IV Drugs for Hypertensive Crises

(Circ 2018;138:e426; Stroke 2018;49:46) Labetalol 20–80 mg IVB q10min or 0.4–2 mg/min AoD, ACS, Stroke, Eclampsia Esmolol 0.5–1 mg/kg load → 50–200 µg/kg/min AoD, ACS Nitroprusside* 0.25–10 µg/kg/min Pulm edema Nitroglycerin 5–500 µg/min Pulm edema, ACS Nicardipine 5–15 mg/h (can ↑ 2.5 mg/h q 5 min) Stroke, AKI, Eclampsia, Pheo Clevidipine 1–32 mg/h (can titrate q 5–10 min) Stroke, Pulm edema, AKI, Pheo Fenoldopam 0.1–1.6 µg/kg/min AKI Hydralazine 10–20 mg q20–30min prn Eclampsia Phentolamine 5–15 mg bolus q5–15min Pheo

*Metabolized to cyanide → ∆ MS, lactic acidosis, death. Limit use of very high doses (8–10 µg/kg/min) to <10 min.