Browse the corpus

Children >50 kg: Initial: 5 to 10 mg/day Maximum: 40 mg/day Once daily Lisinopril Initial: 0.07 mg/kg per d up to 5 mg/day Once daily Maximum: 0.6 mg/kg per day up to 40 mg/day Quinapril Initial: 5 to 10 mg/day Once daily Maximum: 80 mg/day Angiotensin-receptor blocker Irbesartan 6 to 12 years: 75 to 150 mg/day Once daily 1. All ARBs are contraindicated in pregnancy; females of childbearing age should use reliable contraception. 2. Check serum potassium and creatinine periodically to monitor for hyperkalemia and azotemia. 3. Losartan label contains information on the preparation of a suspension. 4. FDA approval for ARBs is limited to children six years of age and to children with creatinine clearance 30 mL/min per 1.73 m 2 . ≥13 years: 150 to 300 mg/day Losartan Initial: 0.7 mg/kg per day up to 50 mg/day Once daily Maximum: 1.4 mg/kg per day up to 100 mg/day Alpha- and beta-blocker Labetalol Initial: 1 to 3 mg/kg per day Twice daily 1. Asthma and overt heart failure are contraindications. 2. Heart rate is dose-limiting. 3. May impair athletic performance. 4. Should not be used in insulin-dependent diabetics. Maximum: 10 to 12 mg/kg per day up to 1200 mg/day Beta-blocker Atenolol Initial: 0.5 to 1 mg/kg per day Once to twice daily 1. Noncardioselective agents (propranolol) are contraindicated in asthma and heart failure. 2. Heart rate is dose-limiting. 3. May impair athletic performance. 4. Should not be used in insulin-dependent diabetics. 5. A sustained-release formulation of propranolol is available that is dosed once daily. Maximum: 2 mg/kg per day up to 100 mg/day Bisoprolol/HCTZ Initial: 2.5/6.25 mg/day Once daily Maximum: 10/6.25 mg/day Metoprolol Initial: 1 to 2 mg/kg per day Twice daily Maximum: 6 mg/kg per day up to 200 mg/day Propranolol Initial: 1 to 2 mg/kg per day Two to three times daily Maximum: 4 mg/kg per day up to 640 mg/day Calcium channel blocker Amlodipine Children 6 to 17 years: 2.5 to 5 mg once daily Once daily 1. Amlodipine and isradipine can be compounded into stable extemporaneous suspensions. 2. Felodipine and extended-release nifedipine tablets must be swallowed whole. 3. Isradipine is available in both immediate-release and sustained-release formulations; sustained-release form is dosed once or twice daily. 4. May cause tachycardia. Felodipine Initial: 2.5 mg/day Once daily Maximum: 10 mg/day Isradipine Initial: 0.15 to 0.2 mg/kg per day Three to four times daily (immediate release formulation) Maximum: 0.8 mg/kg per day up to 20 mg/day Extended-release nifedipine Initial: 0.25 to 0.5 mg/kg per day Once to twice daily

3. Isradipine is available in both immediate-release and sustained-release formulations; sustained-release form is dosed once or twice daily. 4. May cause tachycardia. Felodipine Initial: 2.5 mg/day Once daily Maximum: 10 mg/day Isradipine Initial: 0.15 to 0.2 mg/kg per day Three to four times daily (immediate release formulation) Maximum: 0.8 mg/kg per day up to 20 mg/day Extended-release nifedipine Initial: 0.25 to 0.5 mg/kg per day Once to twice daily Maximum: 3 mg/kg per day up to 120 mg/day Central alpha-agonist Clonidine

Children ≥12 years: Initial: 0.2 mg/day Maximum: 2.4 mg/day Twice daily 1. May cause dry mouth and/or sedation. 2. Transdermal preparation also available. 3. Sudden cessation of therapy can lead to severe rebound hypertension. Diuretic HCTZ Initial: 1 mg/kg per day Once daily 1. All patients treated with diuretics should have electrolytes monitored shortly after initiating therapy and periodically thereafter. 2. Useful as add-on therapy in patients being treated with drugs from other drug classes. 3. Potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with ACE inhibitor or ARB. 4. Furosemide is labeled only for treatment of edema, but may be useful as add-on therapy in children with resistant hypertension, particularly in children with renal disease. 5. Chlorthalidone may precipitate azotemia in patients with renal diseases and should be used with caution in those with severe renal impairment. Maximum: 3 mg/kg per day up to 50 mg/day Chlorthalidone Initial: 0.3 mg/kg per day Once daily Maximum: 2 mg/kg per day up to 50 mg/day Furosemide Initial: 0.5 to 2.0 mg/kg per dose Once to twice daily Maximum: 6 mg/kg per day Spironolactone Initial: 1 mg/kg per day Once to twice daily Maximum: 3.3 mg/kg per day up to 100 mg/day Triamterene Initial: 1 to 2 mg/kg per day Twice daily Maximum: 3 to 4 mg/kg per day up to 300 mg/day Amiloride Initial: 0.4 to 0.625 mg/kg per day Once daily Maximum: 20 mg/day Alpha 1-antagonist Doxazosin Initial: 1 mg/day Once daily May cause hypotension and syncope, especially after first dose. Maximum: 4 mg/day Prazosin Initial: 0.05 to 0.1 mg/kg per day Three times daily Maximum: 0.5 mg/kg per day Terazosin Initial: 1 mg/day Once daily Maximum: 20 mg/day Vasodilator Hydralazine Initial: 0.75 mg/kg per day Four times daily 1. Tachycardia and fluid retention are common side effects. 2. Hydralazine can cause a lupus-like syndrome in slow acetylators. 3. Prolonged use of minoxidil can cause hypertrichosis. 4. Minoxidil is usually reserved for patients with hypertension resistant to multiple drugs. Maximum: 7.5 mg/kg per day up to 200 mg/day Minoxidil

Children ≥12 years: Initial: 5 mg/day Maximum: 100 mg/day FDA: US Food & Drug Administration; ARB: angiotensin-receptor blocker; HCTZ: hydrochlorothiazide. * The maximum recommended adult dose should not be exceeded in routine clinical practice. • Comments apply to all members of each drug class except where otherwise stated. Includes drugs with prior pediatric experience or recently completed clinical trials. Data from: National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (2 Suppl 4th Report):555.