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Landiolol Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

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

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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Landiolol Uses, Dosage, Side Effects & Warnings | DrugsAtlas

DRUG NAME: Landiolol

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Secondary Indications — Adults Only (Off-label, if any)

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Secondary Indications — Paediatric Doses (Off-label, if any)

RENAL ADJUSTMENT

HEPATIC ADJUSTMENT

CONTRAINDICATIONS

CAUTIONS

PREGNANCY

LACTATION

ELDERLY

MAJOR DRUG INTERACTIONS

MODERATE DRUG INTERACTIONS

COMMON ADVERSE EFFECTS

SERIOUS ADVERSE EFFECTS

MONITORING REQUIREMENTS

BRANDS AVAILABLE IN INDIA

PRICE RANGE (INR)

CLINICAL PEARLS

TAGS

VERSION

REFERENCES

Clinical Responsibility

Is this information helpful?

RxIndia

Landiolol Uses, Dosage, Side Effects & Warnings | DrugsAtlas

DRUG NAME: Landiolol

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Secondary Indications — Adults Only (Off-label, if any)

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Secondary Indications — Paediatric Doses (Off-label, if any)

RENAL ADJUSTMENT

HEPATIC ADJUSTMENT

CONTRAINDICATIONS

CAUTIONS

PREGNANCY

LACTATION

ELDERLY

MAJOR DRUG INTERACTIONS

MODERATE DRUG INTERACTIONS

COMMON ADVERSE EFFECTS

SERIOUS ADVERSE EFFECTS

MONITORING REQUIREMENTS

BRANDS AVAILABLE IN INDIA

PRICE RANGE (INR)

CLINICAL PEARLS

TAGS

VERSION

REFERENCES

Clinical Responsibility

Is this information helpful?