Intravenous Labetalol Research Articles

A study on efficacy of intravenous labetalol versus oral Nifedipine in control of acute hypertension in severe pre-eclampsia/eclampsia

A Hypertensive disorder of pregnancy is one of the life threatening complication encountered in obstetrics. Management of hypertension in pregnancy is a challenging task, because drastic reduction of BP leads to uteroplacental insufficiency & that may lead to intrauterine fetal death and continuation of pregnancy with severe hypertension leads to adverse feto-maternal outcome. Therefore, there is a need for an ideal antihypertensive agents for effective control of severe hypertension in pregnancy. Our present study compares the efficacy of oral Nifedipine and IV Labetalol in reaching the therapeutic goal. From the results of our study we can well conclude that both the Labetalol & Nifedipine regimen are equally effective & well tolerated when used for the rapid control of blood pressure in severe hypertension in pregnancy.

Wrong-Patient Ordering Errors in Peripartum Mother-Newborn Pairs: A Unique Patient-Safety Challenge in Obstetrics.

Because maternal morbidity and mortality remain persistent challenges to the U.S. health care system, efforts to improve inpatient patient safety are critical. One important aspect of ensuring patient safety is reducing medical errors. However, obstetrics presents a uniquely challenging environment for safe ordering practices. When mother-newborn pairs are admitted in the postpartum setting with nearly identical names in the medical record (for example, Jane Doe and Janegirl Doe), there is a potential for wrong-patient medication ordering errors. This can lead to harm from the wrong patient receiving a medication or diagnostic test, especially a newborn receiving an adult dose of medication, as well as delaying treatment for the appropriate patient. We describe two clinical scenarios of wrong-patient ordering errors between mother-newborn pairs. The first involves an intravenous labetalol order that was placed for a postpartum patient but was released from the automated dispensing cabinet under the newborn's name. The medication was administered correctly, but an automatic order for labetalol was generated in the neonate's chart. Another scenario involves a woman presenting in labor with acute psychotic symptoms. The psychiatry service placed a note and orders for antipsychotic medications in the neonate's chart. These orders were cancelled shortly thereafter and replaced for the mother. These scenarios illustrate this specific patient-safety concern inherent in the treatment of mother-newborn pairs and highlight that perinatal units should evaluate threats to patient safety embedded in the unique mother-newborn relationship and develop strategies to reduce risk.

Clinical Experiences of Intravenous Hydralazine and Labetalol for Acute Treatment of Severe Hypertension in Pregnant Thai Women.

Response to acute treatment of severe hypertension during pregnancy in Asian women was not known. Labor and delivery checklists of Thai women treated with intravenous hydralazine or labetalol for systolic blood pressure (SBP) ≥ 160 or diastolic blood pressure (DBP) ≥ 110 mmHg from January 2011 to December 2013 were reviewed as parts of an audit. Primary outcome was prompt achievement of SBP 140-150 and DBP 90-100 mmHg after the first bolus. Secondary outcomes were medication-related undesired effects. The mean ± standard deviation age and prevalence of chronic hypertension in hydralazine (n = 62) versus labetalol (n = 64) groups were 32.5 ± 6 versus 29.9 ± 6.8 years and 50% versus 21.9%, respectively (P < .05). Magnesium sulfate was promptly administered on admission to every woman to prevent seizure. Targeted blood pressure was timely achieved in 41.9% and 67.2% of the hydralazine and labetalol groups, respectively (P < .05). Nonreassuring fetal heart rate occurred in 51.6% and 32.8% of the hydralazine and labetalol groups, respectively (P = .05). The prevalence of cesarean section and Apgar score < 7 were not significantly different (P > .05). Real-life clinical experiences suggested significant advantages of intravenous labetalol over hydralazine in pregnant women with severe hypertension.

Hemodynamic Safety of Continuous Infusion Labetalol Versus Esmolol Combination Therapies for Type B Aortic Dissections

Background: Medical management for type B aortic dissections (TBADs) require aggressive blood pressure and heart rate control to minimize further dissection extension and to restore perfusion to vital organs. Current guidelines recommend β-blockers (BB) as first-line therapy, however do not differentiate an ideal agent for use. Objective: This study evaluated the hemodynamic safety of continuous infusion labetalol compared to esmolol combination (EC) therapies for TBADs. Methods: This single-center, retrospective analysis identified patients with a TBAD who received high dose continuous intravenous labetalol (HD-CIVL) or EC therapies. Patients who received HD-CIVL or EC therapies for a minimum of 2 hours, during which a minimum of 4 blood-pressure readings were recorded, were included. The primary end point was the incidence of hemodynamic instability with the use of HD-CIVL versus EC therapies. Results: A total of 20 patients receiving HD-CIVL and 22 patients receiving EC therapy were included in the analysis. Ten (50%) of patients receiving HD-CIVL and 7 (32%) of patients receiving EC therapies met the clinical definition of hemodynamic instability (P = .23). Patients experiencing hemodynamic instability were all due to hypotension, with one also being due to bradycardia. Over half the patients in both groups had discontinued therapy ( P = .06) and were administered bolus fluids (P = .27). Only one patient receiving HD-CIVL required vasopressor administration while none in the EC group (P = .48). Conclusion: Our study suggests that HD-CIVL is associated with a nonstatistical significant higher incidence of hemodynamic instability compared to an EC regimen in TBADs. Further studies are warranted in this patient population.

Intravenous labetalol versus oral nifedipine for acute hypertension in pregnancy: effects on cerebral perfusion pressure

Pregnant women with preeclampsia have been found to have elevated cerebral perfusion pressure and impaired cerebral autoregulation compared with normal pregnant women. Transcranial Doppler is a noninvasive technique used to estimate cerebral perfusion pressure. The effects of different antihypertensive medications on cerebral perfusion pressure in preeclampsia are unknown. To compare the change in cerebral perfusion pressure before and after intravenous labetalol vs oral nifedipine in the setting of acute severe hypertension in pregnancy. This is a prospective cohort study of pregnant women between 24 and 42 weeks' gestation with severe hypertension (systolic blood pressure ≥160 mm Hg and/or diastolic blood pressure ≥110 mm Hg). Women who consented to the study and received either intravenous labetalol or oral nifedipine were included. Exclusion criteria included active labor or receipt of any antihypertensive medication within 2 hours of initial cerebral perfusion pressure measurement. Peripheral blood pressure and transcranial Doppler studies for middle cerebral artery hemodynamics were performed prior to the administration of antihypertensive medications and repeated 30 minutes after medication administration. A total of 16 women with acute severe hypertension were enrolled; 8 received intravenous labetalol and 8 received oral nifedipine. There were no significant differences between the labetalol and nifedipine groups in baseline characteristics such as maternal age, race and ethnicity, payment, hospital site, body mass index, nulliparity, gestational age, preexisting diabetes mellitus or chronic hypertension, fetal growth restriction, magnesium sulfate administration, and symptomatology (P>.05). When examined 30 minutes after the administration of either intravenous labetalol or oral nifedipine, there was a significantly greater decrease in systolic blood pressure (-9.8 mm Hg vs-39 mm Hg; P=.003), mean arterial pressure (-7.1 mm Hg vs-22.3 mm Hg; P=.02), and cerebral perfusion pressure (-2.5 mm Hg vs-27.7 mm Hg; P=.01) in the nifedipine group. There was no statistically significant decrease in diastolic blood pressure (-12.9 mm Hg vs-5.4 mm Hg; P=.15). The change in middle cerebral artery velocity by transcranial Doppler was compared between the groups and was not different (0.07 cm/s vs 0.16 cm/s; P=.64). Oral nifedipine resulted in a significant decrease incerebral perfusion pressure, whereas labetalol did not, after administration for acute severe hypertension among women with preeclampsia. This decrease seems to be driven by a decrease in peripheral arterial blood pressure rather than a direct change in cerebral blood flow.

Comparative study of oral nifedipine versus intravenous labetalol in severe hypertension in pregnancy: A randomized controlled study

To compare the efficacy of oral nifedipine with intravenous labetalol in the treatment of severe hypertension in pregnancy.It was a double-blind, randomized, controlled study conducted in pregnant women with blood pressure ≥160/110 mm Hg. Total 60 patients were enrolled from October 2016 to September 2017. Patients were randomized to receive nifedipine (10 mg tablet orally up to five doses) and intravenous placebo saline injection or intravenous labetalol injection in doses of 20, 40, 80, 80, and 80 mg and a placebo tablet every 20 minutes until the target blood pressure of ≤ 150/100 mmHg was achieved. The primary outcome of the study was time necessary to achieve target blood pressure. Secondary outcome were number of doses required, onset of labour, mode of delivery, adverse maternal and neonatal effects, side effect, and perinatal outcome. The time to achieve the blood pressure goal was significantly shorter with nifedipine (mean ± SD, 34.67 ± 20.297 minutes) than with labetalol (52.00 ± 29.054minutes; P &amp;#60;.017). Nifedipine group required significantly lower doses (mean ± SD, 1.73±1.015) as compared to labetalol (2.60±1.453, p&amp;#60;0.017). Urine output was significantly increased in nifedipine group (mean ± SD, 2296 ± 210.483 ml) compared with labetalol group (1374 ± 155.798 ml, P &amp;#60; .0001) and remained significantly increased 24 hours after initial administration. No patients required crossover therapy. The a dverse effects were infrequent. There were no significant differences in maternal age, gestational age, and blood pressures between the groups. Oral nifedipine and intravenous labetalol both are effective in the management of severe hypertension of pregnancy; however, nifedipine controls hypertension more rapidly with less number of dos es and was associated with a significant increase in urinary output.

Study the prevalence of pre eclampsia in vitamin D supplemented non supplemented primigravida women

Vitamin D is an essential factor in the regulation of calcium and phosphorus balance. It is synthesized in the skin but is also present in the diet. To study the prevalence of pre eclampsia in vitamin D supplemented non supplemented primigravida women. Group I included 100 pregnant women who received vitamin D supplementation in the form of oral cholecalciferol sachet 60,000IU weekly till 10 weeks along with routine iron, folic acid and calcium supplementation. Group II comprised of 100 pregnant women who received only routine iron, folic acid and calcium supplementation. Out of 200 patients, 22(11%) patients developed pre-eclampsia out of which 19 patients were not supplemented with vitamin D. The p-value was 0.0004 making this correlation statistically significant. Out of 200 patients, 19(9.50%) patients were managed with oral medication and 3(1.5%) required intravenous labetalol. The p-value was 0.001 making this correlation statistically significant. there is significant role of vitamin D supplementation in pregnant women in prevention of pre eclampsia.

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Identification of factors associated with delayed treatment of obstetric hypertensive emergencies

Obstetric hypertensive emergency is defined as having systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg, confirmed 15 minutes apart. The American College of Obstetricians and Gynecologistsrecommends that acute-onset, severe hypertension be treated with first line-therapy (intravenous labetalol, intravenous hydralazine or oral nifedipine) within 60 minutes to reduce risk of maternal morbidity and death. Our objective was to identify barriers that lead to delayed treatment of obstetric hypertensive emergency. A retrospective cohort study was performed that compared women who were treated appropriately within 60 minutes vs those with delay in first-line therapy. We identified 604 patients with discharge diagnoses of chronic hypertension, gestational hypertension, or preeclampsia using International Classification of Diseases-10 codes and obstetric antihypertensive usage in a pharmacy database at 1 academic institution from January 2017 through June 2018. Of these, 267 women (44.2%) experienced obstetric hypertensive emergency in the intrapartum period or within 2 days of delivery; the results from 213 women were used for analysis. We evaluated maternal characteristics, presenting symptoms and circumstances, timing of hypertensive emergency, gestational age at presentation, and administered medications. Chi square, Fisher's exact, Wilcoxon rank-sum, and sample t-tests were used to compare the 2 groups. Univariable logistic regression was applied to determine predictors of delayed treatment. Multivariable regression model was also performed; C-statistic and Hosmer and Lemeshow goodness-of-fit test were used to assess the model fit. A result was considered statistically significant at P<.05. Of the 213 women, 110 (51.6%) had delayed treatment vs 103 (48.4%) who were treated within 60 minutes. Patients who had delayed treatment were 3.2 times more likely to have an initial blood pressure in the nonsevere range vs those who had timely treatment (odds ratio, 3.24; 95% confidence interval, 1.85-5.68). Timeliness of treatment was associated with presence or absence of preeclampsia symptoms; patients without preeclampsia symptoms were 2.7 times more likely to have delayed treatment (odds ratio, 2.68; 95% confidence interval, 1.50-4.80). Patients with hypertensive emergencies that occurred overnight between 10 pm and 6 am were 2.7 times more likely to have delayed treatment vs those emergencies that occurred between 6 am and 10 pm (odds ratio, 2.72; 95% confidence interval, 1.27-5.83). Delayed treatment also had an association with race, with white patients being 1.8 times more likely to have delayed treatment (odds ratio, 1.79; 95% confidence interval, 1.04-3.08). Patients who were treated at <60 minutes had a lower gestational age at presentation vs those with delayed treatment (34.6±5 vs 36.6±4 weeks, respectively; P<.001). For every 1-week increase in gestational age at presentation, there was a 9% increase in the likelihood of delayed treatment (odds ratio, 1.11; 95% confidence interval, 1.04-1.19). Another factor that was associated with delay of treatment was having a complaint of labor symptoms, which made patients 2.2 times as likely to experience treatment delay (odds ratio, 2.17; 95% confidence interval, 1.07-4.41). Initial blood pressure in the nonsevere range, absence of preeclampsia symptoms, presentation overnight, white race, having complaint of labor symptoms, and increasing gestational age at presentation are barriers that lead to a delay in the treatment of obstetric hypertensive emergency. Quality improvement initiatives that target these barriers should be instituted to improve timely treatment.

A comparative study of IV labetalol with oral nifedipine in severe preeclampsia

Aims and Objectives: To compare the efficacy and safety of intravenous Labetalol over Nifedipine in severe preeclampsia patients and to study the effect of Labetalol on maternal and fetal outcome in severe preeclampsia patients. Methodology: This is a prospective comparative study in antenatal mother with sever preeclampsia done from June 2017 and May 2018. All the data were entered and analyzed using SPSS version 22. Results: Among 50 study patient population 25 patients received oral nifedipine (group A) and 25 patients received i.v. Labetalol (group B). Result shows that from1 hr to 6 hrs the mean systolic BP in the labetalol group was found to be lower than nifedipine group and mean diastolic BP from 1 hr to 6 hrs in the labetalol group was found to be lower than nifedipine group. 32% of antenatal mothers in the nifedipine group delivered before 36 weeks whereas in labetalol group only 4% of antenatal mothers delivered before 36 weeks. 32% of newborn, born to the mothers in the nifedipine group required NICU admission whereas in the labetalol group it was only 4%. Conclusion: Thus, concluded that both the drugs were found to be safe and effective in the reduction of blood pressure. But intravenous labetalol showed a rapid reduction of blood pressure at a shorter duration with a minimal dosage compared to oral nifedipine along with a lower incidence of preterm and lesser admission to NICU among the antenatal mothers treated with labetalol compared to oral nifedipine.

Efficacy of nifedipine versus hydralazine in the management of severe hypertension in pregnancy: A randomised controlled trial.

Despite the availability of effective antihypertensive drugs, the quality of evidence regarding the best antihypertensive agent for the treatment of hypertensive emergencies in pregnancy is still poor. The aim of this study was to compare the efficacy and side effects of oral nifedipine and intravenous hydralazine for control of blood pressure (BP) in severe hypertension in pregnancy. An open-label, parallel, randomised, controlled trial of 78 pregnant women (≥28 weeks' gestation) with severe hypertension was conducted. Severe hypertension was defined as systolic BP of 160 mmHg or above and/or diastolic BP of 110 mmHg or above. They were randomly (1:1 ratio) administered oral nifedipine 20 mg or intravenous hydralazine 10 mg every 30 min up to 5 doses or until the target BP of 140-150 mmHg systolic and 90-100 mmHg diastolic was achieved. Intravenous labetalol was given if the primary treatment failed. The primary outcome measure was the number of doses needed to achieve targeted BP. The secondary outcome measures were the time needed to achieve desired BP, maternal adverse effects and perinatal outcome. The sociodemographic characteristics did not differ between the two study groups. The average number of dosages (nifedipine; 1.4 ± 0.6 vs. hydralazine; 1.7 ± 0.5, P = 0.008) needed to control the BP was lower in the nifedipine arm. Time (min) taken to control the BP was similar between the groups (hydralazine; 43.7 ± 19.7 vs. nifedipine; 51.2 ± 18.9, P = 0.113). Adverse maternal and perinatal effects did not differ in the study groups. Oral nifedipine and intravenous hydralazine showed comparable efficacy in the BP control in the severe hypertensive disorders of pregnancy without significant difference in adverse maternal and perinatal outcomes. However, further studies are required to explore the role of these drugs in BP control during hypertensive emergencies in pregnancy. (Identification number: NCT04435210).

Effect of intravenous labetalol for intranasal surgeries under general anaesthesia

Effect of intravenous labetalol for intranasal surgeries under general anaesthesia

22: Intravenous labetalol versus oral nifedipine for acute hypertension in pregnancy: effects on cerebral perfusion pressure

22: Intravenous labetalol versus oral nifedipine for acute hypertension in pregnancy: effects on cerebral perfusion pressure

COMPARISON OF INTRAVENOUS LABETALOL AND ORAL NIFEDIPINE IN MANAGEMENT OF BLOOD PRESSURE IN PATIENTS WITH SEVERE PREGNANCY INDUCED HYPERTENSION

ABSTRACT:It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective.&#x0D; OBJECTIVE: To compare the mean time to achieve blood pressure control of oral Nifedipine with intravenous Labetalol for management of severe pregnancy induced hypertension.&#x0D; METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t- test and consider significant at p value &lt;5%.RESULTS: Patients were ranged between 20-40 years. Mean age of the patients was calculated as 26.98+4.54 and 27.36+4.43 years in group-A and B respectively. Gestational age shows that 64%(n=32) in Group-A 74%(37%) in Group–B were between 20-30 weeks of gestation while 36%(n=18) in Group-A were between 31-40 weeks of gestation mean±SD was calculated as 28.92+4.91 and 28.94+4.72 weeks in Group-A and B respectively. Mean time to achieve B.P control in group A was 31.24+5.62 and in group B 45.5+4.63 with p value &lt;0.05.&#x0D; CONCLUSION: Mean time to achieve blood pressure control was shorter with oral Nifedipine when compared to I/V Labetalol for management of female presenting with severe pregnancy induced hypertension.

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Improving the use of intravenous antihypertensive medications in the hospital setting: a quality improvement initiative for patient safety

Intravenous (IV) hydralazine, enalapril and labetalol are oftentimes used without indication for the treatment of asymptomatic hypertension in the hospital setting and have been shown to have substantial adverse effects...

Epidemiology and Management of Children with Hypertensive Crisis: A Single-Center Experience.

Most children who present with hypertensive crisis have a secondary cause for hypertension. This study describes the epidemiology and management of children with hypertensive crisis. A retrospective cohort study was done in a tertiary pediatric hospital from 2009 to 2015. Thirty-seven patients were treated for hypertensive crisis. Twelve (32.4%) patients were treated for hypertensive emergency. The majority of our patients (33 [89.1%]) had a secondary cause of hypertension. The most common identifiable cause of hypertension was a renal pathology (18/37 [48.6%]). Oral nifedipine (23 [62.1%]) was the most frequently used antihypertensive, followed by intravenous labetalol (8 [21.6%]). There were no mortalities or morbidities. Hypertensive crisis in children is likely secondary in nature. Oral nifedipine and intravenous labetalol are both effective treatments.

Hypertensive Urgency: An Undesirable Complication of a "Male Performance" Herbal Product.

Hypertensive urgency is a clinical scenario that may be associated with herbal supplement use and that requires special consideration with regard to emergency department management. A 49-year-old man presented to the emergency department with palpitations and severely elevated blood pressure without evidence of end organ dysfunction. Hypertension failed to be controlled with multiple doses of oral clonidine and intravenous labetalol. The patient later admitted to using an herbal supplement containing yohimbine, a selective ⍺2-adrenoreceptor antagonist specifically linked to cases of refractory hypertension. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Between 17-35% of the U.S. adult population may use herbal supplements on a sporadic or regular basis; pharmacologically active agents in herbal supplements may affect both a patient's presentation and response to treatment. Most patients do not mention over-the-counter and herbal products in their medication profile unless specifically asked, and therefore it is important for emergency physicians to be aware of the pharmacologic effects of herbal supplements in the evaluation and treatment of refractory severe hypertension.

IV labetalol and oral nifedipine in acute control of severe hypertension in pregnancy–A randomized controlled trial

ObjectiveTo compare the efficacy of intravenous labetalol with oral nifedipine in the treatment of severe hypertension in pregnancy with blood pressure ≥160/110 mm Hg. Design, setting and participantsWe conducted a parallel double-blinded randomized controlled trial between December 2014 to December 2016 in 120 antenatal women of gestational age >28 weeks, admitted with severe hypertension of blood pressure ≥160/110 mm Hg to maternity ward at a tertiary hospital.The labetalol group received 20 mg initially followed by escalating doses of 40 mg, 80 mg, 80 mg and 80 mg (5 doses) every 15 min to a maximum of 300 mg. Nifedipine group received 10 mg initially followed by repeated doses of 20 mg every 15 min (total 5 doses) to a maximum of 90 mg. Vital signs were recorded every 15 min.-The time taken and the number of doses required to achieve the target blood pressure (150/100 mmHg). Survival analysis was used to compare the efficacy of treatment regimens. ResultsSixty women were randomised to each group and none were lost to follow-up. None of the patients in nifedipine group required labetalol, whereas three patients in labetalol group achieved target BP only after receiving nifedipine was administered after the maximum dose of labetalol.The mean time taken to achieve the target blood pressure in the labetalol group was higher (36.75 min) than in the nifedipine group (27.25 min) [mean difference 9.5 min,p = 0.002]. Nifedipine group required significantly lower doses (1.82 ± 0.83) as compared to labetalol (2.45 ± 1.32) [p = 0.002]. Nifedipine was 1.8 times more likely to achieve target blood pressure (Hazard Ratio = 1.8). ConclusionsBoth intravenous Labetalol and oral Nifedipine were effective in controlling blood pressure. Nifedipine reduced BP more rapidly than Labetalol. Oral Nifedipine may be a better alternative because of its ease of oral administration and a flat dosing regimen.

Safety of high-dose intravenous labetalol in hypertensive crisis.

The study assesses the safety of high-dose intravenous (i.v.) labetalol in adults. This is a retrospective administrative record review of 28 hospitals in one health care system, from October 2010 through October 2015. Patients were included if they received 300 mg of i.v. labetalol within a 24-hour period. Vital signs, adverse events and cumulative medication doses were obtained for up to 24 hours while on labetalol. Adverse events were defined as any systolic blood pressure measurement less than 90 mm Hg or heart rate less than 60 beats per minute. We analyzed the records of 188 patients who received i.v. labetalol at higher than the maximum recommended dose of 300 mg. The mean dose of labetalol was 996 mg (range 300 to 4465 mg). The cumulative labetalol dose was not associated with adverse safety outcomes (p = 0.428), although eighty-one patients (44.3%) experienced adverse events. Sixty-six patients (36.5%) developed bradycardia and 34 patients (18.6%) developed hypotension. Only five patients (2.7%) required a rescue agent for refractory adverse events. A retrospective review of high-dose i.v. labetalol hydrochloride with doses greater than 300 mg in 24 hours observed a high rate of bradycardia and hypotension, but the study found that these events rarely caused clinically significant hemodynamic compromise and was not statistically associated with adverse events.