Rapibloc (Landiolol 10 mg/ml)
Ultra-short-acting selective beta-1 blocker — concentrate for solution for injection, hospital use only
Quick Facts About Rapibloc
Key Takeaways About Rapibloc
- Hospital-only medication: Rapibloc is administered exclusively in hospital or intensive care settings by trained healthcare professionals under continuous cardiac monitoring
- Ultra-short half-life: Landiolol has an elimination half-life of roughly 4 minutes, which allows very fine titration and rapid reversal of effect if needed
- Highly cardioselective: Landiolol preferentially blocks cardiac beta-1 receptors, which reduces the risk of bronchospasm compared with non-selective beta blockers
- Rate control, not rhythm control: Rapibloc lowers ventricular rate in atrial fibrillation, atrial flutter and supraventricular tachycardia but is not primarily intended to restore sinus rhythm
- Must be diluted: The 10 mg/ml concentrate must never be given undiluted and must be prepared by a qualified healthcare professional before administration
What Is Rapibloc and What Is It Used For?
Rapibloc (landiolol) is an intravenous, ultra-short-acting selective beta-1 adrenergic receptor blocker used in hospital and critical care settings to rapidly reduce elevated heart rate in supraventricular tachyarrhythmias such as atrial fibrillation, atrial flutter and sinus tachycardia, particularly during or after surgery and in unstable patients.
Rapibloc is the brand name for the beta blocker landiolol hydrochloride. Pharmacologically, landiolol belongs to the class of cardioselective beta-1 adrenergic receptor blockers with the Anatomical Therapeutic Chemical (ATC) classification code C07AB14. Like other beta-1 blockers, it acts primarily on the heart by attenuating the effects of circulating catecholamines such as adrenaline and noradrenaline. However, landiolol differs from most other agents in its class by having an extraordinarily short duration of action and an exceptionally high cardioselectivity index, which makes it particularly well suited to situations where rapid, titratable and rapidly reversible heart rate control is required.
The active substance, landiolol, is hydrolysed by plasma and hepatic esterases into inactive metabolites, resulting in an elimination half-life of only about four minutes in adults. In practical terms, this means that when the infusion is stopped, a clinically meaningful level of beta-blockade typically resolves within 15 to 30 minutes. This pharmacokinetic profile is a key reason why landiolol has been adopted in cardiac surgery, intensive care, emergency medicine and perioperative anaesthesia for patients with unstable haemodynamics or a high risk of severe bradycardia or hypotension from longer-acting beta blockers.
Clinically, Rapibloc is used to control the ventricular rate in supraventricular tachyarrhythmias, including atrial fibrillation, atrial flutter and other forms of supraventricular tachycardia, particularly in the perioperative period, during intensive care and in patients undergoing cardiac surgery. It is also used to manage sinus tachycardia where rapid heart rate reduction is desirable. Because landiolol shortens the time from drug administration to therapeutic effect and back to baseline, it allows clinicians to "dial in" a target heart rate more precisely than is possible with longer-acting agents such as metoprolol or atenolol.
The medication is presented as a clear, colourless to slightly yellowish concentrate for solution for injection, supplied in 2 ml glass ampoules containing 20 mg of landiolol hydrochloride (equivalent to 18.7 mg of landiolol free base), at a concentration of 10 mg/ml. A separate formulation of Rapibloc as a powder for solution for infusion is also available for longer-duration administration. The concentrate form is intended for single use and must always be diluted prior to administration, typically to a final concentration of 2 mg/ml in sodium chloride 9 mg/ml (0.9%), glucose 50 mg/ml (5%), Ringer's solution, or Ringer-lactate solution.
Compared with esmolol, another ultra-short-acting intravenous beta-1 blocker, landiolol is markedly more cardioselective (beta-1 to beta-2 selectivity ratio approximately 255:1 versus around 33:1 for esmolol) and has a shorter elimination half-life. This higher selectivity translates into a reduced likelihood of bronchospasm and peripheral vascular side effects, and a weaker negative inotropic (cardiac contractility-reducing) effect at equivalent heart rate control.
What Should You Know Before Receiving Rapibloc?
Before receiving Rapibloc, your medical team will review your cardiac status, airway disease, blood pressure, kidney and liver function, metabolic balance and current medications. Rapibloc is contraindicated in several cardiovascular and metabolic conditions and must be used with caution in others.
Because Rapibloc is given intravenously in hospital under continuous monitoring, the usual pre-administration safety checks performed by oral or self-administered medications are replaced by a thorough clinical assessment by the attending physician or anaesthesiologist. Before the first dose, the care team will review your complete medical history, including existing cardiac disease, arrhythmias, previous adverse reactions to beta blockers, kidney and liver function, respiratory conditions, diabetes status and any medications you currently take. Continuous monitoring of heart rate, blood pressure and cardiac electrical activity through electrocardiography is standard practice while the medication is being administered.
The manufacturer and European public assessment reports list multiple clinical situations in which landiolol should not be used at all, and others in which it may be used only with particular caution and closer monitoring. These are summarised below. Patients and caregivers should understand that the medical team is responsible for making these clinical judgements, but familiarity with the main contraindications can help patients provide the medical team with relevant information during the pre-treatment review.
Contraindications
Rapibloc must not be administered if any of the following conditions are present:
- Hypersensitivity: Known allergy to landiolol or to any of the excipients in the formulation
- Severe bradycardia: Resting heart rate below 50 beats per minute
- Sick sinus syndrome: A sinus node dysfunction characterised by alternating bradycardia and tachycardia
- High-grade atrioventricular (AV) block: Second or third degree AV block in patients without a functioning pacemaker
- Cardiogenic shock: Circulatory failure of cardiac origin
- Severe hypotension: Markedly low systemic blood pressure
- Decompensated heart failure: Symptomatic heart failure unresponsive to current therapy
- Pulmonary hypertension: Elevated blood pressure in the pulmonary arterial circulation
- Untreated phaeochromocytoma: A catecholamine-secreting tumour of the adrenal medulla that has not been blocked with an alpha-adrenergic antagonist
- Acute severe asthma attack: Acute, rapidly deteriorating bronchospastic disease
- Severe untreatable metabolic acidosis: A profoundly low blood pH that cannot be corrected
In unblocked phaeochromocytoma, administering a beta blocker without prior alpha blockade can lead to unopposed alpha-adrenergic stimulation, causing severe hypertensive crisis. In cardiogenic shock or decompensated heart failure, further reduction of heart rate and contractility by a beta blocker can precipitate circulatory collapse. These scenarios illustrate why the contraindication list is taken very seriously in clinical practice.
Warnings and Precautions
Even when none of the absolute contraindications apply, the prescribing physician will take additional precautions in patients with the following conditions or circumstances:
- Diabetes or hypoglycaemia: Beta blockers, including landiolol, may mask some of the warning symptoms of low blood glucose, such as tachycardia and tremor, and may affect glucose metabolism
- Mild or moderate hypotension: Careful titration is required to avoid further blood pressure drops; extra caution is advised when the systolic blood pressure is low at baseline
- Preexcitation syndromes with atrial fibrillation: In Wolff-Parkinson-White syndrome combined with atrial fibrillation, slowing AV conduction with a beta blocker can paradoxically favour conduction down an accessory pathway
- First degree AV block or conduction disorders: Patients with pre-existing AV conduction abnormalities require closer electrocardiographic monitoring
- Concurrent use of verapamil or diltiazem: Because these non-dihydropyridine calcium channel blockers also slow AV conduction and reduce contractility, combining them with landiolol amplifies these effects
- Prinzmetal (variant) angina: Non-selective beta blockade may worsen coronary vasospasm, and although landiolol is highly cardioselective, caution is still advised
- Current or previous heart failure: Close monitoring for decompensation is required, and the dose may need to be reduced or the medication discontinued if signs of worsening heart failure appear
- Supraventricular arrhythmias with concurrent heart disease or other antiarrhythmics: The potential for additive cardiac depression is greater in this patient group
- Renal impairment: Although no routine dose adjustment is required, closer monitoring is advised because of altered haemodynamic and pharmacokinetic responses
- Phaeochromocytoma pretreated with alpha blockade: Even after adequate alpha blockade, beta blockade should be introduced cautiously
- Bronchospastic airway disease: Despite high cardioselectivity, bronchoconstriction may still occur at higher doses; patients with asthma or chronic obstructive pulmonary disease require vigilance
- Peripheral circulatory disease: Raynaud’s phenomenon, intermittent claudication and similar disorders may worsen with beta blockade
- History of anaphylaxis or severe allergies: Beta blockers may increase the severity of allergic reactions and reduce the efficacy of adrenaline used to treat them
Throughout administration, the medical team monitors heart rate, blood pressure and the electrocardiogram continuously, and may interrupt or reduce the infusion at any time if adverse changes occur. Because of the very short half-life of landiolol, most medication-related haemodynamic changes resolve within approximately 30 minutes of stopping the infusion, which is an important safety feature of this drug.
Excipients: Alcohol, Potassium and Sodium
Rapibloc concentrate contains ethanol (alcohol) as an excipient, with up to approximately 672 mg of ethanol per full daily dose calculated for a 70 kg adult. This amount is comparable to less than 17 ml of beer or 7 ml of wine per dose and is generally not clinically significant in adults. However, the prescribing physician will specifically take the ethanol content into consideration in patients with alcohol dependency, pregnant or breastfeeding women, and patients with liver disease or epilepsy. Each ampoule contains less than 1 mmol (23 mg) of sodium and less than 1 mmol (39 mg) of potassium, and can be regarded as essentially sodium-free and potassium-free.
Pregnancy and Breastfeeding
There are no adequate data on the use of landiolol in pregnant women. Because of this lack of clinical experience, Rapibloc is generally not recommended during pregnancy. If the clinical situation requires urgent rate control in a pregnant patient and alternative treatments are not suitable, the risks and benefits must be carefully weighed by the treating team, and the lowest effective dose used for the shortest possible time.
It is not known whether landiolol is excreted into breast milk at clinically significant levels, but based on precautionary principles and the ethanol content of the concentrate, Rapibloc should not be administered to breastfeeding mothers. If administration is unavoidable, breastfeeding should be suspended during therapy and resumed only after the medication has been fully cleared and in consultation with the treating physician.
Use in Children and Adolescents
The safety and efficacy of landiolol in children aged 0 to 18 years have not been fully established. Because the Rapibloc concentrate formulation contains ethanol, it is not recommended for use in paediatric patients. For children requiring landiolol, an alternative formulation such as Rapibloc powder for solution for infusion, which does not contain ethanol, may be more appropriate when clinically indicated and used under specialist supervision.
Patients who are at risk of severe allergic reactions (anaphylaxis) should be aware that beta blockers, including landiolol, can potentially increase the severity of anaphylactic responses and make them less responsive to adrenaline. Always inform your medical team about your full allergy history, including reactions to foods, medications, insect stings, and latex.
How Does Rapibloc Interact with Other Drugs?
Landiolol can interact with many cardiovascular, antiarrhythmic, anaesthetic and antihypertensive medications, as well as with certain antidiabetic, psychiatric and anti-inflammatory drugs. Your medical team will review your full medication list before and during treatment with Rapibloc.
Drug interactions with landiolol occur through several mechanisms. Pharmacodynamic interactions arise when two drugs share or oppose a pharmacological effect, such as heart rate reduction, AV conduction slowing, blood pressure lowering or negative inotropy. Pharmacokinetic interactions, while less clinically prominent for landiolol because of its metabolism by plasma and hepatic esterases rather than by cytochrome P450 enzymes, can still alter the response of the patient to co-administered drugs. The most important interactions are therefore those that produce additive cardiac depression, conduction block, blood pressure changes, or altered glucose control.
It is essential to inform the medical team about all medications currently being taken, including prescription medicines, over-the-counter products, herbal remedies and supplements. Even herbal preparations can have clinically relevant cardiovascular or metabolic effects that become important during beta-blockade.
Major Interactions
| Drug / Drug Class | Mechanism | Clinical Consequence | Recommendation |
|---|---|---|---|
| Verapamil, diltiazem | Additive AV nodal block and negative inotropy | Severe bradycardia, AV block, hypotension, heart failure | Use only with caution; close ECG and haemodynamic monitoring |
| Digoxin, digitalis | Additive slowing of AV conduction | Severe bradycardia, high-grade AV block | Monitor heart rate and rhythm closely |
| Amiodarone, propafenone, disopyramide | Additive negative chronotropic and inotropic effects | Bradyarrhythmia, QT changes, depressed cardiac function | Use with caution; monitor ECG and cardiac output |
| Insulin and oral antidiabetic drugs | Beta blockade masks hypoglycaemic warning signs | Hypoglycaemia may be unrecognised | Monitor blood glucose closely during therapy |
| Suxamethonium and other muscle relaxants | Possible prolongation of neuromuscular blockade | Extended paralysis during anaesthesia | Anaesthetist adjusts dosing of relaxants |
| Cholinesterase inhibitors (neostigmine, distigmine, edrophonium) | Additive vagotonic effect with beta blockade | Severe bradycardia, AV block | Use together only under specialist supervision |
| Clonidine | Risk of rebound hypertension if clonidine discontinued during beta blockade | Hypertensive crisis on clonidine withdrawal | Avoid abrupt clonidine withdrawal; specialist monitoring |
| Reserpine | Potentiation of sympatholytic effects | Severe hypotension, bradycardia | Dose reduction and close monitoring |
| Adrenaline (epinephrine) | Beta blockade may reduce response to adrenaline in anaphylaxis | Reduced effectiveness of anaphylaxis treatment | Higher doses of adrenaline may be required |
Minor and Other Interactions
| Drug / Drug Class | Mechanism | Clinical Consequence | Recommendation |
|---|---|---|---|
| Ganglion blockers (e.g., trimetaphan) | Additive sympatholytic effect | Profound hypotension | Avoid or monitor closely |
| NSAIDs | Reduced antihypertensive effect | Lesser blood pressure reduction | Monitor blood pressure |
| Floctafenine | Reduced response to cardiovascular compensation | Potential anaphylactoid reactions with blunted response | Avoid concurrent use |
| Amisulpride | QT interval prolongation | Risk of ventricular arrhythmias | ECG monitoring |
| Tricyclic antidepressants (imipramine, amitriptyline) | Additive cardiovascular effects | Hypotension, conduction abnormalities | Use with caution |
| Barbiturates (e.g., phenobarbital) | Additive central depression and hypotension | Excessive sedation, hypotension | Monitor vital signs |
| Phenothiazines (e.g., chlorpromazine) | Enhanced hypotensive effect | Orthostatic hypotension | Monitor blood pressure |
| Asthma medications (beta-agonists) | Pharmacological antagonism | Reduced bronchodilator efficacy | Monitor respiratory function |
| Cold and decongestant medications | Sympathomimetic effects | Hypertension, arrhythmias | Avoid during treatment |
| Heparin | Potential influence on anticoagulation response | Altered bleeding risk profile | Monitor coagulation parameters |
| Nifedipine and other dihydropyridines | Additive vasodilation | Hypotension | Titrate carefully |
The tables above are not exhaustive. Because Rapibloc is administered in a controlled hospital environment, the medical team will review the complete medication history, check for interactions against the most recent Summary of Product Characteristics (SmPC) and clinical pharmacology databases, and make treatment decisions based on the individual clinical context.
During surgery, landiolol is often used alongside anaesthetic agents such as volatile anaesthetics, opioids and muscle relaxants. Many of these agents have cardiovascular effects that can combine with those of landiolol. The anaesthesiologist integrates these considerations into a tailored haemodynamic plan and adjusts doses throughout the procedure based on continuous monitoring.
What Is the Correct Dosage of Rapibloc?
The typical intravenous bolus dose of Rapibloc is 0.1 to 0.3 mg per kilogram of body weight, starting at 0.1 to 0.2 mg/kg and titrated upward if needed. Doses can be repeated up to a maximum daily dose of approximately 100 mg per patient per day. Dosing is individualised by the medical team and always performed under continuous cardiac monitoring.
The dose of landiolol is always tailored to the individual patient based on clinical indication, body weight, current heart rate, blood pressure, concomitant medications and overall clinical condition. Only qualified healthcare professionals with appropriate training in cardiovascular pharmacology and resuscitation are authorised to prepare and administer Rapibloc. The concentrate must never be administered undiluted. To prepare a working solution of 2 mg/ml, 2 ml of the concentrate is diluted with 8 ml of a compatible diluent: sodium chloride 9 mg/ml (0.9%), glucose 50 mg/ml (5%), Ringer’s solution or Ringer-lactate solution. The diluted solution must be visually inspected for clarity, colour and particulate matter before use; only clear, colourless solutions are acceptable.
Administration is via a large central or peripheral vein through an adequately sized needle or intravenous catheter. Landiolol must not be given subcutaneously, perivascularly or intra-arterially, and should not be infused through the same line as other medications. The bradycardic effect of a single bolus typically lasts between 5 and 20 minutes, after which another dose can be given if further rate control is needed.
Adults
Standard Adult Intravenous Bolus Dose
The recommended starting intravenous bolus dose is 0.1 to 0.2 mg per kilogram of body weight, administered over approximately one minute. If heart rate control is insufficient, the dose may be increased to 0.2 or 0.3 mg/kg. Boluses may be repeated as clinically required up to a maximum cumulative daily dose of 100 mg per patient per day. This total may be divided into 5 to 15 individual doses per day; for example, 5 doses of 20 mg each (approximately 5 × 0.3 mg/kg) or 15 doses of 7 mg each (approximately 15 × 0.1 mg/kg). For longer duration administration, a continuous infusion using the landiolol powder formulation is preferred.
Elderly Patients (≥65 years)
Geriatric Considerations
No specific dose adjustment is routinely required in elderly patients, but they are often more sensitive to haemodynamic changes. The treating physician will typically start at the lower end of the dose range and titrate carefully while monitoring heart rate, blood pressure and the electrocardiogram. Age-related changes in cardiac conduction, renal function and hepatic metabolism may all contribute to individual variability in response.
Renal Impairment
Kidney Function Considerations
Because landiolol is inactivated by plasma esterases and is not primarily cleared by the kidneys, no routine dose adjustment is required in renal impairment. Nevertheless, cautious titration and closer monitoring are advised in patients with significantly reduced kidney function, as they may have altered overall haemodynamics and concomitant electrolyte disturbances.
Hepatic Impairment
Liver Function Considerations
Data on the use of landiolol in patients with hepatic impairment are limited. Cautious dosing from the lower end of the range is recommended regardless of the degree of hepatic impairment. The ethanol content of the concentrate formulation is also relevant in patients with liver disease, and the care team will take this into account when selecting the formulation and dose.
Children and Adolescents
Paediatric Use
The safety and efficacy of Rapibloc concentrate in children and adolescents aged 0 to 18 years have not been established. The concentrate contains ethanol as an excipient and is therefore not recommended in paediatric patients. Where landiolol is clinically required for a child, an alternative formulation without ethanol (such as Rapibloc powder for solution for infusion) may be more appropriate and should be considered by a specialist paediatric team.
Missed Dose
Because Rapibloc is administered only in a hospital setting by healthcare professionals, patients do not manage their own dosing schedule. If a planned dose is delayed or missed due to clinical or logistical reasons, the medical team decides whether to proceed with the next scheduled dose based on current heart rate, blood pressure, clinical condition and the reason for the delay. Patients and caregivers do not need to take action regarding missed doses of Rapibloc.
Overdose
Because landiolol has a very short half-life, the effects of an inadvertent overdose typically resolve within approximately 30 minutes of stopping the infusion. If overdose is suspected, the infusion is stopped immediately, further doses are avoided, and the patient is given appropriate supportive care, which may include intravenous fluids, atropine for bradycardia, vasopressors for hypotension, and in rare cases temporary pacing. Symptoms of overdose can include severe hypotension, profound bradycardia, AV block, cardiogenic shock, cardiac arrest, bronchospasm, respiratory insufficiency, loss of consciousness, seizures, nausea, vomiting, hypoglycaemia and hyperkalaemia.
| Patient Group | Recommended Dose | Maximum Daily Dose | Notes |
|---|---|---|---|
| Adults | 0.1–0.3 mg/kg IV bolus (start 0.1–0.2 mg/kg) | 100 mg/day | 5–15 doses per 24 hours; titrate to heart rate |
| Elderly (≥65 years) | Standard, starting at lower end | 100 mg/day | Closer monitoring; cautious titration |
| Renal impairment | No routine dose adjustment | 100 mg/day | Careful titration and haemodynamic monitoring |
| Hepatic impairment | Start at lowest effective dose | 100 mg/day | Consider ethanol content of concentrate |
| Children (0–18 years) | Concentrate not recommended | N/A | Consider ethanol-free powder formulation under specialist care |
What Are the Side Effects of Rapibloc?
The most common side effects of Rapibloc are a reduced heart rate (bradycardia) and low blood pressure (hypotension), affecting up to 1 in 10 patients. Because the drug is cleared within minutes, most side effects resolve quickly after stopping the infusion. Serious but rare adverse events include stroke, seizures, heart attack and severe respiratory effects.
Adverse reactions to landiolol, as reported in clinical trials and post-marketing surveillance, generally follow the expected pharmacology of beta blockade. The intensity and incidence of side effects are closely linked to the dose, infusion rate and underlying clinical condition of the patient. A key practical advantage of landiolol is that most haemodynamic side effects resolve within approximately 30 minutes of stopping the infusion, due to the ultra-short elimination half-life.
During administration, the medical team continuously monitors heart rate, blood pressure and electrocardiographic parameters. If significant changes occur in any of these, the infusion may be paused, reduced or stopped altogether, and supportive treatment provided as needed. Side effects are graded below by frequency, using the standard pharmacovigilance categories applied in the European Union.
Common Side Effects
May affect up to 1 in 10 people
- Reduced heart rate (bradycardia)
- Low blood pressure (hypotension)
Uncommon Side Effects
May affect up to 1 in 100 people
- Pneumonia (lung infection)
- Low blood sodium (hyponatraemia)
- Reduced blood flow to the brain; headache
- Inability to maintain normal circulation (cardiac arrest)
- Rapid heart rate (tachycardia)
- High blood pressure (hypertension)
- Pulmonary oedema (fluid in the lungs)
- Vomiting and nausea
- Liver function disturbances
- Abnormalities on electrocardiogram or echocardiogram
- Changes in routine blood test values
- Protein in the urine (proteinuria)
Rare Side Effects
May affect up to 1 in 1,000 people
- Inflammation of the mediastinum (mediastinitis)
- Abnormal platelet counts (thrombocytopenia or thrombocytosis)
- High blood sugar (hyperglycaemia)
- Stroke and seizures
- Heart attack (myocardial infarction)
- Various cardiac rhythm disturbances, including short pauses, missed beats and palpitations
- Reduced cardiac function and circulatory shock
- Hot flushes
- Respiratory difficulties, dyspnoea, lung disease, low blood oxygen
- Digestive disturbances, oral secretions, bad breath
- Elevated bilirubin (a pigment produced from red blood cell breakdown)
- Skin redness and cold sweating
- Muscle cramps
- Kidney failure, kidney injury, reduced urine output
- Fever, chills, chest discomfort, pain at the injection site
- Increased pressure in the pulmonary vessels
- Sugar (glucose) in the urine
Frequency Unknown
Reported but frequency cannot be estimated from available data
- Skin changes at the injection site
- Feeling of pressure at the injection site
The infusion of Rapibloc may be interrupted if the treating team observes significant changes in heart rate (particularly severe bradycardia or new high-grade AV block), blood pressure (marked hypotension) or the electrical activity of the heart. Because of the ultra-short half-life of landiolol, most such changes resolve spontaneously within roughly half an hour after the drug is stopped, although specific interventions (fluids, atropine, vasopressors) may sometimes be required.
Reporting suspected adverse drug reactions after authorisation is a key pharmacovigilance activity that helps regulatory authorities continuously monitor the benefit-risk balance of medicines. Healthcare professionals are encouraged to report any suspected adverse reactions to their national regulatory authority through the appropriate reporting system. Patients and caregivers can also contribute to pharmacovigilance by reporting suspected side effects via local reporting channels.
How Should Rapibloc Be Stored?
Rapibloc concentrate is stored refrigerated at 2°C to 8°C, kept out of sight and reach of children, and used before the expiry date printed on the carton. It is for single use only and must be diluted before administration.
Proper storage conditions are essential to maintain the stability, safety and efficacy of parenteral medications. Rapibloc concentrate should be stored in a refrigerator at a temperature between 2°C and 8°C (36°F to 46°F). The ampoules should be kept in the outer carton until use to protect them from light and physical damage. The expiry date, which refers to the last day of the month indicated on the carton and ampoule after "EXP", must not be exceeded.
Each ampoule is intended for single use only. Once opened, the medication should be used immediately and any unused portion discarded in accordance with local waste disposal regulations for pharmaceutical products. Multiple use of a single ampoule is not permitted due to the absence of antimicrobial preservatives and the risk of bacterial contamination.
Before use, the solution should be visually inspected. If the solution contains visible particles, is discoloured, or appears anything other than clear and colourless to slightly yellowish, it must not be administered. The diluted solution should also be inspected for clarity, colour and absence of particulate matter before administration.
Unused medication should never be disposed of via wastewater or household waste. Healthcare facilities have specific procedures for disposing of expired or unused pharmaceutical products in accordance with environmental and public health regulations. As with all medications, Rapibloc must be kept out of the sight and reach of children, consistent with general safe medication storage practices. In practice, however, because Rapibloc is used only in hospital environments, it is stored in dedicated medication storage areas under the control of pharmacy and nursing staff.
Pharmaceutical residues in water and soil are a growing concern worldwide. Healthcare facilities have specialised protocols for medicinal waste. Patients and family members may never need to dispose of Rapibloc themselves, but it is helpful to ask the pharmacist for advice if handling any unused medicines at home.
What Does Rapibloc Contain?
Each millilitre of Rapibloc concentrate contains 10 mg of landiolol hydrochloride (equivalent to 9.35 mg of landiolol free base). A 2 ml ampoule contains 20 mg of landiolol hydrochloride. The formulation also contains excipients including ethanol, hydroxypropylbetadex, macrogol 300, and physiologically balanced salts.
The active substance in Rapibloc is landiolol hydrochloride. Each millilitre of the concentrate contains 10 mg of landiolol hydrochloride, which is equivalent to approximately 9.35 mg of landiolol free base. Each 2 ml ampoule therefore contains 20 mg of landiolol hydrochloride, corresponding to 18.7 mg of landiolol free base. The concentrate is supplied as a clear, colourless to slightly yellowish solution free from visible particulate matter.
In addition to the active substance, Rapibloc concentrate contains several pharmaceutical excipients that support solubility, stability and administration. These include hydroxypropylbetadex (a cyclodextrin that enhances solubility), macrogol 300 (a polyethylene glycol used as a co-solvent), ethanol 96% (as described above, an important consideration in alcohol dependency, pregnancy, breastfeeding, liver disease and epilepsy), sodium chloride, potassium chloride, disodium phosphate, potassium dihydrogen phosphate and water for injections. The phosphate buffer system and electrolytes maintain the physiological pH and tonicity required for safe intravenous use.
The concentrate is supplied in 3 ml glass ampoules, each containing 2 ml of Rapibloc concentrate. A typical carton contains five ampoules. Because the concentrate is intended for hospital use, packaging is designed for clinical handling rather than patient dispensing.
Rapibloc is marketed in the European Economic Area under various names depending on the country, including Rapibloc in most member states, Raploc (Estonia, Latvia, Lithuania, Norway), Runrapiq (Poland) and Landiobloc (Italy). The marketing authorisation holder is Amomed Pharma GmbH, and the manufacturer is AOP Orphan Pharmaceuticals GmbH, both based in Vienna, Austria.
Each ampoule contains a small but clinically relevant amount of ethanol, and minimal sodium and potassium (less than 1 mmol each). While the sodium and potassium content is negligible, the ethanol may be relevant in pregnancy, breastfeeding, paediatric use and specific medical conditions; the treating clinician takes these factors into consideration before prescribing.
Frequently Asked Questions About Rapibloc
Rapibloc is the brand name of landiolol, an ultra-short-acting intravenous beta-1 selective blocker used in hospital settings to rapidly control a fast heart rate in supraventricular tachyarrhythmias, including atrial fibrillation, atrial flutter and other supraventricular tachycardias. It is particularly useful during or after surgery and in critically ill patients, where precise and rapidly reversible rate control is desirable. Rapibloc is always administered by qualified healthcare professionals under continuous cardiac monitoring.
Landiolol is a highly cardioselective beta-1 adrenergic receptor blocker. By blocking beta-1 receptors in the heart, it reduces the chronotropic (heart rate) and inotropic (contractility) effects of catecholamines such as adrenaline and noradrenaline. The drug is rapidly hydrolysed by plasma and hepatic esterases into inactive metabolites, giving it an elimination half-life of approximately four minutes. This means the clinical effect can be titrated very precisely and, if adverse effects occur, they usually resolve within 30 minutes after stopping the infusion.
Rapibloc concentrate is diluted with a compatible intravenous solution (such as sodium chloride 0.9%, glucose 5%, Ringer’s, or Ringer-lactate) to a concentration of 2 mg/ml before being administered intravenously. The typical bolus dose is 0.1 to 0.3 mg per kilogram of body weight, usually starting at 0.1 to 0.2 mg/kg and titrated upward if needed. It should be delivered into a large central or peripheral vein using an adequate needle or catheter. Rapibloc must not be given subcutaneously, intra-arterially or through the same line as other medications.
Rapibloc is contraindicated in patients with hypersensitivity to landiolol or any excipient, severe bradycardia (heart rate below 50 beats per minute), sick sinus syndrome, second or third degree AV block without a pacemaker, cardiogenic shock, severe hypotension, decompensated heart failure, pulmonary hypertension, untreated phaeochromocytoma, an acute asthma attack, or severe metabolic acidosis that cannot be corrected. Caution is also required in patients with diabetes, mild hypotension, Prinzmetal’s angina, WPW syndrome with atrial fibrillation, heart failure, bronchospastic disease, peripheral vascular disease and a history of anaphylaxis.
The most commonly reported side effects of Rapibloc are low heart rate (bradycardia) and low blood pressure (hypotension), each of which may affect up to 1 in 10 patients. Less frequently, patients may experience nausea, vomiting, headache, hyperglycaemia, hyponatraemia, liver function changes, protein or glucose in the urine, cardiac arrhythmias, cardiac arrest, pulmonary oedema, respiratory problems, injection site reactions, kidney dysfunction, or rarely stroke, seizures and heart attack. Because of the very short half-life of landiolol, most side effects resolve within about 30 minutes after stopping the infusion.
Clinical data on landiolol in pregnancy are limited, so Rapibloc is generally not recommended during pregnancy unless the clinical need clearly outweighs the risks. It should not be administered to breastfeeding mothers, and the ethanol content of the concentrate is an additional reason for avoidance. In children and adolescents aged 0 to 18 years, the concentrate formulation is not recommended, again largely because of the ethanol excipient. A landiolol powder formulation without ethanol may be more appropriate for paediatric patients when clinically required.
Rapibloc (landiolol), esmolol and metoprolol all belong to the class of beta-1 adrenergic receptor blockers but differ in several important respects. Landiolol has the highest cardioselectivity of the three and an elimination half-life of approximately four minutes, which is shorter than esmolol (around nine minutes) and much shorter than metoprolol (hours). Landiolol also has a weaker negative inotropic effect than esmolol at equivalent doses. These properties make landiolol particularly suitable when precise, rapidly reversible heart rate control is required, for example, in cardiac surgery, intensive care and in patients with borderline haemodynamics.
References and Sources
This article is based on internationally recognized clinical and pharmaceutical guidelines and peer-reviewed medical literature. All information has been reviewed by qualified healthcare professionals and follows evidence-based principles consistent with the GRADE framework.
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