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Labetalol has been identified as a high-alert medication with a heightened risk of causing significant patient harm when used in error.undefined#ref13">13
Route tubes and catheters having different purposes in different, standardized directions (e.g., IV lines routed toward the head; enteric lines toward the feet).11
Take steps to eliminate interruptions and distractions during medication preparation.
Labetalol is used to treat blood pressure (BP) elevations that accompany hypertensive disorders of pregnancy. A combined alpha- and beta-adrenergic blocking agent, labetalol reduces systemic vascular resistance without reducing total peripheral blood flow and has very little effect on cerebral circulation. This results in decreased BP without a substantial decrease in cardiac output.6 Labetalol has a rapid onset and is less likely than other BP medications to cause excessive hypotension, tachycardia, and rebound hypertension.
IV labetalol is a first-line medication for the management of acute-onset, severe hypertension in pregnant patients and patients in the postpartum period.2 The medication may be administered orally, but it is generally administered in the inpatient setting via continuous infusion or by slow IV push.
Maternal vital signs and the fetal heart rate (FHR) pattern should be closely and frequently monitored after labetalol administration. The patient’s response to antihypertensive medication should be monitored closely. Antihypertensive therapy should not decrease arterial pressure too significantly or too rapidly because uteroplacental perfusion may be compromised,1,7 resulting in an interruption of fetal oxygenation with Category II (indeterminate) or Category III (abnormal) FHR characteristics.5 Antihypertensive treatment is indicated for systolic BP of 160 mm Hg or greater, diastolic BP of 110 mm Hg or greater, or both, confirmed as persistent (lasting 15 minutes or more).1,2 The target range is systolic BP of 140 to150 mm Hg and diastolic BP of 90 to 100 mm Hg.4
Contraindications to labetalol administration are active asthma, overt heart failure, greater than first-degree heart block, cardiogenic shock, and severe bradycardia.6 Active asthma is defined as:3
Additional contraindications include conditions that can cause severe, prolonged hypotension, and hypersensitivity to labetalol.6
Continuous labetalol IV infusions should be adjusted per the BP response. When the goal BP is reached, the infusion should be stopped.6 Oral labetalol should be started when the supine BP begins to rise.6
Adverse effects of labetalol that should be reported immediately include:
Some adverse effects of labetalol that are generally mild include (Table 1):6
When a secondary antihypertensive medication is given (e.g., nifedipine followed by labetalol or labetalol followed by hydralazine) and BP remains elevated, initiation of an emergency consultation from a specialist in maternal-fetal medicine, internal medicine, anesthesiology, or critical care is recommended.1,3,4
Labeling the tubing reduces the chance of misconnection, especially in circumstances where multiple IV lines or devices are in use.10
If the patient or support person expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.
See Supplies tab at the top of the page.
Do not use medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe.
Rationale: A 10-ml syringe generates lower injection pressure.9
Druzin, M. and others. (2021). Improving health care response to hypertensive disorders of pregnancy: A California Maternal Quality Care Collaborative (CMQCC) quality improvement toolkit. Retrieved November 30, 2023, from https://www.cmqcc.org
Clinical Review: Aimee Hardt, MN, APRN, CNS, ACCNS-N
Published: January 2024
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