title: Labetalol - Neonatal Intensive Care Drug Manual
text: |
  Neonatal Intensive Care Drug Manual
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  bet | 332/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Labetalol
  Revision Date : 07/12/2020
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  Approved: NS , KOH
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  Indication:
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  1)Hypertension.
  2) and 3) Hypertensive emergency/urgency
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  Dose:
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  1)Oral dose:
  Initial dose is 1-3 mg/kg/day
  Maximum oral dose is 10 mg/kg/day
  2)Intravenous bolus dose:
  0.2-1 mg/kg/dose over 2 minutes (maximum 10 mg/minute), can be repeated in 10 minutes if required.
  3) Continuous Intravenous Infusion: 0.25 to 3 mg/kg/hour. Initiate at lower dose and titrate up slowly
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  Interval:
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  1)Oral dose: 12 hourly (it can be prescribed 6 hourly if dose needs to be increased).
  2)Intravenous bolus can be repeated in 10 minutes if required.
  3)Intravenous infusion: Initiate at lower end of range and titrate up slowly.
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  Route:
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  1)Oral
  2) and 3) Intravenous
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  Total Daily Dose:
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  1)Oral dose: up to 10 mg/kg/day (maximum 1200mg/day)
  2)IV bolus: maximum 40 mg/dose
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  Comments:
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  Alpha-beta blocking agent.
  Contraindicated in asthma.
  Contraindicated in uncompensated cardiac failure.
  Use with caution, if at all, in patients with cardiac failure and conduction disorders(heart block greater than first degree).
  ECG monitoring and BP monitoring recommended during IV administration. Patient should remain supine up to 3 hours post dose.
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  Side effects:
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  Hypotension (>10%)
  Rare (1% to 10%): arrythmia, oedema, skin rush, vomits, feeding intolerance, increased serum transaminases, increased levels of serum creatinine and urea, wheezing.
  Very rare (<1%): bradycardia, bronchospasm, cardiac failure, angioedema, anaphylactoid reaction, fever, jaundice, hepatitis, 2 cases of myopathy have been described in children.
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  Supplied as:
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  1)Oral tablets: 100 mg and 200 mg.
  2)Intravenous solution: ampoule contains 5mg/ml
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  Dilution:
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  1)Oral: Pharmacy will prepare oral doses.
  2)Infusion:
  Draw up 25 mg/Kg (5 ml/kg of the 5mg/ml solution) with Dextrose 5% or Normal Saline to make a 50ml solution. Infusion at a rate of 1ml/hour is equivalent to 0.5 mg/kg/hr).
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  Storage/Stability:
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  1)Tablets: store between 2°C and 30°C. Protect from light and moisture.
  2)Injectable: Store between 20°C and 25°C. Do not freeze. Protect from light.
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  Incompatibility (IV solution):
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  Sodium Bicarbonate, Albumin, Aciclovir, Benzylpenicillin, Cefotaxime, Ceftriaxone, Dexamethasone, Furosemide, Heparin Sodium, Hydrocortisone, Ibuprofen, Insulin (Actrapid), Piperacillin-Tazobactam.
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  Compability (IV solution)
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  Glucose 5%, Normal Saline, Amikacin, Ampicillin, Calcium chloride/gluconate, Ceftazidime, Dexmedetomidine, Dobutamine, Dopamine, Fentanyl, Ganciclovir, Gentamicin, Insulin (Novorapid), Magnesium Sulfate, Metronidazole, Midazolam, Morphine, Noradrenaline, Potassium Chloride, Ranitidine, Trimethprim-sulfamethoxazole, Vancomycin
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  Serum Levels :
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  References:
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  Uptodate 2020.
  Drug Doses. Frank Shann, 17th Edition, 2017.
  Australian Injectable Drugs Handbook, 8th Edition.
  Therapy of Acute Hypertension in Hospitalized Children and Adolescents. Curr Hypertens Rep. 2014 Ap; 16 (4): 425
  Management of Severe Hypertension in the Newborn. Arch Dis Child 2017; 102: 1176-1179.
  Neonatal Hypertension. Neoreviews; Vol 18; Number 6; June 2017.
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  Original version Date: 9/1/2014
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  Author: AK, JD
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  Current Version number: 2
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  Version Date: 7/12/2020
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  Risk Rating: Low
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  Due for Review: 7/12/2025
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  Approved by: DTC
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  Approval Date: TBA
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