LabetalolLabetalol hydrochloride

About Labetalol

Labetalol blocks alpha-1 receptors, relaxing blood vessels, and beta receptors; the label notes that blood pressure falls without a reflex fast heartbeat or a significant drop in heart rate. The tablets are labeled for high blood pressure, alone or with other blood pressure medicines, especially thiazide and loop diuretics; safety and effectiveness in children have not been established. Treatment usually starts at 100 mg twice a day and rises by 100 mg twice a day every two or three days, guided by standing blood pressure; most people settle on 200 to 400 mg twice a day, most older adults on 100 to 200 mg twice a day, and severe high blood pressure can need 1,200 to 2,400 mg a day. The hospital injection is given with the patient lying down, since sitting up or standing within three hours of it is likely to cause dizziness from low blood pressure.

There is no boxed warning, but the label warns that severe liver injury, including liver necrosis and deaths, occurs rarely, so liver tests are checked periodically, and if they show injury or jaundice appears, labetalol is stopped and not restarted. Dizziness on standing is most likely two to four hours after a dose, especially after a large first dose or dose change. It must not be taken with bronchial asthma, overt heart failure, heart block beyond first degree, cardiogenic shock, a very slow heart rate, conditions causing severe, prolonged low blood pressure, or an allergy to any ingredient. People with other lung disease that narrows the airways, such as chronic bronchitis or emphysema, generally should not take beta blockers, and after past heart failure it is used only with caution if that is well controlled. Dizziness, nausea, tiredness, a stuffy nose and indigestion are common, and the scalp may tingle briefly when treatment starts.

It is not stopped suddenly: the label calls for reducing the dose over one to two weeks, particularly in people with ischemic heart disease, because abruptly stopping some beta blockers in people with coronary artery disease has worsened angina and, in some cases, led to heart attacks. It can hide the fast heartbeat that warns of low blood sugar and blunt beta-agonist inhalers such as albuterol, and the anesthetist and any eye surgeon planning cataract surgery need to know about it, the latter because of intraoperative floppy iris syndrome. It can cause a false positive urine amphetamine screen and falsely raise urine catecholamine tests. In pregnancy the label says to use it only if the potential benefit justifies the potential risk to the fetus; low blood pressure, a slow heartbeat, low blood sugar and slowed breathing have been reported in newborns of mothers treated with it. Small amounts pass into breast milk.

Taking Labetalol

How to take it

Usually twice a day at about the same times; the prescriber may split the daily amount into three doses if nausea or dizziness is a problem. Food increases how much of each dose is absorbed. Get out of bed slowly, resting your feet on the floor for a few minutes before standing.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture and out of reach of children; use a take-back program for tablets you no longer need.

Interactions to know about

Tremor was reported more often when it was taken with tricyclic antidepressants, and cimetidine raises labetalol levels. Verapamil-type calcium channel blockers need care, digoxin adds to the risk of a slow heartbeat, and with nitroglycerin blood pressure can fall further.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Labetalol differs from pharmacy to pharmacy

Generic labetalol 100, 200 and 300 mg tablets have many makers and cost pharmacies little, so a quote is mostly the dispensing fee and markup, which differ between pharmacies. It is taken at least twice a day, so a month is sixty tablets or more. The 400 mg tablet is a newer generic with fewer makers.

Ways to pay less for Labetalol without insurance

• Ask whether labetalol is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is settled, ask for a ninety-day supply, and refill early enough never to run out, since it is not stopped suddenly.
• If you take 400 mg a dose, ask which is quoted lower: one 400 mg tablet, or two 200 mg tablets, which needs the prescription written that way.
• If the price is a barrier, ask the prescriber whether another generic, such as carvedilol or metoprolol, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Labetalol

1. 1.When will my liver tests be checked, and which symptoms of liver trouble mean I should call?
2. 2.Is it safe with my asthma, COPD or past heart failure?
3. 3.Does it interact with my inhaler, antidepressant, cimetidine or diabetes medicines?
4. 4.Should I tell the lab I take it before a urine drug screen?

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