47
Table 15. Intravenous Antihypertensive Drugs for Treatment
of Hypertensive Emergencies
Class Drug(s) Usual Dose Range Comments
CCB
Dihydropyridines Nicardipine • Initial 5 mg/h,
increasing every
5 min by 2.5 mg/h to
maximum 15 mg/h.
• Contraindicated
in advanced aortic
stenosis.
• No dose adjustment
needed for elderly.
Clevidipine • Initial 1–2 mg/h,
doubling every 90 s
until BP approaches
target, then
increasing by less
than double every
5–10 min.
• Maximum dose
32 mg/h.
• Maximum duration
72 h.
• Contraindicated in
patients with soybean,
soy product, egg,
and egg product
allerg y and in patients
with defective
lipid metabolism
(e.g., pathological
hyperlipidemia, lipoid
nephrosis or acute
pancreatitis).
• Use low-end dose
range for elderly
patients.
Vasodilators
Nitric-oxide
dependent
Sodium
nitroprusside
• Initial 0.3–0.5 mcg/
kg/min; increase
in increments of
0.5 mcg/kg/min to
achieve BP target.
• Maximum dose
10 mcg/kg/
min. Duration of
treatment as short
as possible.
• For infusion rates
≥4–10 mcg/kg/min
or duration >30
min, thiosulfate can
be coadministered
to prevent cyanide
toxicity.
• Intra-arterial
BP monitoring
recommended to
prevent "overshoot."
• Lower dosing
adjustment required
for elderly.
• Tachyphylaxis
common with
extended use.
• Cyanide toxicity with
prolonged use can
result in irreversible
neurological changes
and cardiac arrest.
Nitroglycerin • Initial 5 mcg/min.
• Increase in
increments of 5
mcg/min every 3–5
min to a maximum
of 20 mcg/min.
• Use only in patients
with acute coronary
syndrome and/or
acute pulmonary
edema.
• Do not use in volume-
depleted patients.
