TABLE 22-30

Sodium nitroprusside (Nipride)

0.5 μg/kg/min initially

10 μg/kg/min

IV

Marked postural effect; monitor pressure frequently; check arterial pH for metabolic acidemia; if used over 48 hours may be toxic if thiocyanate concentrations exceed 12 mg/dL blood

Phentolamine (Regitine)

0.02 mg/kg; if no response, 0.1 mg/kg

—

IV

Only if pheochromocytoma is suspected

Diazoxide (Hyperstat)

2 mg/kg; if no response, 1 mg/kg every 10 minutes

5 mg/kg

IV

Give rapidly without dilution; may cause tachycardia

Hydralazine (Apresoline)

0.15-0.6 mg/kg

6 mg/kg/d

IV

Give 4-6 hourly; action starts in 20-30 minutes; peak at 2 hours; may cause tachycardia

Minoxidil

0.1-0.2 mg/kg

1 mg/kg

PO

Nifedipine (Adalat)

0.2-0.5 mg/kg

20 mg/dose

PO or sublingual

Capsules contain 10 mg in 0.34 mL or 20 mg in 0.45 mL; chew and swallow or use a tuberculin syringe; do not expose to light; may give headaches

Esmolol

500 μg/kg loading dose, then 200 μg/kg/min; can increase by 50-100 μg/kg every 5-10 min

1 mg/kg

IV

Avoid in asthmatics, heart failure, heart block

Labetalol (Normodyne, Trandate)

0.3 mg/kg/dose every 20 minutes until pressure is controlled, or 1 mg/kg/h

300 mg/day or 3 mg/kg/h

IV

Avoid in asthmatics, heart failure, heart block

α-Methyldopa (Aldomet)

10 mg/kg

50 mg/kg/d

IV

Takes 1-2 hours to act; somnolence

Enalaprilat (Vasotec IV)

25-100 μg/kg every 6 hours

—

IV

Precipitous fall of BP in high-renin states