Drug | Class | Initial dose | Usual effective dose range | Maximum suggested total daily dose | Comments |
Labetalol | Combined alpha and beta blocker | 100 mg 2 times daily, increase by 100 mg twice daily every 2 to 3 days as needed | 200 to 800 mg in 2 divided doses | 2400 mg | Can cause bronchoconstriction. Avoid in patients with asthma, chronic obstructive lung disease, heart failure, bradycardia (heart rate <60 beats per minute), or greater than first-degree heart block. The dosing interval can be increased to 3 times daily if blood pressure is increased prior to the next prescribed dose. |
Hydralazine NOTE: Due to reflex tachycardia, monotherapy with oral hydralazine is not recommended; hydralazine may be combined with methyldopa or labetalol if needed as add-on therapy | Peripheral vasodilator | Begin with 10 mg 4 times per day, increase by 10 to 25 mg/dose every 2 to 5 days | 50 to 100 mg in 2 to 4 divided doses | 200 mg* | |
Nifedipine extended release (ER)¶ | Calcium channel blocker | 30 to 60 mg once daily as an extended release tablet, increase at 7 to 14 day intervals | 30 to 90 mg once daily | 120 mg | Do not administer sublingually. Based upon clinical experience of UpToDate contributors, some patients better tolerate nifedipine ER administered in 2 divided doses, which may serve to minimize its peak to trough effects (eg, instead of increasing the dose to 60 mg once daily, it may be desirable in some patients to increase to 30 mg 2 times daily). |
Methyldopa | Centrally acting alpha agonist | 250 mg 2 to 3 times daily, increase every 2 days as neededΔ | 250 to 1000 mg in 2 to 3 divided doses | 3000 mg | Sedation is a common side effect. |
* Chronic hydralazine doses above 100 mg daily are associated with an increased risk for developing lupus erythematosus, particularly in females and slow acetylators; ascertainment of acetylator status is recommended before increasing dose above 100 mg per day in many countries.
¶ UpToDate suggests not using immediate-release nifedipine (oral or sublingual) because it can cause significant rapid decreases in blood pressure. If used, the dose is 10 to 20 mg every 2 to 6 hours, with a maximum daily dose of 180 mg.
Δ The full hypotensive effect of an initial dose or adjustment of methyldopa may not occur until after 2 to 3 days of continuous use.Do you want to add Medilib to your home screen?