Landiolol Uses, Dosage, Side Effects & Warnings | DrugsAtlas
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DRUG NAME: Landiolol
Therapeutic Class: Beta-adrenergic blocker
Subclass: Ultra-short-acting selective β1-blocker
Speciality: Critical Care Medicine
Schedule (India): Schedule H
Route(s): Intravenous
Formulations Available in India:
| Formulation | Strength | Pack Size |
| Injection | 20 mg | 2 mL vial |
| Injection | 50 mg | 5 mL vial |
| Injection | 300 mg | 20 mL vial |
Note: Limited availability in India; primarily through institutional/hospital procurement channels.
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
⮞ Supraventricular Tachyarrhythmias (Atrial Fibrillation/Flutter, Non-compensatory Sinus Tachycardia) — Short-term Rate Control in ICU/Perioperative Setting
| Parameter | Recommendation |
| Starting dose | 10 µg/kg/min IV infusion (optional loading: 1 mg/kg bolus over 1 minute) |
| Titration | Increase by 10 µg/kg/min every 10–15 minutes based on heart rate and haemodynamic response |
| Usual maintenance dose | 10–40 µg/kg/min |
| Maximum dose | 80 µg/kg/min (ICU-monitored, select patients only) |
Clinical Notes:
- Onset of action: within 5 minutes
- Elimination half-life: approximately 4 minutes
- Offset: haemodynamic recovery within 15–20 minutes of discontinuation
- Requires continuous ECG and blood pressure monitoring throughout administration
- Haemodynamically unstable patients: use with extreme caution; specialist-only and ICU setting mandatory
- Reconstitution: dilute with normal saline or 5% dextrose as per manufacturer guidelines
Secondary Indications — Adults Only (Off-label, if any)
⮞ Perioperative Control of Tachycardia/Hypertension in Non-cardiac Surgery — OFF-LABEL
| Parameter | Details |
| Indication | Intraoperative rate/BP control |
| Starting dose | 5–10 µg/kg/min IV infusion |
| Titration | Adjust based on haemodynamic targets |
| Duration | Taper and discontinue postoperatively as targets achieved |
| Supervision | Specialist only — anaesthesiologist or intensivist required |
| Evidence basis | Small RCTs (predominantly Japanese/European); used in select Indian tertiary centres |
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
NOT ROUTINELY APPROVED for paediatric use. Limited Indian data available.
⮞ Rate Control in Supraventricular Tachyarrhythmia — Critical Care Use Only
For Paediatric Cardiologist/Intensivist use only:
| Weight | Starting Dose | Titration | Maximum Dose |
| ≥10 kg | 1–5 µg/kg/min IV infusion | Increase by 1–2 µg/kg/min every 10–20 minutes | 40 µg/kg/min |
Safety Monitoring:
- Continuous ECG monitoring mandatory
- Continuous arterial blood pressure monitoring
- Heart rate target assessment every 5–10 minutes during titration
- Watch for hypotension and bradycardia
Age Restrictions:
- Avoid in neonates — safety not established
- Use only in specialist paediatric cardiac/ICU units
Secondary Indications — Paediatric Doses (Off-label, if any)
NOT RECOMMENDED — No validated off-label indications in Indian paediatric practice.
Statement: Not recommended in children below 10 kg or neonates except under specialist supervision in tertiary care settings with full resuscitation facilities.
RENAL ADJUSTMENT
| Renal Status | Recommendation |
| All stages of CKD | No dose adjustment required |
| Haemodialysis | No supplemental dosing needed |
Rationale: Landiolol undergoes rapid ester hydrolysis; minimal renal clearance of parent drug.
HEPATIC ADJUSTMENT
| Severity | Recommendation |
| Mild impairment | No adjustment required |
| Moderate impairment | Use with caution; initiate at lower infusion rate (5 µg/kg/min) and titrate slowly |
| Severe impairment | Limited data; initiate only under specialist supervision with close haemodynamic monitoring |
CONTRAINDICATIONS
- Severe hypotension (systolic BP <90 mmHg)
- Cardiogenic shock
- Decompensated heart failure
- Severe bradycardia (heart rate <50 bpm)
- Second or third-degree atrioventricular block (without functional pacemaker)
- Sick sinus syndrome (without functional pacemaker)
- Known hypersensitivity to landiolol or other beta-blockers
- Untreated phaeochromocytoma
CAUTIONS
- Compensated heart failure — use only under close specialist supervision
- Bronchial asthma or COPD — although β1-selective, may precipitate bronchospasm at higher doses
- Diabetes mellitus — may mask adrenergic warning symptoms of hypoglycaemia
- Peripheral arterial disease — may exacerbate claudication symptoms
- Concurrent use of calcium channel blockers (verapamil/diltiazem) — risk of additive bradycardia and AV block
- Hypokalaemia or hypomagnesaemia — correct electrolyte abnormalities before initiation
- Abrupt discontinuation — may cause rebound tachycardia; taper when clinically feasible
PREGNANCY
| Parameter | Details |
| Safety category | Limited human data; not well studied in pregnancy |
| Risk | Potential fetal bradycardia, hypoglycaemia, growth restriction |
| Preferred alternatives | Labetalol or metoprolol when beta-blockade indicated |
| When permissible | Only in life-threatening maternal arrhythmia when benefit clearly outweighs risk; ICU setting only |
| Monitoring | Maternal blood pressure, heart rate; fetal heart rate monitoring if used in second/third trimester |
LACTATION
| Parameter | Details |
| Compatibility | Unknown — no human lactation data available |
| Drug levels in milk | Likely very low due to ultra-short half-life and IV-only administration |
| Preferred alternatives | Labetalol or metoprolol (oral) if beta-blockade required during lactation |
| Infant monitoring | Feeding tolerance, signs of bradycardia, lethargy if exposure suspected |
ELDERLY
| Parameter | Recommendation |
| Starting dose | Lower initial rate: 5 µg/kg/min IV infusion |
| Titration | Slower titration; increase by 5 µg/kg/min every 15–20 minutes |
| Special risks | Increased sensitivity to hypotension, bradycardia; higher risk of falls if mobilised early post-procedure |
| Monitoring | More frequent BP and HR checks; assess renal and cardiac reserve before initiation |
MAJOR DRUG INTERACTIONS
| Interacting Drug | Effect | Management |
| Verapamil, diltiazem (IV or oral) | Severe additive bradycardia, AV block, hypotension | Avoid concurrent use; if essential, intensive cardiac monitoring required |
| Amiodarone | Profound bradycardia, AV block, hypotension | Avoid combination; use alternative rate control if possible |
| Digoxin | Additive negative chronotropic effect; risk of AV block | Monitor heart rate closely; consider dose reduction of one agent |
| General anaesthetic agents (volatile anaesthetics) | Synergistic myocardial depression, hypotension, bradycardia | Coordinate with anaesthesiologist; reduce doses of both agents |
| Catecholamine-depleting drugs (reserpine, guanethidine) | Enhanced beta-blockade; severe bradycardia/hypotension | Avoid combination |
MODERATE DRUG INTERACTIONS
| Interacting Drug | Effect | Management |
| Other antihypertensives (ACE inhibitors, ARBs, diuretics) | Additive hypotensive effect | Monitor blood pressure; adjust doses as needed |
| Insulin, sulfonylureas | Masking of hypoglycaemic symptoms (tachycardia, tremor) | Frequent blood glucose monitoring in diabetic patients |
| Neuromuscular blocking agents | Possible potentiation of neuromuscular blockade | Monitor neuromuscular function during anaesthesia |
| Clonidine | Risk of rebound hypertension if clonidine stopped abruptly | Discontinue beta-blocker before tapering clonidine |
COMMON ADVERSE EFFECTS
- Hypotension
- Bradycardia
- Nausea
- Dizziness
- Injection site reactions (pain, erythema)
SERIOUS ADVERSE EFFECTS
| Adverse Effect | Clinical Action |
| Severe hypotension or shock | Discontinue immediately; IV fluids, vasopressors as needed |
| High-degree AV block or asystole | Stop infusion; atropine, temporary pacing if required |
| Severe bradycardia (<40 bpm) | Discontinue; atropine, glucagon, or isoprenaline as indicated |
| Bronchospasm | Discontinue; administer bronchodilators; avoid rechallenge |
| Acute heart failure exacerbation | Discontinue; initiate appropriate heart failure management |
MONITORING REQUIREMENTS
| Phase | Parameters |
| Baseline | 12-lead ECG, blood pressure, heart rate, serum electrolytes (K⁺, Mg²⁺), LVEF (if cardiac function questionable) |
| During infusion | Continuous ECG and invasive/non-invasive BP monitoring; heart rate every 5–10 minutes during titration phase |
| After discontinuation | Monitor for rebound tachycardia for at least 30–60 minutes; reassess haemodynamic stability |
BRANDS AVAILABLE IN INDIA
| Brand Name | Manufacturer | Remarks |
| Rapibloc | Nichi-Iko / Takeda (via institutional tie-ups) | Available primarily through hospital-based procurement |
Note: Limited commercial availability in India; primarily accessed through institutional import or specialty distributors.
PRICE RANGE (INR)
| Formulation | Approximate Price |
| 20 mg/2 mL vial | ₹800–1,000 |
| 50 mg/5 mL vial | ₹1,800–2,200 |
| 300 mg/20 mL vial | ₹8,000–9,500 |
- Not included under NLEM
- Available through institutional/hospital procurement primarily
- Price may vary based on import and procurement channel
CLINICAL PEARLS
- Ultra-short half-life advantage: Approximately 4-minute half-life allows rapid titration and quick offset; particularly useful in haemodynamically unstable patients requiring careful rate control
- Comparison with esmolol: Higher β1-selectivity than esmolol; consider when esmolol is not tolerated or unavailable
- ICU/OT setting only: Not suitable for chronic oral rate control; strictly IV and monitored-setting use
- Elderly patients: Start at lower infusion rates (5 µg/kg/min) and titrate more gradually
- Cost consideration: Significantly more expensive than esmolol; reserve for cases where alternative ultra-short-acting beta-blockers are insufficient or contraindicated
- Continuous monitoring mandatory: Never administer without ECG and blood pressure monitoring in place
TAGS
landiolol; beta-blocker; ultra-short-acting; supraventricular tachycardia; ICU; perioperative; IV antiarrhythmic; rate control; atrial fibrillation; bradycardia-risk; critical-care
VERSION
RxIndia v0.1 — 19 Feb 2026
REFERENCES
- CDSCO import registrations and product information
- Indian hospital ICU protocols (AIIMS, select tertiary centres)
- Goodman & Gilman’s The Pharmacological Basis of Therapeutics
- API Textbook of Medicine
- Indian cardiology and anaesthesiology specialist practice protocols
- Published RCTs for off-label perioperative indications (Japan, EU data) — noted as off-label
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Clinical Responsibility
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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