Drug* | Route | Dose range¶ | Onset of action | Duration of action | Mechanism of action | CommentsΔ |
Labetalol | IV infusion or bolus | Bolus: 0.2 to 1 mg/kg per dose up to maximum 40 mg per dose Infusion: 0.25 to 3 mg/kg per hour | 2 to 5 minutes | 2 to 6 hours | α- and β - adrenergic blocker | Relatively contraindicated in asthma, BPD, HF and may mask symptoms of hypoglycemia |
Nicardipine | IV infusion | Bolus: 30 mcg/kg up to maximum 2 mg per dose Infusion: 0.5 to 4 mcg/kg per minute | 2 to 5 minutes | 30 minutes to 4 hours (increases with time of infusion) | Calcium channel blocker | May cause reflex tachycardia |
Hydralazine | IV bolus | IV: 0.1 to 0.2 mg/kg per dose up to 0.4 mg/kg per dose Maximum single dose: 20 mg | 10 minutes (max effect may take up to 80 minutes) | 4 to 6 hours | Direct vasodilator | May cause reflex tachycardia Variable response with potential for prolonged hypotension |
Esmolol | IV infusion | 100 to 500 mcg/kg loading dose then 100 to 500 mcg/kg per minute | Immediate | 10 to 30 minutes | β - adrenergic blocker | Relatively contraindicated in asthma, BPD, HF and may cause profound bradycardia |
Fenoldopam | IV infusion | 0.2 mcg/kg per minute up to 0.8 mcg/kg per minute | 5 to 40 minutes | 1 hour | Peripheral dopamine receptor agonist | Limited experience in children |
Nitroprusside | IV infusion | 0.5 to 3 mcg/kg per minute starting dose Maximum dose 10 mcg/kg per minute | Seconds | Effect requires continuous infusion | Venodilator with some arteriolar dilation | Monitor cyanide levels with prolonged (>72 hours) use or in renal failure, or coadminister sodium thiosulfate May increase ICP |
BPD: bronchopulmonary dysplasia; HF: heart failure; ICP: intracranial pressure; IV: intravenous.
* Bolded medications are preferred for hypertensive emergencies in children.
¶ For more specific drug information, refer to drug database included within UpToDate.
Δ All agents may cause excessive hypotension.Do you want to add Medilib to your home screen?