Memorandum To:
UPMC Mercy Hospital Staff
From: Sandra Nickman, Pharm.D., Department of Pharmaceutical Services Date:
June 7, 2017
Re:
Intravenous Labetalol Shortage: Update
The labetalol IV shortage has become more critical; therefore, the UPMC System Pharmacy & Therapeutics Committee has developed guidelines for appropriate use that restricts labetalol to the treatment of hypertension in stroke or aortic dissection. The committee has also developed guidelines for alternatives to labetalol in specific clinical scenarios. A summary of these recommendations may be found on the second page of this memo.
We appreciate everyone’s cooperation as we continue to deal with medication shortages. We will keep you informed as the supply of these medications changes.
Questions regarding this shortage may be directed to Sandy Nickman, Pharm.D. at extension 232-7902 or email
[email protected] or Robert Simonelli, Pharm.D., at (412) 600-4756 or email
[email protected].
Indication Hypertension in Stroke Hypertension in Aortic Dissection
Intraoperative tachycardia +/hypertension
Hypertension (For patients NPO)
Labetalol IV Shortage Guidelines June 2017 Usual Labetalol Dose Therapeutic Alternatives 10 - 20 mg IV push over 1-2 minutes, may **Labetalol should be reserved for use for this indication** repeat x 1 20 mg IV push over 2 minutes, then **Labetalol should be reserved for use for this indication** continuous infusion 1 - 2 mg/min^ Metoprolol 5 mg IV Q 5 minutes x 3 doses, then esmolol infusion if HR/BP goal not achieved 20 mg IV push over 2 minutes, then (some patients may require initial doses up to 10 mg) 40 - 80 mg IV Q 10 minutes PRN to achieve goal BP Esmolol 500 mcg/kg IV loading dose over 1 minute, then 50-150 mcg/kg/min IV (recommended max daily dose 300 mg) infusion (maximum recommended rate 300 mcg/kg/min) 20 mg IV push over 2 minutes, then Metoprolol 1.25 - 5 mg IV Q6 - 12 hours; Adjust dose to BP response. 40 - 80 mg IV Q 10 minutes PRN to achieve goal (some patients may require 15 mg IV Q 3 - 6 hours) BP Hydralazine 10 - 20 mg IV Q 4-6 hours PRN to achieve goal BP (recommended max daily dose 300 mg) (maximum recommended single dose 40 mg) **If BP fails to respond to two alternative agents, then labetalol may be considered** 20 - 80 mg IV push over 2 minutes, then 40 - 80 mg IV Q 10 minutes PRN to achieve goal BP (recommended max daily dose 300 mg)
Enalaprilat 1.25 mg IV Q6 hours PRN to achieve goal BP (reduce initial dose to 0.625 mg for patients receiving diuretic)
**If BP fails to respond to two alternative agents, then labetalol may be considered**
Enalaprilat 1.25 mg IV Q6 hours PRN to achieve goal BP (reduce initial dose to 0.625 mg for patients receiving diuretic)
Hypertensive Emergency Continuous infusion 0.5 - 2 mg/min^ **Continuous infusion should be used ONLY in patients with aortic dissection (see above)**
Metoprolol 1.25 - 5 mg IV Q6 - 12 hours PRN to achieve goal BP (some patients may require 15 mg IV Q 3 - 6 hours) Hydralazine 10 - 20 mg IV Q 4-6 hours PRN to achieve goal BP (IM dose 10 - 40 mg, if no IV access)
Nicardipine 5 mg/hr, titrate 2.5 mg/hr Q 5 minutes to achieve goal BP (maxium recommended rate 15 mg/hr) Clevidipine 2 mg/hr, then double dose Q 90 seconds to achieve goal BP (maximum recommended dose 32 mg/hr or 1000 mL in 24 hours; maximum duration 72 hours) Esmolol 250 - 500 mcg/kg IV loading dose over 1 minute, then 50-100 mcg/kg/min IV (maximum recommended rate 300 mcg/kg/min)
