Landiolol parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Parenteral formulations of landiolol.
Drugs List
Therapeutic Indications
Uses
Cardiac arrhythmias especially supraventricular tachycardia
Non-compensatory sinus tachycardia
Supraventricular tachycardia and rapid control of ventricular rate in patients with atrial flutter or atrial fibrillation in perioperative, postoperative, or other situations where short-term control of the ventricular rate with a short acting agent is desirable.
Non-compensatory sinus tachycardia where the rapid heart rate requires specific intervention.
Dosage
Adults
Initial dose is 10 to 40micrograms/kg/minute. This will establish the heart rate lowering effect within 10 to 20 minutes.
If a quicker onset of heart rate lowering effect is required (within 2 to 4 minutes), an optional loading dose of 100micrograms/kg/minute for 1 minute can be considered, followed by continuous infusion of 10 to 40micrograms/kg/minute.
The maintenance infusion rate may be increased to a maximum of 80micrograms/kg/minute if required, and if tolerated by the patient.
The maximum daily dose is 57.6mg/kg/day (based on a dose of 40micrograms/kg/minute over a maximum duration of 24 hours).
Additional Dosage Information
Patients with cardiac dysfunction (impaired left ventricular function)
Initial dose of 1microgram/kg/minute. This can be titrated up, whilst closely monitoring blood pressure, to 10micrograms/kg/minute.
Switching to an alternative drug
Switching to another drug, such as oral antiarrhythmics, may only be considered when adequate control of the heart rate has been achieved.
When switching to an alternative drug, the infusion rate of landiolol should be reduced by 50% within the first hour after the first dose of the alternative drug being administered. Following administration of the second dose of the alternative product, the patients response should be monitored and if satisfactory control is maintained for at least 1 hour, the landiolol infusion may be discontinued.
Administration
For intravenous administration via a central or peripheral line.
Contraindications
Children under 18 years
Acute asthma
Breastfeeding
Cardiogenic shock
Decompensated cardiac failure
Non paced second/third degree AV block
Pre-excitation syndrome with atrial fibrillation
Pulmonary hypertension
Severe bradycardia
Severe hypotension
Severe metabolic acidosis
Severe sinus node dysfunction
Uncontrolled phaeochromocytoma
Precautions and Warnings
Bronchospastic disorder
Cardiac failure
Diabetes mellitus
First degree atrioventricular block
Hepatic impairment
Hypoglycaemia
Hypotension
Intermittent claudication
Phaeochromocytoma
Pregnancy
Prinzmetal's angina
Raynaud's syndrome
Renal impairment
Consider reducing initial dose in hepatic impairment
Reduce dose in patients with cardiac dysfunction
Not recommended for chronic administration
Administer reconstituted solution immediately
Monitor blood pressure continuously
Monitor ECG
Beta blockers may reduce the response to adrenaline in anaphylaxis
Hypoglycaemic symptoms may be masked/altered with beta blockers
May aggravate symptoms of peripheral arterial circulatory disorders
Avoid dose increments and consider discontinuation if condition worsens
Discontinue if bronchospasm occurs
Maximum treatment 24 hours
In the event of an adverse reaction to landiolol, it is recommended to reduce the dose or discontinue the infusion. If hypotension or bradycardia has occurred, administration may be restarted at a lower dose after the blood pressure or heart rate has returned to a satisfactory level.
Caution is advised during maintenance infusion and dose adjustment in patients with low systolic blood pressure.
When treating patients with pre-existing cardiac failure, patients who are haemodynamically compromised or patients or are taking drugs which decrease any or all of the following: peripheral resistance, myocardial filling, myocardial contractility, or electrical impulse propagation in the myocardium, the benefits of potential rate control should be balanced against the risk of further depressing myocardial contractility.
Pregnancy and Lactation
Pregnancy
Use landiolol with caution during pregnancy.
The manufacturer does not recommend using landiolol during pregnancy. At the time of writing there is limited published information regarding the use of landiolol during pregnancy. The general side effects on the foetus and neonate of beta-blocker use during late pregnancy, including hypoglycaemia, hypotension and bradycardia, should be taken into account. If treatment with landiolol is considered necessary, foetal growth and uteroplacental blood flow should be monitored. The newborn must be monitored closely.
Lactation
Landiolol is contraindicated during breastfeeding.
The manufacturer advises that the patient either discontinues landiolol or discontinues breastfeeding. Animal data reports excretion of landiolol into breast milk, however presence in human breast milk is unknown. Effects on exposed infants are unknown.
Side Effects
Abdominal discomfort
Acute kidney injury
Altered liver function tests
Asthma
Atrial fibrillation
Atrioventricular block
Blood dyscrasias
Bradycardia
Bronchospasm
Cardiac arrest
Cerebral infarct
Cerebral ischaemia
Cerebrovascular accident
Chest discomfort
Chills
Cold sweat
Decrease in blood pressure
Decreased cardiac output
Dyspnoea
ECG changes
Erythema
Extrasystoles
Headache
Hepatic disorders
Hot flushes
Hyperbilirubinaemia
Hyperglycaemia
Hypertension
Hyponatraemia
Hypotension
Hypoxia
Impaired platelet function
Injection site reactions
Local pain (injection site)
Mediastinitis
Muscle spasm
Myocardial infarction
Nausea
Oliguria
Oral discharge
Pneumonia
Possible alteration of laboratory tests
Pulmonary oedema
Pyrexia
Renal failure
Respiratory disorders
Respiratory distress
Right bundle branch block
Seizures
Sensation of pressure
Shock
Sinus arrest
Tachycardia
Thrombocytopenia
Unpleasant breath
Ventricular tachycardia
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2023
Reference Sources
Summary of Product Characteristics: Rapibloc 300mg powder for solution for infusion. AOP Orphan Ltd. Revised June 2022.
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