Antihypertensive(s)
Initial BP lowering medication
|
Drug |
Initial dose |
Titration frequency |
Maximal dose |
How supplied |
|
Amlodipine* |
0.1 mg/kg (up to 2.5 mg) once daily |
Every 3-5 days |
0.3 mg/kg (up to 10 mg) once daily |
Tablet: 2.5, 5 and 10 mg Liquid: 1 mg/mL |
*Consider Angiotensin converting enzyme inhibitor (e.g., lisinopril) if patient has concomitant diabetes mellitus
Rescue medications
|
Drug |
Route |
Dosage |
|
Nifedipine immediate release |
Oral |
0.25 mg/kg (max 5 mg) every 4-6 hours for severe BP elevations^. May increase to 0.5 mg/kg (max 10 mg) if inadequate response to lower dose |
|
Isradipine
|
Oral |
0.1 mg/kg |
|
Hydralazine |
IV |
0.1 mg/kg (up to 20 mg) every 4-6 hours for severe BP elevations^. May increase to 0.2 mg/kg (max 40 mg) if inadequate response to lower dose |
^Severe BP elevation means a BP consistently ≥ 99th percentile
Consult Nephrology if ≥ 2 doses in 24 hours required to normalize BP
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.