Drug | Class | Dose | Route | Comments |
Intravenous agentsa: | ||||
Diazoxide | Vasodilator (arteriolar) | 2–5 mg/kg/dose | Rapid bolus injection | Slow injection is ineffective. Duration unpredictable. May cause rapid hypotension. |
Enalaprilat | ACE-inhibitor | 15 ± 5 μg/kg/dose; repeat after 8–24 h | Injection over 5–10 min | May cause prolonged hypotension and acute renal insufficiency. |
Esmolol | β-blocker | 100–300 μg/kg/min | IV infusion | Very short-acting. Constant infusion necessary. |
Hydralazine | Vasodilator (arteriolar) | Bolus: 0.15–0.6 mg/kg/dose every 4 h. Drip: 0.75–5.0 μg/kg/min | IV bolus or infusion | Frequently causes tachycardia. |
Labetalol | α- and β-blocker | 0.20–1.0 mg/kg/dose 0.25–3.0 mg/kg/h | IV bolus or constant infusion | Heart failure and BPD are relative contraindications. |
Nicardipine | Calcium antagonist | 1–3 μg/kg/min | Constant infusion | May cause reflex tachycardia. |
Sodium nitroprusside | Vasodilator (arteriolar and venous) | 0.5–10 μg/kg/min | Constant infusion | In case of prolonged therapy (>72 h) or renal failure thiocyanate toxicity may occur. |
Drug | Class | Dose | Interval | Comments |
Oral agentsa | ||||
Captopril | ACE-inhibitor | 0.01–0.5 mg/kg | TID | Monitor serum creatinine and potassium. |
Clonidine | Central α-agonist | 0.05–0.1 mg/kg? | BID-TID | Side effects: sedation, dryness of the mucosa. Abrupt interruption may cause rebound hypertension. |
Hydralazine | Vasodilator (arteriolar) | 0.25–1.0 mg/kg (max 7.5 mg/kg per day) | TID-QID | Frequent side effects: fluid retention and tachycardia. Lupus-like syndrome may occur in slow acetylators. |
Isradipine | Calcium antagonist | 0.05–0.15 mg/kg | QID | Useful for both chronic and acute hypertension. |
Amlodipine | Calcium antagonist | 0.1-0.3 mg/kg | BID | Causes sudden hypertension less frequently than isradipine. |
Nifedipine | Calcium antagonist | 0,25–0,5 mg/kg Max. dose: 1–2 mg/kg per day | Repeat every 4–6 h | Hypotensive response poorly predictable. |
Minoxidil | Vasodilator (arteriolar) | 0.1–0.2 mg/kg | BID-TID | The most potent oral vasodilator. Hypertrichosis in case of prolonged use. |
Propranolol | β-blocker | 0.5–1.0 mg/kg | TID | Maximum dose to be defined according to heart rate (up to 8–10 mg/kg if no bradycardia). Not to be used in infants with BPD. |
Atenolol | β-blocker | 0.8–1 mg/kg Max. dose 2 mg/kg per day | QD | |
Labetalol | α- and β-blocker | 1.0 mg/kg | BID-TID | Monitor heart rate. Not to be used in infants with BPD. |
Spironolactone | Aldosterone antagonist | 0.5–1.5 mg/kg | BID | Potassium-sparing. Check serum electrolytes. May take several days to reach maximum effectiveness. |
Hydrochlorothiazide | Thiazide diuretic | 1–3 mg/kg | QID | Check serum electrolytes. |
Chlorothiazide | Thiazide diuretic | 5–15 mg/kg | BID | Check serum electrolytes. |