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Alpha- and Beta-Blocker (Antihypertensive) Pregnancy: C — used in pregnancy, monitor neonate

Labetalol

Brand names: Trandate

Adult dose

Dose: IV: 20mg bolus, repeat 40mg then 80mg every 10 min (max 300mg). Infusion: 20–160mg/hr. Oral: 100–200mg two to three times daily
Route: IV or Oral
Frequency: Per protocol
Target BP in pre-eclampsia: systolic 140–150 mmHg. Oral maintenance in pregnancy: 200mg BD, titrate up.

Clinical pearls

  • First-line IV antihypertensive in acute severe hypertension in pregnancy
  • Combined alpha+beta blockade — lowers BP without compromising uteroplacental blood flow
  • Can cause neonatal bradycardia and hypoglycaemia — monitor neonate for 24h after delivery
  • Avoid in asthma — safe alternative is nifedipine or hydralazine
  • Do NOT use atenolol or metoprolol in pregnancy — associated with fetal growth restriction

Contraindications

  • Asthma
  • Heart block (>1st degree)
  • Cardiogenic shock
  • Severe bradycardia

Side effects

  • Bradycardia
  • Postural hypotension
  • Bronchospasm
  • Neonatal bradycardia (fetal passage)
  • Dizziness

Interactions

  • Cimetidine — increases labetalol bioavailability
  • General anaesthetics — enhanced hypotension
  • Verapamil — severe bradycardia/heart block risk

Monitoring

  • Blood pressure (continuous IV monitoring)
  • Fetal heart rate (CTG)
  • Neonatal HR and glucose (post-delivery)
  • HR (avoid bradycardia <60 bpm)

Reference: RCOG Hypertension in Pregnancy Guideline; NICE NG133. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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