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.
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.
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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