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Due to their negative inotropic and chronotropic actions, beta-adrenergic receptor antagonists are typically indicated in individuals with chronic cardiovascular disease (hypertension, coronary artery disease, congestive heart failure) with a significant reduction in mortality. The FDA-approved indication for labetalol is to treat arterial hypertension, which ranges from acute hypertensive crises (urgent/emergency) to stable chronic hypertension. Labetalol in clinical practice has several common off-label uses that include acute hypertension in pregnancy and hypertension associated with acute ischemic stroke, and intracranial hemorrhage, including subarachnoid hemorrhage. Today, labetalol is usually reserved for the acute management of hypertensive crises. This activity covers labetalol, including mechanism of action, pharmacology, adverse event profiles, eligible patient populations, contraindications, monitoring, and highlights the role of the interprofessional team in the management of labetalol therapy. Objectives: Identify the indications for clinicians to use labetalol. Explain the mechanism of action of labetalol. Review the contraindications to labetalol therapy. Summarize how interprofessional team strategies can improve patient results in cases where labetalol therapy is indicated. Access free multiple choice questions on this topic.

Supportive care and close monitoring are the staples of treatment for an overdose of beta-blockers with the addition of glucagon for severe refractory hypotension and bradycardia. Glucagon provides several important clinical effects when used for beta-blocker overdose. It provides an increase in HR and improves both myocardial contractility as well as atrioventricular conduction. Its MOA seems to be independent of the beta-adrenergic binding site allowing it to be effective. The recommended initial dose of glucagon to reverse severe symptomatic beta-blockade is 50 mcg/kg IV as a loading dose, followed by an infusion of 1 to 15 mg per hour IV, titrated to clinical response and improvement.[10]

As labetalol is typically used to treat acute hypertension, whether it presents in the emergency department or an outpatient clinic, an interprofessional team approach and effective communication are essential for quality patient care. This interprofessional team can include specialists, other clinicians (MDs, DOs, PAs, NPs), nursing staff, and pharmacists. In the emergency department, swift intake and triage by the nurse or medical technician to identify a patient with dangerously elevated blood pressure and quickly but effectively convey the critical information to a physician or provider are necessary. If hospital admission is warranted, communicating the crucial details of the patient's presentation, medical history, and the treatment and current medical workup that have been completed are important, so time and resources are not wasted on repeating tests and exams. Utilizing an interprofessional team methodology that employs open communication between all team members and coordinated activity will improve patient outcomes and fewer adverse effects, particularly in hypertensive emergencies. [Level 5]