Pharm

Intravenous Antihypertensive

search

Intravenous Antihypertensive, IV Antihypertensive

  • See Also
  1. Hypertension Management for Specific Emergencies
  2. Hypertensive Encephalopathy (PRES)
  • Precautions
  1. IV Antihypertensive use in non-cardiac related adult hospitalizations is associated with HARM
    1. Acute Kidney Injury (RR 1.5)
    2. Myocardial injury (RR 2)
    3. Inpatient mortality (RR 2)
    4. Increased risk of Cerebrovascular Accident
    5. Higher risk of escalation to ICU care
    6. Associated with prolonged hospital length of stay
    7. Kondrad (2025) Am Fam Physician 112(1): 81-2 [PubMed]
  1. Nicardipine
    1. Start: 5 mg/hour
    2. Maximum: 15 mg/hour
    3. Titrate
      1. Increase by 2.5 mg/hour every 5-15 minutes until Blood Pressure goal reached or maximum reached (15 mg/hour)
      2. Once goal Blood Pressure achieved, titrate down towards 3 mg/hour as long as Blood Pressure is controlled
      3. Exercise caution when titrating dose in renal Impairment
    4. Transitioning from IV Nicardipine to oral agents
      1. Administer oral Antihypertensive 1 hour after discontinuing IV infusion
  2. Clevidipine
    1. Start: 1-2 mg/hour IV infusion
    2. Titrate: Double dose (as often as every 90 seconds, then every 5-10 min) until approaching target Blood Pressure
      1. Blood Pressure drops 2-4 mmHg for every 1-2 mg/h
    3. Target
      1. Typical maintenance dose 4-6 mg/h
      2. Half of maximal effect reached at 10 mg/h
    4. Maximum
      1. Typical maximum dose 16 mg/h
      2. Absolute maximum dose 32 mg/h
  1. Hydralazine (Apresoline)
    1. Dose: 10-40 mg IV/IM q4-6h
  2. Diazoxide (Hyperstat)
    1. Dose: 1-3 mg/kg up to 150 mg IV q5-15 min
  3. Nitroprusside Sodium (Nipride)
  4. Nitroglycerin Drip
  1. Esmolol (Brevibloc)
    1. Half-Life: 9 minutes
    2. Preparation: 5g in 500 ml (10 mg/ml)
    3. Load: 500 ug/kg over 1 minute (70 kg: 35 mg, 3.5 ml)
    4. Infusion: 50-200 ug/kg/min IV (70 kg: 40 ml/h)
  2. Labetalol (Trandate)
    1. Start: 20 mg IV
    2. Titrate: 40-80 mg every 10 min up to 300 mg
  3. Metoprolol (Lopressor)
    1. Start: 5 mg increments IV
    2. Titrate: 5 mg IV q5-15 minutes to maximum of 15 mg
  1. Enalapril (Vasotec)
    1. Dose: 1.25 mg IV q6h