Parenteral drugs for treatment of hypertensive emergencies*
Drug
Dose
Onset of action
Duration of action
Adverse effects
Special indications
Vasodilators
Sodium nitroprusside
0.25-10 µg/kg/min as IV infusion
Immediate
1-2 min
Nausea, vomiting, muscle twitching, sweating, thiocynate and cyanide intoxication
Most hypertensive emergencies; caution with high intracranial pressure or azotemia
Nicardipine hydrochloride
5-15 mg/h IV
5-10 min
15-30 min, may exceed 4 h
Tachycardia, headache, flushing, local phlebitis
Most hypertensive emergencies except acute heart failure; caution with coronary ischemia
Fenoldopam mesylate
0.1-0.3 µg/kg per min IV infusion
<5 min
30 min
Tachycardia, headache, nausea, flushing
Most hypertensive emergencies; caution with glaucoma
Nitroglycerin
5-100 µg/min as IV infusion§
2-5 min
5-10 min
Headache, vomiting, methemoglobinemia, tolerance with prolonged use
Coronary ischemia
Enalaprilat
1.25-5 mg every 6 h IV
15-30 min
6-12 h
Precipitous fall in pressure in high-renin states; variable response
Acute left ventricular failure; avoid in acute myocardial infarction
Hydralazine hydrochloride
10-20 mg IV
10-20 min IV
1-4 h IV
Tachycardia, flushing, headache, vomiting, aggravation of angina
Eclampsia
10-40 mg IM
20-30 min IM
4-6 h IM
* These doses may vary from those in the Physicians' Desk Reference (51st edition).
Hypotension may occur with all agents.
Requires special delivery system.
Reproduced with permission from: Chobanian, AV, Bakris, GL, Black, HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42:1206. Copyright © 2003 Lippincott Williams and Wilkins.
Parenteral drugs for treatment of hypertensive emergencies, continued*
Drug
Dose
Onset of action
Duration of action
Adverse effects
Special indications
Andrenergic inhibitors
Labetalol hydrochloride
20-80 mg IV bolus every 10 min
5-10 min
3-6 h
Vomiting, scalp tingling, bronchoconstriction, dizziness, nausea, heart block, orthostatic hypotension
Most hypertensive emergencies except acute heart failure
0.5-2.0 mg/min IV infusion
Esmolol hydrochloride
250-500 µg/kg/min by infusion; may repeat bolus after 5 min or increase infusion to 300 µg/min
1-2 min
10-30 min
Hypotension, nausea, asthma, first-degree heart block, HF
Aortic dissection, perioperative
Phentolamine
5-15 mg IV bolus
1-2 min
10-30 min
Tachycardia, flushing, headache
Catecholamine excess
* These doses may vary from those in the Physicians' Desk Reference (51st edition).
Hypotension may occur with all agents.
Requires special delivery system.
Reproduced with permission from: Chobanian, AV, Bakris, GL, Black, HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42:1206. Copyright © 2003 Lippincott Williams and Wilkins.
 
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