Version July 2025
Dosage guidance:
Dosing: Landiolol is for short-term use only; limited experience with infusion durations >24 hours.
Dosage form information: Landiolol 280 mg base is equivalent to landiolol hydrochloride 300 mg.
Supraventricular tachycardia:
Rapiblyk:
Note: Doses are expressed as landiolol base.
IV continuous infusion: Initial: 9 mcg/kg/minute; titrate dose every 10 minutes based on response and tolerability by 9 mcg/kg/minute up to a maximum dose of 36 mcg/kg/minute.
Patients with impaired cardiac function: IV continuous infusion: Initial: 1 mcg/kg/minute; titrate dose every 15 minutes based on response and tolerability by 1 mcg/kg/minute up to a maximum dose of 36 mcg/kg/minute.
Sibboran [Canadian product]:
Note: Doses are expressed as landiolol hydrochloride.
Loading dose (optional): IV: 100 mcg/kg/minute for 1 minute (to achieve heart rate lowering in 1 to 4 minutes) followed by IV continuous infusion dosing below.
IV continuous infusion: Initial: 10 to 40 mcg/kg/minute to achieve heart rate lowering in ≤16 minutes; dose may be increased to a maximum of 80 mcg/kg/minute for a short period of time if necessary and if maximum daily dose has not been met; maximum total daily dose: 57.6 mg/kg/day (eg, infusion of 40 mcg/kg/minute for 24 hours).
Patients with left ventricular function impairment (left ventricular ejection fraction <40%, CI <2.5 L/minute/m2, New York Heart Association functional class 3 or 4): IV continuous infusion: Initial: 1 mcg/kg/minute; may increase stepwise to 10 mcg/kg/minute; further dose increases may be considered under close hemodynamic monitoring.
Transitioning to an alternative medication: After achieving heart rate control and stable clinical status, transition to alternative medication while considering pharmacokinetics and pharmacodynamics of that medication. If switching to an oral beta-blocker (or a different rate control medication), reduce landiolol dose by 50% over the next ~60 minutes using heart rate and clinical status as guide. If heart rate remains controlled for at least 1 hour, further reduction and discontinuation of landiolol should be considered.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Mild impairment (Child-Turcotte-Pugh class A): There are no specific dosage adjustments provided in the manufacturer's labeling (has not been studied). More conservative dose titration is recommended.
Moderate or severe impairment (Child-Turcotte-Pugh class B or C): Avoid use.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%: Cardiovascular: Hypotension (10%)
Frequency not defined: Local: Infusion-site reaction (including erythema at injection site, infusion-site pain, swelling at injection site)
Hypersensitivity to landiolol or any component of the formulation; severe sinus bradycardia; sick sinus syndrome; decompensated heart failure; cardiogenic shock; second- or third- degree AV block (without pacemaker); pulmonary hypertension.
Canadian labeling: Additional contraindications (not in the US labeling): Untreated pheochromocytoma; acute asthma attack; severe metabolic acidosis (uncorrectable); severe bradycardia (<50 beats per minute); severe hypotension.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Anaphylactic reactions: Use caution with history of severe anaphylaxis to allergens; patients taking beta-blockers may become more sensitive to repeated allergen challenges. Treatment of anaphylaxis (eg, epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.
• Hyperkalemia: May increase serum potassium; risk is increased in patients with kidney impairment.
• Hypotension: Can commonly occur; patients need close BP monitoring. Patients with hemodynamic compromise, hypovolemia, or on interacting medications are at increased risk. If an unacceptable drop in BP occurs, reduction in dose or discontinuation may reverse hypotension.
• Infusion site reactions: Can commonly occur including pain, swelling, and erythema; avoid infusion into small veins or through a butterfly catheter. If infusion site reaction occurs, use an alternative infusion site. Avoid extravasation.
• Metabolic acidosis: May cause hyperkalemic renal tubular acidosis which may be associated with reduced cardiac contractility.
Disease-related concerns:
• Bronchospastic disease: In general, patients with bronchospastic disease should not receive beta-blockers; however, landiolol with beta1 selectivity may be used cautiously with close monitoring; dose reduction may be necessary.
• Cardiac failure: Beta blockers can cause reduced myocardial contractility and may precipitate heart failure or cardiogenic shock. If signs or symptoms of cardiac failure occur, discontinue therapy and begin supportive care.
• Conduction abnormality: Can cause bradycardia; consider preexisting conditions such as first-degree AV block before initiating. Do not use in patients with pre-excited atrial fibrillation or suspected wide complex tachycardia associated with an accessory pathway as this can lead to ventricular arrhythmias.
• Diabetes: Use with caution in patients with diabetes mellitus; may potentiate hypoglycemia and/or mask signs and symptoms.
• Liver impairment: Use with caution in patients with mild liver impairment; avoid use in patients with moderate to severe liver impairment.
• Peripheral vascular disease and Raynaud disease: May precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease and Raynaud disease; use with caution.
• Pheochromocytoma (untreated): Adequate alpha-blockade is required prior to use of any beta-blocker.
• Thyroid disease: May mask signs of hyperthyroidism (eg, tachycardia). If hyperthyroidism is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm.
• Vasospastic angina: Beta-blockers without alpha1-adrenergic receptor blocking activity should be avoided in patients with vasospastic angina since unopposed alpha1-adrenergic receptors mediate coronary vasoconstriction and can worsen anginal symptoms (Mayer 1998).
Other warnings/precautions:
• Abrupt discontinuation: Severe exacerbations of angina, myocardial infarction, and ventricular arrhythmia may occur upon abrupt discontinuation in patients with coronary artery disease.
Rapiblyk: FDA approved November 2024; anticipated availability is currently unknown.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous [preservative free]:
Rapiblyk: 280 mg (1 ea)
No
Solution (reconstituted) (Rapiblyk Intravenous)
280 mg (per each): $1,020.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous:
Sibboran: 300 mg (1 ea)
IV: Administer as a continuous IV infusion. May be administered via central or peripheral catheter.
Supraventricular tachycardia: Short-term reduction of ventricular rate in patients with supraventricular tachycardia, including atrial fibrillation and atrial flutter.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetylcholinesterase Inhibitors: May increase bradycardic effects of Beta-Blockers. Risk C: Monitor
Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Alpha2-Agonists: Beta-Blockers may increase rebound hypertensive effects of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Alpha2-Agonists may increase AV-blocking effects of Beta-Blockers. Sinus node dysfunction may also be enhanced. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Risk D: Consider Therapy Modification
Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification
Amisulpride (Oral): May increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Antidiabetic Agents: Beta-Blockers (Beta1 Selective) may increase adverse/toxic effects of Antidiabetic Agents. Specifically, beta-blockers may mask the hypoglycemic symptoms of antidiabetic agents. Risk C: Monitor
Antipsychotic Agents (Phenothiazines): May increase hypotensive effects of Beta-Blockers. Beta-Blockers may decrease metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease metabolism of Beta-Blockers. Risk C: Monitor
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor
Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Beta2-Agonists: Beta-Blockers (Beta1 Selective) may decrease bronchodilatory effects of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Risk C: Monitor
Blood Pressure Lowering Agents: May increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Bradycardia-Causing Agents: May increase bradycardic effects of Landiolol. Risk X: Avoid
Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid
Cafedrine: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may decrease therapeutic effects of Cafedrine. Risk C: Monitor
Cannabis: Beta-Blockers may increase adverse/toxic effects of Cannabis. Specifically, the risk of hypoglycemia may be increased. Risk C: Monitor
Cholinergic Agonists: Beta-Blockers may increase adverse/toxic effects of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Risk C: Monitor
Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Dipyridamole: May increase bradycardic effects of Beta-Blockers. Risk C: Monitor
Disopyramide: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may increase negative inotropic effects of Disopyramide. Risk C: Monitor
DOBUTamine: Beta-Blockers may decrease therapeutic effects of DOBUTamine. Risk C: Monitor
DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor
EPHEDrine (Systemic): Beta-Blockers may decrease therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor
EPINEPHrine (Nasal): Beta-Blockers (Beta1 Selective) may decrease therapeutic effects of EPINEPHrine (Nasal). Risk C: Monitor
EPINEPHrine (Oral Inhalation): Beta-Blockers (Beta1 Selective) may decrease therapeutic effects of EPINEPHrine (Oral Inhalation). Risk C: Monitor
EPINEPHrine (Systemic): Beta-Blockers (Beta1 Selective) may decrease therapeutic effects of EPINEPHrine (Systemic). Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): Beta-Blockers may increase vasoconstricting effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor
Etilefrine: Beta-Blockers may decrease therapeutic effects of Etilefrine. Etilefrine may increase bradycardic effects of Beta-Blockers. Risk C: Monitor
Etofylline: Beta-Blockers may decrease therapeutic effects of Etofylline. Risk X: Avoid
Fexinidazole: Bradycardia-Causing Agents may increase arrhythmogenic effects of Fexinidazole. Risk X: Avoid
Grass Pollen Allergen Extract (5 Grass Extract): Beta-Blockers may increase adverse/toxic effects of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers. Management: Consider alternatives to either grass pollen allergen extract (5 grass extract) or beta-blockers in patients with indications for both agents. Canadian product labeling specifically lists this combination as contraindicated. Risk D: Consider Therapy Modification
Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Isoproterenol: Beta-Blockers may decrease therapeutic effects of Isoproterenol. Risk C: Monitor
Lacosamide: Bradycardia-Causing Agents may increase AV-blocking effects of Lacosamide. Risk C: Monitor
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Mavacamten: Beta-Blockers may increase adverse/toxic effects of Mavacamten. Specifically, negative inotropic effects may be increased. Risk C: Monitor
Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor
Methacholine: Beta-Blockers may increase adverse/toxic effects of Methacholine. Risk C: Monitor
Midodrine: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor
Mivacurium: Beta-Blockers may increase therapeutic effects of Mivacurium. Risk C: Monitor
Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
NIFEdipine (Topical): May increase adverse/toxic effects of Beta-Blockers. Risk C: Monitor
NIFEdipine: May increase hypotensive effects of Beta-Blockers. NIFEdipine may increase negative inotropic effects of Beta-Blockers. Risk C: Monitor
Nitrendipine: May increase therapeutic effects of Beta-Blockers. Risk C: Monitor
Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor
Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Beta-Blockers. Risk C: Monitor
Nonsteroidal Anti-Inflammatory Agents: May decrease antihypertensive effects of Beta-Blockers. Risk C: Monitor
Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification
Opipramol: Beta-Blockers may increase serum concentration of Opipramol. Opipramol may increase serum concentration of Beta-Blockers. Risk C: Monitor
Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor
Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Reserpine: May increase hypotensive effects of Beta-Blockers. Reserpine may increase bradycardic effects of Beta-Blockers. Risk C: Monitor
Rivastigmine: May increase bradycardic effects of Beta-Blockers. Risk X: Avoid
Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Succinylcholine: Beta-Blockers may increase neuromuscular-blocking effects of Succinylcholine. Risk C: Monitor
Sympathomimetics: May decrease therapeutic effects of Landiolol. Risk C: Monitor
Tasimelteon: Beta-Blockers may decrease therapeutic effects of Tasimelteon. Management: Consider avoiding nighttime administration of beta-blockers during tasimelteon therapy due to the potential for reduced tasimelteon efficacy. Risk D: Consider Therapy Modification
Theodrenaline: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may decrease therapeutic effects of Theodrenaline. Risk C: Monitor
Theophylline Derivatives: Beta-Blockers (Beta1 Selective) may decrease bronchodilatory effects of Theophylline Derivatives. Risk C: Monitor
White Birch Allergen Extract: Beta-Blockers may increase adverse/toxic effects of White Birch Allergen Extract. Specifically, beta-blockers may reduce the effectiveness of beta-agonists that may be required to treat systemic reactions to white birch allergen extract. Risk X: Avoid
Outcome data following use of landiolol during delivery are limited (Abe 2010; Ishizaki 2021; Kubo 2005; Saeki 2010). In a small study, a single dose of landiolol prior to intubation in patients undergoing cesarean delivery was found to prevent intraoperative and postoperative tachycardia and/or hypertension without adversely effecting uterine contractions or Apgar scores (Suehiro 2012).
It is not known if landiolol is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
BP, heart rate, continuous ECG; serum glucose (in patients with diabetes); signs/symptoms of bronchospasm in patients with existing bronchospastic disease, serum potassium (especially with kidney impairment), IV site; consult institutional policies and procedures.
Ultra-short-acting selective beta1-adrenergic receptor site blocker that reduces heart rate, slows conduction, and increases refractory period of the AV node. It does not have any membrane-stabilizing activity or any intrinsic sympathomimetic activity.
Distribution: 0.3 to 0.4 L/kg.
Protein binding: <10%.
Metabolism: Metabolized via hydrolysis of the ester moiety in the plasma by pseudocholinesterases and carboxylesterases. Active metabolite, M1, has <1/40th of the pharmacological activity of landiolol.
Half-life elimination: Bolus: 3.2 minutes; Infusion: 4.5 minutes.
Excretion: Urine (~50% to 75% within 4 hours [54.4% and 11.5% as M1 and M2 metabolites]; 89% to 99% within 24 hours [landiolol and M1 and M2 metabolites]).
Clearance: Bolus: 66.1 mL/kg/minute; Infusion: 57 mL/kg/minute.
Liver impairment: Patients with mild liver impairment have shown an increased landiolol plasma concentration by ~40% to 44%.
