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Dr Eisele's point is well taken; however, the package insert for labetalol states that 300 mg is the usual intravenous dosage required prior to starting oral therapy, rather than an absolute maximum. In addition, it states that the infusion may be adjusted as needed to maintain an adequate blood pressure response.Our patient was maintained at non per os status due to his nausea with vomiting and because surgery was considered an option had medical therapy proved unsuccessful. Thus, rather than risk a rebound of blood pressure in a patient with aortic dissection, we chose to continue intravenous labetalol therapy at a low, effective, well-tolerated dose until oral therapy could be initiated.
Grubb BP, Zelis R. Intravenous Labetalol in Acute Aortic Dissection-Reply. JAMA. 1987;258(13):1732-1733. doi:10.1001/jama.1987.03400130046023