Intravenous Drugs for Children With Severe Hypertension and Symptoms or Signs of Target Organ Damage

First-line drugs

Infusion: 0.25–3 mg/kg/hour IV; Initiate at low end dose and gradually titrate as needed to control blood pressure

Bolus: 0.2–1 mg/kg IV every 10 to 20 minutes, increasing up to 40 mg/dose if needed

May cause bradycardia, wheezing

Relative contraindications for or caution should be used in patients with asthma or heart failure.

Infusion: Initially 0.5–1 mcg/kg/minute IV (may give initial one-time bolus of 30 mcg/kg not to exceed 2 mg prior to infusion) titrate upward every 15 to 30 minutes to maximum 4 mcg/kg/minute

May cause reflex tachycardia

2nd-line drugs

Bolus: 0.1–0.2 mg/kg up to 0.4 mg/kg per dose IV every 4 to 6 hours, maximum dose 20 mg (may be given IM but has an even slower onset of action)

Tachycardia, headache

Response to this drug varies in effect and rate.

Infusion: Starting 0.3 to 0.5 mcg/kg/minute IV increase every 3 to 5 minutes as needed to a maximum dose of 10 mcg/kg/minute (typical dose 3 to 4 mcg/kg/minute)

Cyanide toxicity with prolonged use (> 72 hours) or in renal failure

May increase intracranial pressure

This drug is difficult to use.

2nd- or 3rd-line drug

Infusion: 100–500 mcg/kg/minute IV

May cause profound bradycardia

This drug is contraindicated if a pheochromocytoma is possible.