Landiolol Hydrochloride: A Comprehensive Pharmacological and Clinical Review

1. Introduction to Landiolol Hydrochloride

Landiolol Hydrochloride is an ultra-short-acting, highly β1​-selective intravenous (IV) adrenergic antagonist. It is specifically formulated for the rapid control of heart rate in acute clinical settings where immediate and titratable β-blockade is imperative.[1] Its principal utility is in the management of supraventricular tachyarrhythmias (SVT), including atrial fibrillation and atrial flutter, particularly during the perioperative and postoperative periods, or in other critical care scenarios demanding short-term ventricular rate control.[2] The defining characteristics of Landiolol—its ultra-short duration of action and high β1​-selectivity—underpin its specialized therapeutic niche in acute care, distinguishing it from beta-blockers typically employed for chronic management.[1]

Landiolol Hydrochloride is classified as a beta-adrenergic receptor antagonist, commonly referred to as a beta-blocker, exhibiting pronounced selectivity for β1​-adrenergic receptors.[1] In the Vaughan Williams classification of antiarrhythmic drugs, it is categorized as a Class II agent.[7] The therapeutic importance of Landiolol is derived from its distinctive pharmacokinetic profile, characterized by an ultra-short elimination half-life that facilitates rapid onset and offset of action, and its pharmacodynamic properties, notably high β1​-selectivity, which leads to targeted cardiac effects with a potentially reduced incidence of systemic side effects. This combination offers considerable advantages over less selective or longer-acting beta-blockers in critical care and perioperative medicine, where precise and rapidly reversible hemodynamic control is often crucial.[1] The development of a drug with such a profile addresses the limitations of traditional beta-blockers, which often have longer half-lives and less selectivity, potenti