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©2013 UpToDate ® Print Email Recommended doses for selected agents to treat hypertensive infants Class Drug Route Dose range Interval Comments ACE inhibitors Captopril Oral <3 months: 0.01-0.5 mg/kg/dose Max 2 mg/kg/day Three to four times per day First dose may cause rapid drop in BP, especially if receiving diuretics In infants already receiving a diuretic, start at the lowest recommended dose Monitor serum creatinine and potassium Intravenous enalaprilat NOT recommended - see text Only captopril and enalapril are US Food & Drug Administration approved in infancy ACE inhibitors should not be used in infants who are less than 44 weeks post conceptual age >3 months: 0.15-0.3 mg/kg/dose Max 6 mg/kg/day Enalapril Oral 0.08-0.6 mg/kg/day Once or twice daily Lisinopril Oral 0.07-0.6 mg/kg/day Once daily Alpha and beta antagonists Labetalol Oral 0.5-1 mg/kg/dose Max 10 mg/kg/day Two or three times daily Acute decompensated heart failure, bronchopulmonary dysplasia relative contraindications IV bolus 0.2-1 mg/kg/dose Administer every four to six hours IV infusion 0.25-3 mg/kg/hr Continuous infusion Carvedilol Oral 0.1 mg/kg/dose up to 0.5 mg/kg/dose Twice per day May be useful in chronic heart failure Beta antagonists Esmolol IV infusion 100-500 mcg/kg/min Continuous infusion Very short-acting; constant infusion necessary. May be useful for management of acute hypertension after repair of aortic coarctation. Propranolol Oral 0.5-1 mg/kg/dose Max 8-10 mg/kg/day Three to four times per day Monitor heart rate; avoid in bronchopulmonary dysplasia Calcium channel blockers Amlodipine Oral 0.05-0.3 mg/kg/dose Max 0.6 mg/kg/day Once per day May cause mild reflex tachycardia. Some infants may benefit by dividing dose twice per day. Full effect of dose adjustment may require one week or more. Isradipine Oral 0.05-0.15 mg/kg/dose Max 0.8 mg/kg/day Four times per day May cause mild reflex tachycardia Nicardipine IV infusion 0.5-4 mcg/kg/min Continuous infusion Central alpha-agonist Clonidine Oral 5-10 mcg/kg/day Max 25 mcg/kg/day Divided two to four times daily May cause mild sedation Diuretics Chlorothiazide Oral 5-15 mg/kg/dose Twice per day Monitor electrolytes Hydrochlorothiazide Oral 1-3 mg/kg/day Once daily or as two divided doses per day Spironolactone Oral 0.5-1.5 mg/kg/dose Twice per day Vasodilators Hydralazine Oral 0.25-1 mg/kg/dose Max 7.5 mg/kg/day Three to four times per day Tachycardia and fluid retention are common side effects IV bolus 0.15-0.6 mg/kg/dose Q four hours Minoxidil Oral 0.1-0.2 mg/kg/dose Two to three times per day

1-3 mg/kg/day Once daily or as two divided doses per day Spironolactone Oral 0.5-1.5 mg/kg/dose Twice per day Vasodilators Hydralazine Oral 0.25-1 mg/kg/dose Max 7.5 mg/kg/day Three to four times per day Tachycardia and fluid retention are common side effects IV bolus 0.15-0.6 mg/kg/dose Q four hours Minoxidil Oral 0.1-0.2 mg/kg/dose Two to three times per day Tachycardia and fluid retention common side effects; prolonged use causes hypertrichosis; pericardial effusion may occur Nitroprusside IV infusion 0.5-10 mcg/kg/min Continuous infusion Thiocyanate toxicity can occur with prolonged (>72 h) use or in renal failure ACE inhibitor: angiotensin converting enzyme inhibitor. Adapted from: Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management, and outcome. Pediatr Nephrol 2011 with kind permission from Springer Science + Business Media B.V. Copyright © 2011.