Oral ACE Inhibitors for Hypertension in Children

Captopril

For neonates: Initial dose 0.01–0.05 mg/kg once a day to a maximum of 0.5 mg/kg 4 times a day

For younger children: Initial dose 0.2–0.5 mg/kg 2 to 4 times a day, or for older children 6.25–12.5 mg 2 to 4 times a day (maximum daily dose 6 mg/kg)

For adolescents: 12.5–25 mg 2 to 4 times a day (maximum daily dose 150 mg)

Common adverse effects: Cough, headache, dizziness

Severe adverse effects: Fetal toxicity, hyperkalemia, acute kidney injury, angioedema

Contraindications include pregnancy and history of angioedema.

Dosage adjustments are needed for children who have renal dysfunction.

Compliance with captopril may be improved with maximum dosing 3 times a day instead of 4.

Enalapril

For infants and children: Initial dose 0.08 mg/kg once a day (maximum daily dose 0.6 mg/kg or 5 mg)

For adolescents: Initial dose 2.5–5 mg once a day (maximum daily dose 40 mg)

Lisinopril

For children < 6 years of age: Limited data

For children ≥ 6 years of age: Initial dose 0.07 mg/kg once a day with a maximum initial daily dose of 5 mg (titrated to a maximum daily dose of 40 mg once a day)