landiolol hydrochloride: clinical use

Prescribing considerations

• Use only in a monitored setting with individual titration by an appropriately qualified healthcare professional.
• Balance rate control against further myocardial depression in heart failure or haemodynamic compromise.
• Use caution with first-degree heart block, bronchospastic disease, diabetes or hypoglycaemia, renal or hepatic impairment, peripheral circulatory disease and vasospastic angina.
• Avoid beta-blockade in atrial fibrillation with pre-excitation because accessory-pathway conduction may increase.
• Safety and efficacy have not been established in children.

Contraindications and cautions

• Hypersensitivity to landiolol or an excipient
• Severe bradycardia
• Sick sinus syndrome
• Second- or third-degree atrioventricular block without a pacemaker
• Cardiogenic shock or severe hypotension
• Decompensated heart failure not caused by the arrhythmia
• Pulmonary hypertension
• Untreated phaeochromocytoma
• Acute asthma attack
• Severe uncorrectable metabolic acidosis

Monitoring

• Continuous ECG and blood pressure
• Heart rate, rhythm and atrioventricular conduction
• Clinical and haemodynamic signs of worsening cardiac function
• Blood glucose when relevant, particularly with antidiabetic treatment
• Respiratory status in bronchospastic disease
• Infusion site and solution appearance

Clinical pharmacology

A highly beta-1-selective antagonist with rapid onset and offset. It is hydrolysed mainly by plasma pseudocholinesterases and carboxylesterases into metabolites with negligible beta-blocking activity. Its elimination half-life is only a few minutes, and CYP-mediated interaction potential appears low.

Formulation and product differences

• The selected product is a powder for solution for infusion requiring reconstitution.
• Compatible reconstitution fluids include sodium chloride, glucose, Ringer's solution and Ringer-lactate solution.
• It contains mannitol, is essentially sodium-free and must not be mixed with other medicines except as specified in the product information.

Solution for infusion

Route: Intravenous

Strengths: 300 mg