Antihypertensive Dosing
Antihypertensive Dosing
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Note: This reference is for commonly-used drugs, specifically for the indication of hypertension. Other indications may have different typical doses/ranges. This page does not include dose adjustments for kidney/hepatic impairment.
Guide: 💊 pill | 🧪 liquid (may req. compounding) | 💉 intravenous (IV) | 🔁 continuous infusions (drips, gtt) | 💪 intramuscular (IM)
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Hypertension (HTN)
Calcium channel blockers (CCBs)
Calcium channel blockers (CCBs)
Enteral 💊/🧪
Age <6: 0.05-0.1 mg/kg once daily
Max 0.6 mg/kg/day or 5 mg/day
Age ≥6: 2.5-5 mg daily
Max 0.6 mg/kg/day or 10 mg/day
>10 mg → ↑ side effects, no proven BP benefit
Note: long elimination half-life (t½ 35-50 hours)
May divide BID for a few days to get to steady state
Doses >5 mg/day not studied in pediatric patients but are often used in patients aged ≥6
Enteral 💊/🧪
0.05-0.15 mg/kg q6-8h PRN (≤5 mg/dose)
Start with lower dose, especially for age ≤2 years
Max 0.6 mg/kg/day or 10 mg/day
>10 mg → ↑ side effects, no proven BP benefit
Time to effect: 2-3 hours
Note: if patient is already on max dose of one calcium channel blocker, recommend using another class for a PRN agent
Warning: oil-in-water emulsion contains soy, egg yolk phospholipids, glycerin and delivers significant lipid load (2 kcal/mL).
Contraindicated in pathologic hyperlipidemia
May need to reduce parenteral lipid administration
Expect development of hypertriglyceridemia with higher doses and longer infusions
Intravenous (IV) 💉🔁
0.5-1 mcg/kg/min
Titrate by 0.5-1 mcg/kg/min every 2-10 min
Max 10 mcg/kg/min
Adults: 1-2 mg/h
Typical 4-6 mg/h
Max 21 mg/h
Intravenous (IV) 💉🔁
0.2-1 mcg/kg/min
Titrate by 0.2-1.5 mcg/kg/min every 15-30 min
Max 5 mcg/kg/min
Adults: 5 mg/h
Titrate by ≤2.5 mg/h every 15 min
Max 15 mg/h
Beta blockers
Beta blockers
Warning: avoid in asthma, obstructive airway disease (e.g., BPD), untreated pheochromocytoma, heart failure (especially uncompensated), heart block, sinus bradycardia
Enteral 💊/🧪 💉🔁
0.5-1 mg/kg/day (25-50 mg/day)
Usual range 0.5-1.5 mg/kg/day
Max 2 mg/kg/day (≤100 mg/day)
Note: may be dosed daily or divided BID
Enteral 💊/🧪
0.5-1.5 mg/kg/dose BID
Max 10-12 mg/kg/day (≤1200 mg/day)
Intravenous (IV) 💉
Bolus: 0.2-1 mg/kg q4-6h
Max 40 mg/dose
Drip: 0.25-3 mg/kg/hour
Note: labetalol is also α1-antagonist (especially when given enterally)
Enteral
Immediate release 💊/🧪
Age 1-17: 0.5-1 mg/kg/dose BID
Max 6 mg/kg/day (≤200 mg/day)
Extended release 💊
Age ≥6: 1 mg/kg daily (≤50 mg/day)
Max 2 mg/kg/day (≤200 mg/day)
Note: scored extended release tablets can be halved, but do not crush/chew
Note: when switching between immediate/extended release, keep same total daily dose
Enteral 💊/🧪
0.25-0.5 mg/kg q12h or 0.125-0.25 mg/kg q6h
Titrate every 5-7 days
Usual range 1-5 mg/kg/day
Max 8 mg/kg/day
Intravenous (IV) 💉🔁
500 mcg/kg/min x1 minute load, then 50-200 mcg/kg/min
Max 500 mcg/kg/min
Alpha agonists
Alpha agonists
Enteral 💊/🧪
Age <12: 1.25-3 mcg/kg q6-8h or 2.5-5 mcg/kg q12h
Max 10 mcg/kg/dose or 0.9 mg/day (900 mcg/day)
Age ≥12: 0.05-0.1 mg/dose BID
Titrate every ~7 days
Usual range 0.2-0.4 mg/day divided BID
Max 2.4 mg/day
Transdermal (TD)
0.05-0.1 mg/24h (1/2 patch-#1 patch)
Must change the patch every 7 days
Titrate every 1-2 weeks
May take 2-3 days to see effects
Usual range 0.1-0.3 mg/24h
Max 0.6 mg/24h
Note: TD patch dose is approximately equal to the total enteral daily dose used
Direct vasodilators
Direct vasodilators
Enteral 💊
0.25 mg/kg PO q6-8h PRN
Max 25 mg/dose
Intravenous (IV) 💉/💪
0.1-0.2 mg/kg IV q4-6h PRN
Max 0.6 mg/kg/dose
Can also be given IM (1:1)
Note: response can be unpredictable; close monitoring is warranted
Enteral 💊/🧪
Age <12: 0.1-0.2 mg/kg daily (≤5 mg/day)
Titrate every 3 days
Usual range 0.25-1 mg/kg/day
Max 5 mg/kg/day (≤50 mg/day)
Age ≥12: 5 mg/day
Titrate every 3 days
Usual range 2.5-80 mg/day
Max 100 mg/day
Note: can be given daily or divided BID
Warning: risk of cyanide and thiocyanate toxicity
Avoid in kidney/hepatic dysfunction
Send thiocyanate level if on drip ≥3-5 days or if rate >4 mcg/kg/min or if renal dysfunction
Goal thiocyanate level <1 mmol/L
Monitor cyanide levels in patients with hepatic dysfunction
Acidosis may be earliest sign of cyanide toxicity
Risk of methemoglobinemia
Intravenous (IV) 💉🔁
0.5-10 mcg/kg/min
Recommend limiting to 3 mcg/kg/min
Max 1 mcg/kg/min in kidney failure
Angiotensin-converting enzyme inhibitors (ACEis)
Angiotensin-converting enzyme inhibitors (ACEis)
Warning: contraindicated in pregnancy
Avoid in hyperkalemia, AKI, CKD with GFR <30 mL/min/1.73m²
Start with lower doses if on diuretics/volume depleted
Enteral 💊/🧪
Neonates: 0.04-0.1 mg/kg daily
Titrate every few days
Max 0.27 mg/kg/day
Infants/Children: 0.08 mg/kg/dose daily
Titrate every 1-2 weeks
Max 0.58 mg/kg/day (≤40 mg/day)
Intravenous (IV) 💉 (Enalaprilat) [UpToDate]
Neonates/Infants/Children: 5-10 mcg/kg q8-24h
Max 1.25 mg/dose (1250 mcg/dose) in infants/children
Adults: 0.625-1.25 mg q6h
Max 20 mg/day
Enteral 💊/🧪
Infants: 0.07-0.1 mg/kg daily
Titrate every 2 weeks
Max 0.5 mg/kg/day
Children/Adolescents: 0.07-0.1 mg/kg daily (≤5 mg/day)
Titrate every 1-2 weeks
Max 0.6 mg/kg/day (≤40 mg/day)
Angiotensin II receptor blockers (ARBs)
Angiotensin II receptor blockers (ARBs)
Warning: contraindicated in pregnancy
Avoid in hyperkalemia, AKI, CKD with GFR <30 mL/min/1.73m²
Start with lower doses if on diuretics/volume depleted
Enteral 💊/🧪
Age 6-16: 0.7 mg/kg daily (≤50 mg/day)
Max 1.4 mg/kg/day (≤100 mg/day)
Age ≥17: 25-50 mg daily
Max 100 mg/day
Note: may be dosed daily or divided BID
References
References
[AMA formatted citations]
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