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Table 4 Drugs useful in the treatment of neonatal hypertension

From: Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors

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.

  1. amodified from Flynn, [6]