- Discussion:
- combined alpha & beta blocking agent that may be given IV w/o intrarterial monitoring;
- for HTN, for HTN emergencies w/ IV therapy;
- may also be used for aortic dissection;
- for myocardial infarction:
- reduces mortality and infarct size and is recommended unless there are specific contraindicated;
- Dosing:
- adult: HTN: 100mg PO bid initially; then increase by 100mg bid q 3 days;
- maintenance: 200-400mg PO bid;
- continuous infusion is given at rate of 1-2 mg/min IV w/ max daily dose of 2400 mg;
- HTN emergency: 20mg IV (slow injection);
- may repeat with 20-80 mg q 10 min upto max dose of 300 mg IV;
- misc:
- maximum effect occurs w/in 5 min of IV injection;
- t1/2 = 5-8hrs
- Precautions:
- contraindicated w/: bronchial asthma, severe bradycardia, second or third degree block, overt cardiac failure, cardiogenic shock;
- must decrease dosage in with hepatic dysfunction;
- use with caution when administering to patients w/:
- pheochromocytoma (increased risk of paradoxical hyper-tensiveresponse)
- diabetes (blunted signs of hypoglycemia)
- cimetidine (increased bioavailability of labetolol)
- tricyclic antidepressants (increased tremor)
- nitrates (blunting of reflex tachycardia associatted w/ hypotension)