Recommended doses for selected agents to treat hypertensive infants

Class	Drug	Route	Dose range	Interval	Comments
ACE inhibitors	Captopril	Oral	<3 months – 0.01 to 0.5 mg/kg/dose Maximum 2 mg/kg/day	3 to 4 times per day	First dose may cause rapid drop in BP, especially if receiving diuretics In infants already receiving a diuretic, start at the lowest recommended dose Monitor serum creatinine and potassium Intravenous enalaprilat is not recommended; see text Only captopril and enalapril are US Food and Drug Administration approved in infancy ACE inhibitors should not be used in infants who are less than 44 weeks postconceptual age
	Captopril	Oral	>3 months – 0.15 to 0.3 mg/kg/dose Maximum 6 mg/kg/day	3 to 4 times per day
	Enalapril	Oral	0.08 to 0.6 mg/kg/day	1 or 2 times per day
	Lisinopril	Oral	0.07 to 0.6 mg/kg/day	1 time per day
Alpha and beta antagonists	Labetalol	Oral	0.5 to 1 mg/kg/dose Maximum 10 mg/kg/day	2 or 3 times per day	Acute decompensated heart failure, bronchopulmonary dysplasia-relative contraindications
		IV bolus	0.2 to 1 mg/kg/dose	Administer every 4 to 6 hours
		IV infusion	0.25 to 3 mg/kg/hour	Continuous infusion
	Carvedilol	Oral	0.1 mg/kg/dose up to 0.5 mg/kg/dose	2 times per day	May be useful in chronic heart failure
Beta antagonists	Esmolol	IV infusion	100 to 500 mcg/kg/minute	Continuous infusion	Very short-acting; constant infusion necessary May be useful for management of acute hypertension after repair of aortic coarctation
Beta antagonists	Propranolol	Oral	0.5 to 1 mg/kg/dose Maximum 8 to 10 mg/kg/day	3 to 4 times per day	Monitor heart rate; avoid in bronchopulmonary dysplasia
Calcium channel blockers	Amlodipine	Oral	0.05 to 0.3 mg/kg/dose Maximum 0.6 mg/kg/day	1 time per day	May cause mild reflex tachycardia Some infants may benefit by dividing dose twice per day Full effect of dose adjustment may require 1 week or more
	Isradipine	Oral	0.05 to 0.15 mg/kg/dose Maximum 0.8 mg/kg/day	4 times per day	May cause mild reflex tachycardia
	Nicardipine	IV infusion	0.5 to 4 mcg/kg/minute	Continuous infusion	May cause mild reflex tachycardia
Central alpha agonist	Clonidine	Oral	5 to 10 mcg/kg/day Maximum 25 mcg/kg/day	Divided 2 to 4 times per day	May cause mild sedation
Diuretics	Chlorothiazide	Oral	5 to 15 mg/kg/dose	2 times per day	Monitor electrolytes
	Hydrochlorothiazide	Oral	1 to 3 mg/kg/day	1 time per day, or as 2 divided doses per day
	Spironolactone	Oral	0.5 to 1.5 mg/kg/dose	2 times per day
Vasodilators	Hydralazine	Oral	0.25 to 1 mg/kg/dose Maximum 7.5 mg/kg/day	3 to 4 times per day	Tachycardia and fluid retention are common side effects
	Hydralazine	IV bolus	0.15 to 0.6 mg/kg/dose	Q 4 hours	Tachycardia and fluid retention are common side effects
	Minoxidil	Oral	0.1 to 0.2 mg/kg/dose	2 to 3 times per day	Tachycardia and fluid retention common side effects; prolonged use causes hypertrichosis; pericardial effusion may occur
	Nitroprusside	IV infusion	0.5 to 10 mcg/kg/minute	Continuous infusion	Thiocyanate toxicity can occur with prolonged (>72 hour) use or in renal failure

ACE inhibitor: angiotensin-converting enzyme inhibitor; BP: blood pressure; IV: intravenous.

Adapted from: Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management, and outcome. Pediatr Nephrol 2011 with kind permission from Springer Science + Business Media B.V. Copyright © 2011.

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Recommended doses for selected agents to treat hypertensive infants