol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Labetalol controls high blood pressure but does not cure it. Continue to take labetalol even if you feel well. Do not stop taking labetalol without talking to your doctor. If you suddenly stop taking labetalol, you may experience serious heart problems such as angina (chest pain) or heart attack.

Labetalol is also used sometimes to treat angina (chest pain) and to treat patients with tetanus. Talk to your doctor about the possible risks of using this medication for your condition.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking labetalol,

• tell your doctor and pharmacist if you are allergic to labetalol, any other medications, or any ingredients in labetalol tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: medications for high blood pressure or heart disease; cimetidine; nitroglycerin; and medications for asthma, headaches, allergies, colds, or pain.
• tell your doctor if you have or have ever had heart, kidney, or liver disease; asthma or other lung diseases; severe allergies; diabetes; or pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heartbeat).
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking labetalol, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking labetalol.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• remember that alcohol can add to the drowsiness caused by this medication.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Labetalol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• tingling scalp or skin
• lightheadedness
• excessive tiredness
• headache
• upset stomach
• stuffy nose

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• shortness of breath or wheezing
• swelling of the feet and lower legs
• sudden weight gain
• chest pain

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

• Normodyne^®¶
• Trandate^®¶

• Normozide^® (containing Labetalol, Hydrochlorothiazide)^¶
• Trandate HCT^® (containing Labetalol, Hydrochlorothiazide)^¶

^¶ This branded product is no longer on the market. Generic alternatives may be available.

Last Revised – 01/15/2018

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Labetalol – StatPearls – NCBI Bookshelf

Michael Miller; Connor C. Kerndt; Christopher V. Maani.

Author Information and Affiliations

Last Update: July 12, 2022.

Continuing Education Activity

Due to their negative inotropic and chronotropic actions, beta-adrenergic receptor antagonists are typically indicated in individuals with chronic cardiovascular disease (hypertension, coronary artery disease, congestive heart failure) with a significant reduction in mortality. The FDA-approved indication for labetalol is to treat 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. This activity covers labetalol, including mechanism of action, pharmacology, adverse event profiles, eligible patient populations, contraindications, monitoring, and highlights the role of the interprofessional team in the management of labetalol therapy.

Objectives:

• Identify the indications for clinicians to use labetalol.

• Explain the mechanism of action of labetalol.

• Review the contraindications to labetalol therapy.

• Summarize how interprofessional team strategies can improve patient results in cases where labetalol therapy is indicated.

Access free multiple choice questions on this topic.

Indications

Due to their negative inotropic and chronotropic actions, beta-adrenergic receptor antagonists (e.g., carvedilol and metoprolol) are typically indicated in individuals with chronic cardiovascular disease (hypertension, coronary artery disease, congestive heart failure) with a significant reduction in mortality.[1]

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.

Labetalol is often chosen as treatment of acute hypertension by anesthesia providers peri-operatively as it produces a dose-related decrease in blood pressure without reflex tachycardia without significant reduction in heart rate. These effects are produced through a mixture of its alpha- and beta-blocking effects. The hemodynamic effects of labetalol are variable, with small, insignificant changes in cardiac output seen in some studies and small decreases in total peripheral vascular resistance. This hemodynamic profile is favorable in the perioperative setting when the anesthesia provider desires rapid reduction of blood pressure without the reflex tachycardia, which can potentially further compromise a patient’s hemodynamics under general anesthesia. 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. 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]

Due to the alpha1-receptor antagonistic activity of labetalol, blood pressure is lowered more in the standing than in the supine position, but this can lead to symptoms of postural hypotension. When deciding to administer intravenous labetalol, the postural component needs to be considered when positioning the patient for treatment. Also, the patient should not be allowed to move to an erect position unmonitored until their ability to do so safely is established.

Mechanism of Action

Labetalol is useful as it contains both selective, competitive, alpha1-adrenergic antagonism and non-selective, competitive, beta-adrenergic (B1 and B2) blocking activity in a single agent. When analyzed in the laboratory, the activity ratio of alpha to beta-blockade has been estimated to be approximately 1 to 3 and 1 to 7 following oral and intravenous (IV) administration, respectively.[5]

Administration

For acute hypertensive events (emergent/urgent), the IV formulation is indicated and an initial dose of a 10- to 20-mg IV push, with repeat boluses administered every 10 minutes until the systolic blood pressure is within the desired range or a maximum dose of 300 mg per 24-hour period is reached. A dose of 20 mg correlates with approximately 0.25 mg/kg in an 80-kg patient. A continuous infusion can also be considered and initially started at 0.5 to 2 mg per minute with the potential to titrate up to 10 mg per minute.[1]

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.

For a hypertensive emergency in pregnancy (systolic BP equal to 160 mm Hg or diastolic BP equal to 110 mm Hg), which is officially an off-label use, the initial dosing scheme is reportedly very similar to treating non-pregnant patients with acute hypertension with 20 mg as an initial dose. If blood pressure still exceeds this threshold, it is reasonable to consider increasing the dose every 10 minutes in increments of 20 to 40 mg to a maximum single dose of 80 mg. A maximum total cumulative dose of 300 mg is still recommended in this scenario.

Adverse Effects

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]

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]

Contraindications

As a member of the beta-blocker class, labetalol is contraindicated, and its use is strongly cautioned in patients with bronchial asthma, overt cardiac failure, greater-than-first­ degree heart block, cardiogenic shock, severe bradycardia, as well as other conditions associated with severe and prolonged hypotension. Of course, it should be avoided in patients with a history of hypersensitivity to any component of the drug formulation to avoid any degree of allergic reaction.[8]

Monitoring

There are no specific drug monitoring requirements for labetalol. As it is typically used for severe acute hypertension and not chronic use, no monitoring is necessary. Also, it is a safe drug with a large margin of safety, with dosing permitted to an upper limit of 300 mg per day.[9]

Toxicity

Supportive care and close monitoring are the staples of treatment for an overdose of beta-blockers with the addition of glucagon for severe refractory hypotension and bradycardia.

Glucagon provides several important clinical effects when used for beta-blocker overdose. It provides an increase in HR and improves both myocardial contractility as well as atrioventricular conduction. Its MOA seems to be independent of the beta-adrenergic binding site allowing it to be effective. The recommended initial dose of glucagon to reverse severe symptomatic beta-blockade is 50 mcg/kg IV as a loading dose, followed by an infusion of 1 to 15 mg per hour IV, titrated to clinical response and improvement.[10]

Enhancing Healthcare Team Outcomes

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]

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References

1.

Peacock WF, Hilleman DE, Levy PD, Rhoney DH, Varon J. A systematic review of nicardipine vs labetalol for the management of hypertensive crises. Am J Emerg Med. 2012 Jul;30(6):981-93. [PubMed: 21908132]

2.

Muzzi DA, Black S, Losasso TJ, Cucchiara RF. Labetalol and esmolol in the control of hypertension after intracranial surgery. Anesth Analg. 1990 Jan;70(1):68-71. [PubMed: 1967515]

3.

Elatrous S, Nouira S, Ouanes Besbes L, Marghli S, Boussarssar M, Sakkouhi M, Abroug F. Short-term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol. Intensive Care Med. 2002 Sep;28(9):1281-6. [PubMed: 12209278]

4.

Duley L, Henderson-Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD001449. [PubMed: 16855969]

5.

Baum T, Sybertz EJ. Pharmacology of labetalol in experimental animals. Am J Med. 1983 Oct 17;75(4A):15-23. [PubMed: 6314811]

6.

Ågesen FN, Weeke PE, Tfelt-Hansen P, Tfelt-Hansen J., for ESCAPE‐NET. Pharmacokinetic variability of beta-adrenergic blocking agents used in cardiology. Pharmacol Res Perspect. 2019 Aug;7(4):e00496. [PMC free article: PMC6624454] [PubMed: 31338197]

7.

Facchini E, Degiovanni A, Cavallino C, Lupi A, Rognoni A, Bongo AS. Beta-Blockers and Nitrates: Pharmacotherapy and Indications. Cardiovasc Hematol Agents Med Chem. 2015;13(1):25-30. [PubMed: 25544116]

8.

Morales DR, Jackson C, Lipworth BJ, Donnan PT, Guthrie B. Adverse respiratory effect of acute β-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials. Chest. 2014 Apr;145(4):779-786. [PubMed: 24202435]

9.

Ahuja K, Charap MH. Management of perioperative hypertensive urgencies with parenteral medications. J Hosp Med. 2010 Feb;5(2):E11-6. [PubMed: 20104635]

10.

Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003;41(5):595-602. [PubMed: 14514004]

Disclosure: Michael Miller declares no relevant financial relationships with ineligible companies.

Disclosure: Connor Kerndt declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Maani declares no relevant financial relationships with ineligible companies.

Drug list – SCS Clinic

Second generation antipsychotics:

asenapine, safris, saphris, asenapine, aripiprazole, amdoal, abilify, abilify, ariprizol, abizol, arip, ariprazol, aripradex, zicalor, zilaxera, aripiprazole, amdoal, abilify, abilify, ariprizol, abizol, arip, ariprazole, aripradex, zicalor, zilaxera, ziprasidone, zeldox, zipsila, ziprasidon, cariprazine, reagila, cariprazinum, reagila, quetiapine, seroquel, quetiapine, ketilept, kumental, quetiapine-C3, quetiapine , quetiapin San , quetiapine-Vial, quetiapine canon, quetiapine canon prolong, quetiapine-VERTEX, quetiapine-alium-prolong, quetiapine avexima, ketilept, servitor, quentiax, laquel, seroquel prolong, seroquel, victoel, ketiap, quetiapine hemifumarate, quetiapine f umarat, hedonin, cutipin, quetitex, quentiax SR, cupinex, quetitex prolong, clozapine, azaleptin, leponex, clozapine-pharmaplant, clozapine avexima, azaleptin, closasten, azaleptol, azaleptin granules for children, clozalan, lurasidone, latuda, lurasidone, olanzapine, zyprexa, relprevv, zyprexa, zadagio, zalasta, olanklein, parnasan, egolanza, olanzapine-TL, olanzapine-Teva, olanzapine Canon, olanzapine-Vial, olanzapine-SZ, olanzapine-ALSI, olanzapine Medisorb, zalasta Ku-tab, zidis, paliperidone, invega, paliperidonum , xeplion, heplion, trevicta, trevicta, risperidon, rispolept, rispolept Konsta, torendo KU-TAB, sedarex, dozic, raxidon, respidon, respirox, ridonex, rileptid, rispaxol, risperon, risperon, rispolux, rispons, sisodon, torendo, torendo Ku-tab, eperon, leptinorm, risset kvitab, rilept, risset, rispolux, speridan risdonal, rispolept, rispolept, quicklet, torendo, rispaxol, rezalen, rispen, risperidone organic, risperidone-TL, risperidon Canon, risperidone-SZ, risperidone- VERTEX, risperidone-Krka, rileptid

First generation antipsychotics:

Haloperidol, Haldol, Haloperidol-decanoate, Senorm, Aloperidin, Haldol, Serenaz, Halofen, Halidol, Haloperidin, Haloperin, Halopidol, Haloperidol-Acri, Haloperidol-ratiopharm, Haloperidol-Fer ein, haloperidol-ALSI, haloperidol-welfarm, apo-haloperidol, haloper, haloperidoli decanoati, haldol, droperidol, inapsine, inapsine, zuclopenthixol, clopixol, clopixol-depot, clopixol-acufaz, levomepromazine, levomepromazine, tizercin, nosinan, dedoran, levomazine, levomepromazine, mi nosynan, neosin non -rotoril, non -zerocil, synogan, veichyl, metroimeprain, luxapine, luxean, locapine, lociitane, mesoridazine, serentil, molindol, moban, moban, perfenazin, ethaperazin, perphenazine, perfenazin hydrochloride, chlorpiprin, three Lafon, chlorpiprosine, decentan, neuropax, perfenan, trilifan, pimozide, pimozide, prochlorperazine, compazine, prochlorperazine, thioridazine, melleryl, thioryl, thioridazine, thiodazine, tyson, thioridazine, thiodazine, tyson, sonapax, thiothixene, navane, thiothixenum, trifluoperazine, stelazine, triftazine , trifluoperazine- Apo, eskasin, trazine, triftazin-Darnitsa, triftazine hydrochloride, fluphenazil, moditen-depot, cobrin, prolinate, chlorpromazine, chlorpromazine, chlorprothixene, taractan, truxal, chlorprothixene hydrochloride, tarazan, vetakalm, clothixen, minithixen, taktaran, taraktan, trictal, truxil, etoprpazine, parzidol, propazine, promazine

Barbiturates, benzodiazepine tranquilizers, benzodiazepines, anxiolytic, anxiolytics, tranquilizers, dopaminomimetics:

alprazolam alprazolam, xanax, xanax, zolomax, zolomaks, helex , barbital, bromazepam, brotizolam, diazepam, zolpidem, clonazepam , lorazepam, medazepam, mesocarb, meprobamate, midazolam, nitrazepam, oxazepam, temazepam, tetrazepam, phenobarbital, flunitrazepam, flurazepam, chlordiazepoxide, estazolam, zaleplon, sonata, zaleplon, andante, rofen, selofen, zolpidem, zolpidem , ambien, nitrest, ivadal , hypnogen, solsana, zonadine, oniria, sanval, snovitel, clonazepam, clonazepam, klonopin, clonotril, rivotril, clorazepate, tranxene, dipotassium clorazepate, dipotassium clorazepate, tranxene, apoclorazepate, lorazepam, lorafen, merlit, loram, merlit , trapex , u-pan, sodium hydroxybutyrate, sodium oxybate, nitrous oxide, propofol, aquafol, diprivan, diprofol, recofol, oxazepam, serax, serax, tazepam, nozepam, suvorexant, belsomra, suvorexantum, temazepam, signopam, mezapam, nobritem, rudotel, nobrium, nobrium, rudotel, medazepam, ansilan, anxitol, benson, emopan, enobrin, imazepam, medaurin, medazepol, megasedan, merlit, nivelton, pazital, stratium, tofisopam, grandaxin, triazolam, halcion, flumazenil, romazicon, anexat, flurazepam, dalmadorm, staurodorm, apo-flurazepam, chloral hydrate, somnol, imovan, donormil, reslip, aquachloral, kessodrate, lorinal, noktek, orfofarm, somnos, chloraldurate, doxylamine, valocordin-doxylamine, reslip, somnol, sonnate, milovan, zopiclone, chlordiazepoxide, elenium, chlosepide, chlordiazepoxide, elenium, thymazine, librium, napotone, eszopiclone, lunesta, somnol, imovan, normason, zopiclone, apo-zopiclone, dobroson, piclone, sovan, estazolam, millet, estazolam, buspirone, spitomin, buspirone, spitomin, ambarbital, amotal, amobarbitalum, approbatal, alurate, meiltown, Miltown, Metojesal, Brietal, Pentobarbital, Nembutal, Sekobarbital, Sekonal, Barbital, Veronal, Barbitall Solo, Veronal, Veronal-Narios, Diemal-Nemaln , Kalmin, Medinal, sodium diethylbarbiturate, natrinal, arbitalum natrium, mefobarbital, mebaral, midazolam, verse, formicum, flormidal, flormidal, fulsed, thiopental, pentothal, sodium oxybate, proanes, propofol fresenius, propofol medargo, phenobarbital, luminal, adonal, efenal, barben silt, barbifene, dormiral, epanal, episedal, fenemal, gardenal, hypnotal, mefabarbital, neurobarb, nirvonal, omnibarb, phenobarbitone, sedonal, sevenal, somonal, zadonal, corvaldin, valoserdin, valosemide, pentalgin, sedal-M, corvalol Forte, Pagluferal-3 , theofedrin-N, corvalol, sedalgin-Neo

SSRIs, SSRIs, selective serotonin and norepinephrine reuptake inhibitors:

venlafaxine, velaxin, aventa, venlafaxin-ratiopharm, venlafaxin-ALSI, venlafaxin-ORGANIC, prefaxine, dapfix, newlong, venlafaxinum, velaxor, velaxin, venlaxor, velafax, efevelone, vortioxetine, brintelix, vortioxetine, brintellix, duloxetine, simbalta, duloxent, duloxetine canon, levomilnaceprane, fezima, milnacipran, savella, savella, ixel, ixel, nefazodone, serzone, serzone, trazodon, trazodonum, trittiko, azone, beneficate, bimaran , desirel, menegan, pragmarel, sideril, tombran, trazolan, geripax, molipaxin, pragmazine, tramensan, trazone, trezine, agomelatine, valdoxan, suvorexant, belsomra, sertraline, zoloft, misol, sertraline, serenata, serlift, asentra, stimuloton, thorine , aleval, trazodone, trittiko, desyrel, oleptro, fluvoxamine, fevarin, rokona, avoxin, fluoxetine, prozac, apo-fluoxetine, bioxetine, deprex, deprenon, portal, prodep, prozac, profluzac, floxet, fluval, fluxonil, flunate, flunisan , fluoxetine hexal, fludac, frameex, fluoxetine Lannacher, fluoxetine Nycomed, fluoxetine-OBL, fluoxetine Canon, flunisan, profluzak, floxet, fluoxetine hydrochloride, escitalopram, lexapro, cipralex, elicea

Tricyclic antidepressants, tetracyclic antidepressants, antidepressants, monoamine oxidase inhibitors, MAO inhibitors nat, novo-tryptin, saroten, saroten retard , elivel, elavil, amitriptyline lechiva, amitriptyline grindeks, amitriptyline ferein, amitriptyline-LANS, amitriptyline nycomed, amitriptyline-ALSI, apo-amitriptyline, vero-amitriptyline, amoxapine, asendin, bupropion, wellbutrin, zyban, wellbutrin, buprop ion, tenofovir, emtricitabine , efavirenz, tenofovir, emtricitabine, efavirenz, isavuconazole, isavuconazole, metformin, sitagliptin, metformin, sitagliptin, tipranavir, tipranavir, ranolazine, ranolazine, vemurafenib, vemurafenib, eliglustat, eliglustat, elsulfavirin, ulfavirine, desipramine, norpramine, pertofrane, norpramin, pertofrane , desipraminum, doxepin, doxepin, adapin, adepin, sinequan, sinequan, imipramine, tofranil, imipramine, melipramine, melipramin, imizin, depsonil, priloigan, antideprin, deprenyl, deprimin, deprinol, dinapirine, imidobenzyl, imipramine hydrochloride, irmin, psychophorin, clomipramine, anafranil, anafranil SR, clofranil, maprotiline, ludiomil, maprotibene, mirtazapine, remeron, mirazep, mirzaten, mirtastadin, mirtel, esprital, mirtazapine, moclobemide, aurorix, nortriptyline, pamelor, aventyl, pamelor, aventil, nortrilene, nort riptylinum, protrimtylin , vivactil, selegiline, eldepril, trimipramine, surmontil, trimipraminum

Lithium, lamotrigine, valproate, mood stabilizers, antiepileptics, anticonvulsants:

sodium valproate, depakine chrono, depakine, sodium valproate, depakine chronosphere, depakine chrono, depakine, convulex, orfiril, valproic acid, convulex, encorate chrono, acediprol, Apilepsyn, Azedipro Syrup 5%, Azedipro, Valopixim, Valparin, Valpro, convulsopin, sodium enchorate, valproate, valproote sodium, encrate chrono, valproate sodium, depakine chronosphere, Divavloprox, Department Cat, Depakote, Gabapentin, Neurotine, Tebantin, Gabagamma, Convalis, neurotin, catena, gabapentin, gabalept, gabamax, gabantin, gabastadin, gabata, gapentec, gatonin, grimodin, meditan, neuralgin, nupintin, nyuropentin, egipentin, epigan, zonisamide, zonegran, zonisamide, zonisamide, zonegran, zonisamide, irbesartan, avapro, lithium, eskalith, lithobid, lithonate, lithium carbonate, sedalite, quilonum, litosan-SR, contemnol, camcolit, carbopax, licarb, litan, lithobid, litomyl, litonate, lithicar, litho, neurolepsin, plenum, priadel, escalite, lithicarb, lithium carbonate, litizin, terali, carbamazepine, tegretol, finlepsin, zeptol, zeptol SR, carbamax, finlepsin 200 retard, finlepsin 400 retard, tegretol, carbamazepine-Akri, carbamazepine-Nycomed, carbamazepine-Ferein, carbamazepine retard-Akrikhin, carbamaze pin-Akrikhin, carbamazepine-ALSI, carbamazepine avexima, apo-carbamazepine, mazepine, stazepin, carbapin, carbasan retard, epial, storylat, actinerval, zeptol, fimazepsin, carbalepsin retard, lamotrigine, lamiktal, lamotrigine, lamotrin, lameptil, lamiktal, lamolep, lamotriks , lamotrigine canon, lamotrigine FT, vero-lamotrigine, seisar, convulsan, lamitor, lamitor DT, lamothrix, levitiracetam, keppra, levetinol, epiterra, letiram, elsetor, tirapol, comviron, oxcarbazepine, trileptal, oxapine, oxcarbazepine, pregabalin, lyrica, pregabalin, algerica, pregabio, pregabalin-SZ, pregabalin Canon, pregabalin-native, pregabalin Medisorb, pregabalin Dr. Reddy’s, tiagabine, gabitril, topiramate, ropimat, topamax, topepsil, topiralex, zerde, topracar, topiramate-TL, topiramate Canon , topiramate-Vial, topiramate-ALSI, topamax, maxitopir, topsaver, toreal, topalepsin, topiromax, torepimat, epimax, ropimat, phenytoin, difenin

Dopamine receptor agonists and dopamine precursors, antiparkinsonian agents:

amantadine, symmetrel, midantan, neomidantan, PK-Merz, gludantan, amantadine hydrochloride, wigerite, adamantine, amandine, amantane, antadine, atarine, fluviatol, gabirol, mantadix, paramentin , protexin, virofral, virozol, pergolide, permax, apomorphine, apokin, apokyn, bromocriptine, parlodel, bromocriptine, bromocriptine-richter, abergin, bromocriptine-KV, ronalin, bromocriptine mesylate, lactodel, apo-bromocriptine, bromocriptine poly, bromergon, carbi dopa , lodosin, levodopa, laradopa, pramipexole, mirapex, pramipexole, ropinirole, ropinirole hydrochloride, sindranol, sindranol

Sympathomimetics:

armomodafinil, nuvigil, nuvigil, atomoxetine, strattera, dysmaxin, strattera, benzphetamine, didrex, didrex, dexmethylphenidate, focalin, dextroamphetamine, amphetamine, dexedrine, dextrostat, aderall, adderall, dextrostat, dexedrine, diethylpropion, tenuate, lisdexamfetamine, vyvance, mazindol, mazanor, sanorex, methamphetamine, deoxin, desoxyn, methylphenidate, ritalin, concerta, quilivant, ritalin, modafinil, provigil, provigil, pemoline, cylert

alpha2 adrenoceptor agonists, alpha1 adre antagonists noreceptors, beta-antagonists adrenoreceptors, calcium channel blockers:

amlodipine, lotrel, norvasc, normodipine, norvadin, kalchek, amlorus, amlotop, agen, amlovas, amlodimed, amlocard-sanovel, amlocardin, amlong, amlopine, asomex, cardilopin, coronim10, lopicard, lorak5, atenolol, tenor min, tenoric, toneorma, azectol, amlodac-AT, amlong-A, apo-Atenol, atenil, atenobene, atenova, atenol, atenolol, atenosan, atcardil, betadur, betacard, blockotenol, vascoten, vero-atenolol, gene-atenolol, dinoric , dinoric-darnitsa, catenol, kuxanorm, neocard-ATN, prenorm, synarome, tenoblock, tenolol, tenormin, tenochek, unilok, falitonsin, acebutolol, setral, acecor, verapamil, isoptin, calan, isoptin, veratard, verogalide EP, isoptin SR , guanfacine, tenex, intuniv, tenex, intuniv, estulik, yohimbine, yohimbine hydrochloride, yocon, clonidine, clonidine, clonidine, hemiton, proxofelin, labetalol, normodin, trandate, abetol, albetol, amipress, ipolab, labetol, labrocol, lamitol, opercol, presolol, trandat, trandol, labetalol, normodin, trandat, abetol, albetol, amipress, ipolab, labetol, labrocol, lamitol, opercol, presolol, trandat, trandol, metoprolol, lopresso, toprol, betaloc, egilok, corvitol, vasocardin, metozoc, metocard, metocor adifarm, metolol, metoprolol OBL, metoprolol Acry, emzok, nadolol, corgard, nisoldipine, sular, nicardipine, nimodipine, nitrendipine, nifedipine, adalat, procardia, cardene, nimotop, nitremed, pindolol, visken, visken, nadolol , corzid, penbutolol, metipranolol, prazosin, minipress, adverzuten, deprazolin, minipress, pratsiol, decliten, duramipress, eurex, furazonin hydrochloride, hypovas, orbizan, patsolin, peripress, prazopress, sinens, vasoflex, novo-prazin, polpressin, prazosinbene, propranolol , inderal, inderal, obzidan, anaprilin, propranolol hydrochloride, stobetin, alindol, angilol, antarol, avlocardil, bedanol, betadren, brikoran, cardinol, dederal, deralin, dociton, elanol, eliblok, naprilin, cloths, caridorol, indexex, pranol, propanur, propral, pilapron, sloprolol, tenomal, tiperal, theophylline, bronchophyllin, dercast, teotard, theophilus SR, aqualin, asmafil, lanophyllin, optifillin, oralfillin, theolix, theocin, theophene, eufillin, unikontin, teopek, neophyllin

Antiolinergics:

benztropine, cogentin, biperiden, akineton, mendilex, bezac, akineton, mendilex, biperiden, ordenadrin, norflex, disipal, orphenadrinum, trihexyphenidyl, cyclodol, apo-trihex, parkopan, romparkin

Phosphodiesterase type 5 inhibitors , potency regulators:

vardenafil, levitra, sildenafil, viagra, cialis, dynamico, vizarsin, levitra, tadalafil, cialis hydrobromide, galnora SR, galantaminum, donepezil, alzepil, kalimin 60 n, nivalin, prozerin, memantine, namenda, memaxin, akatinol memantine, noogeron, memantal, memantine, memantine-TL, memantine canon, memantine-Akrikhin, memantine avexima, memantine Velpharm, memantine-VERTEX, memantinol, memorel, noogeron, maruxa, tingrex, memaneurin, memantine hydrochloride, auranex, noogeron-teva, zemotin, revastigmine, exelon, tacrine, coqnex, citalopram, celexa

Antihistamines:

hydroxyzine, atarax, hydroxyzine hydrochloride, atarax, hydroxyzin, diphenhydramine, diphenhydramine, diphenhydramine, diphenhydramine hydrochloride, allergan B, benadryl, benzhydramine, alledryl, allergival, amidryl, diabenyl, dimedryl, dimi drill, restamine, eftimethacin, Flurex, Loratadine, Claritin, Claritin, Ligists, Laureno, Lorizan, Alerik, Lomilan, Loragexal, Clarotadin, Claridol, Clarissess, Loratadin, Loratadin 10-CMFARM, Loratadin-Eco, Loratadin-Verta, Loratadin-Bl, Loratadine, Loratadine -Teva, loratadine-Akrikhin, loratadine-VERTEX, loratadine-AKOS, loratadine-ECOlab, vero-loratadine, anvimax, allergoferon, lomilan, claridol, clarotadine, clarisens, clarifer, tirlor, erolin, alerpriv, clarinedin, clallergin, lomilan solo, loratavel, lorapridine, clarinase-12, allergoferon plus, promethazine, pipolfen, diprazine, fexofenadine, allegra, telfast, fexadine, fexofenadine, allerfex, hyphast, dinox, rapido, telfadin, cetirizine, zyrtec, parlazin, cyproheptadine, peritol

Thyroid hormones:

levothyroxine, levoxin, levotroid, synthroid, euthyrox, bagothyrox, L-thyroxine 100 Berlin-Chemie, L-thyroxine-Farmak, levothyron, liothyronine, cytomel

Angiotension receptor antagonists for II:

losartan, cozaar , lorista, angizaar, angisartan, anjoten-sanovel, blocktran, potassium losartan, lorcar, lorcar fort, losa

calcium acetyl homotaurinate, disulfiram:

antaxon, tetlong, naltrexin , antabuse, disulfiram

Labetalol – Wikipedia

Izvor: Wikipedia

, Trandat ) je mešoviti alfa/beta adrenergički antagonist, koji se koristi za tretiranje visokog krvnog pritiska. ^[6]

Koristi se kao tretman trudnoćom indukovanu hipertenziju koja je često vezana za preeklampsiju. ^{[7] [8] [9]}

Labelalol sadrži dva stereogena centra i sastoji se od četiri stereoizomera. Ovo je mješavina (“R”, “R”) -, (“S”, “R”) -, (“R”, “S”) – i ( S , S ) – oblik:

1. ↑ Li Q, Cheng T, Wang Y, Bryant SH (2010). “PubChem as a public resource for drug discovery.” Drug Discov Today 15 (23-24): 1052-7. DOI:10. 1016/j.drudis.2010.10.003. PMID 20970519. edit
2. ↑ Evan E. Bolton, Yanli Wang, Paul A. Thiessen, Stephen H. Bryant (2008). „Chapter 12 PubChem: Integrated Platform of Small Molecules and Biological Activities”. Annual Reports in Computational Chemistry 4 : 217-241. DOI:10.1016/S1574-1400(08)00012-1.
3. ↑ Hettne KM, Williams AJ, van Mulligen EM, Kleinjans J, Tkachenko V, Kors JA. (2010). „Automatic vs. manual curation of a multi-source chemical dictionary: the impact on text mining”. J Cheminform 2 (1): 3. DOI:10.1186/1758-2946-2-3. PMID 20331846. edit
4. ↑ Joanne Wixon, Douglas Kell (2000). “Website Review: The Kyoto Encyclopedia of Genes and Genomes – KEGG”. Yeast 17 (1): 48–55. DOI:10.1002/(SICI)1097-0061(200004)17:1<48::AID-YEA2>3.0.CO;2-H.
5. ↑ Gaulton A, Bellis LJ, Bento AP, Chambers J, Davies M, Hersey A, Light Y, McGlinchey S, Michalovich D, Al-Lazikani B, Overington JP. (2012). “ChEMBL: a large-scale bioactivity database for drug discovery”. Nucleic Acids Res 40 (Database issue): D1100-7. DOI:10.1093/nar/gkr777. PMID 21948594. edit
6. ↑ Fahed S, Grum DF, Papadimos TJ (2008). “Labetalol infusion for refractory hypertension causing severe hypotension and bradycardia: an issue of patient safety”. Patient Saf Surg 2 : 13. DOI:10.1186/1754-9493-2-13. PMC 2429901. PMID 18505576.
7. ↑ C. J. Pickles, E. M. Symonds, F. Broughton Pipkin (January 1989). „The fetal outcome in a randomized double-blind controlled trial of labetalol versus placebo in pregnancy-induced hypertension”. BJOG: An International Journal of Obstetrics & Gynaecology 96 (1): 38–43. DOI:10.1111/j.1471-0528.1989.tb01574.x.
8. ↑ Katzung, Bertram G. (2006). Basic and clinical pharmacology . New York: McGraw-Hill Medical. str. 170. ISBN 0-07-145153-6.
9. ↑ D A Richards, J Tuckman, and B N Prichard (October 1976). „Assessment of alpha- and beta-adrenoceptor blocking actions of labetalol”.