Oral Drugs for Children With Asymptomatic Severe Hypertension

For children < 12 years of age, use weight-based dosing: Initial dose 2–5 mcg/kg every 6 to 8 hours adjusted up to 10 mcg/kg; maximum dose may be given up to 4 times a day

For children ≥ 12 years of age, use fixed dosing schedule: 0.1 mg 2 times a day increased by 0.1 mg a day as needed up to 0.4 mg 2 times a day

Significant drowsiness, fatigue, dizziness, dry mouth

Initial dose 0.25 mg/kg every 6 to 8 hours increased as needed up to maximum 25 mg every 6 hours

Tachycardia, headache

Dosage adjustments are needed for children who have renal dysfunction.

Initial dose 0.05 to 0.1 mg/kg every 6 to 8 hours up to 5 mg using the immediate-release capsules

Common adverse effects: Flushing, peripheral edema

Severe adverse effects: Angioedema

0.1 to 0.2 mg/kg once a day up to 10 mg (may increase to every 8 to 12 hours)

Common adverse effects: Dizziness, prolonged hypotension, fluid retention

Severe adverse effects: Heart failure, pulmonary edema, Stevens-Johnson syndrome

This drug causes significant reflex tachycardia and fluid retention, so may need to use with a beta-blocker and diuretic.

Dosage adjustments are needed for children who have renal dysfunction.