Frågedatum: 1998-07-01
RELIS database 1998; id.nr. 14644, DRUGLINE
www.svelic.se
Utredningen som riktar sig till hälso- och sjukvårdspersonal, har utformats utefter tillgänglig litteratur och resurser vid tidpunkten för utredning. Innehållet i utredningen uppdateras inte. Hälso- och sjukvårdspersonal är ansvarig för hur de använder informationen vid rådgivning eller behandling av patienter.


What is known about the use of labetalol in pregnancy, especially in pregnant women with pheochrom



Fråga: "What is known about the use of labetalol in pregnancy, especially in pregnant women with pheochromocytoma? A woman in the 3rd month of gestation is under treatment with hydralazine and metoprolol for pheochromocytoma. The therapeutic response is "relatively good". Is labetalol a reasonable alternative should problems arise ?"

Sammanfattning: Treatment of pheochromocytoma in pregnant women is essentially the same as for non-pregnant patients. Surgery is preferred if the tumor is diagnosed during the first two trimesters. If medical therapy is chosen and in the absence of diagnostic problems, labetalol together with an alpha blocker seems to be a viable therapeutic option. Proper observation of the newborn for signs of adrenergic blockade is essential.

Svar: Labetalol, an alpha/beta-adrenergic blocker is used for the treatment of hypertension during pregnancy (1,2). Although the drug crosses the placenta and produce significant cord serum levels, available data suggest that its use probably does not pose any major risks to the fetus (1,3). The majority of newborns do not develop any adverse reactions after exposure (1). However, rare cases of bradycardia, hypotension, and hypoglycemia due to adrenergic blockade have been reported (1,4). Although labetalol has been suggested as an alternative to propranolol in the treatment of pheochromocytoma (5), it has the disadvantage of interfering with the measurement of catecholamines and their metabolites and also with scintigraphic studies that might be necessary for the preoperative localization of the tumor (6).

Although the optimal treatment of pheochromocytoma in pregnancy is somewhat controversial, curative treatment is surgical and is recommended if the tumor is diagnosed during the first two trimesters (6). Preoperative alpha- followed by beta-blockade is mandatory (5,6). If the patient is in the third trimester, cesarean section and removal of the tumor are indicated (6).

Referenser: