Dosing Recommendations for the Initial Prescription of Antihypertensive Drugs for Outpatient Management of Chronic HTN
| Drug . | Age . | Initial Dose . | Maximal Dose . | Dosing Interval . | Formulations . |
|---|---|---|---|---|---|
| ACE inhibitors | |||||
| Contraindications: pregnancy, angioedema | |||||
| Common adverse effects: cough, headache, dizziness, asthenia | |||||
| Severe adverse effects: hyperkalemia, acute kidney injury, angioedema, fetal toxicity | |||||
| Benazepril | ≥6 ya | 0.2 mg/kg per d (up to 10 mg per d) | 0.6 mg/kg per d (up to 40 mg per d) | Daily | Tablet: 5, 10, 20, 40 mg (generic) |
| Extemporaneous liquid: 2 mg/mL | |||||
| Captopril | Infants | 0.05 mg/kg per dose | 6 mg/kg per d | Daily to 4 times a day | Tablet: 12.5, 25, 50, 100 mg (generic) |
| Children | 0.5 mg/kg per dose | 6 mg/kg per d | Three times a day | Extemporaneous liquid: 1 mg/mL | |
| Enalapril | ≥1 moa | 0.08 mg/kg per d (up to 5 mg per d) | 0.6 mg/kg per d (up to 40 mg per d) | Daily to twice a day | Tablet: 2.5, 5, 10, 20 mg (generic) |
| Solution: 1 mg/mL | |||||
| Fosinopril | ≥6 y | 0.1 mg/kg per d (up to 5 mg per d) | 40 mg per d | Daily | Tablet: 10, 20, 40 mg (generic) |
| <50 kg | |||||
| ≥50 kga | 5 mg per d | 40 mg per d | |||
| Lisinopril | ≥6 ya | 0.07 mg/kg per d (up to 5 mg per d) | 0.6 mg/kg per d (up to 40 mg per d) | Daily | Tablet: 2.5, 5, 10, 20, 30, 40 mg (generic) |
| Solution: 1 mg/mL | |||||
| Ramipril | — | 1.6 mg/m2 per d | 6 mg/m2 per d | Daily | Capsule: 1.25, 2.5, 5 10 mg (generic) |
| Quinapril | — | 5 mg per d | 80 mg per d | Daily | Tablet: 5, 10, 20, 40 mg (generic) |
| ARBs | |||||
| Contraindications: pregnancy | |||||
| Common adverse effects: headache, dizziness | |||||
| Severe adverse effects: hyperkalemia, acute kidney injury, fetal toxicity | |||||
| Candesartan | 1–5 ya | 0.2 mg/kg per d (up to 4 mg per d) | 0.4 mg/kg per d (up to 16 mg per d) | Daily to twice a day | Tablet: 4, 8, 16, 32 mg |
| ≥6 ya | Extemporaneous liquid: 1 mg/mL | ||||
| <50 kg | 4 mg per d | 16 mg per d | |||
| ≥50 kg | 8 mg per d | 32 mg per d | |||
| Irbesartan | 6–12 y | 75 mg per d | 150 mg per d | Daily | Tablet: 75, 150, 300 mg (generic) |
| ≥13 | 150 mg per d | 300 mg per d | |||
| Losartan | ≥6 ya | 0.7 mg/kg (up to 50 mg) | 1.4 mg/kg (up to 100 mg) | Daily | Tablet: 25, 50 100 (generic) |
| Extemporaneous liquid: 2.5 mg/mL | |||||
| Olmesartan | ≥6 ya | — | — | Daily | Tablet: 5, 20, 40 mg |
| <35 kg | 10 mg | 20 mg | Extemporaneous liquid: 2 mg/mL | ||
| ≥35 kg | 20 mg | 40 mg | |||
| Valsartan | ≥6 ya | 1.3 mg/kg (up to 40 mg) | 2.7 mg/kg (up to 160 mg) | Daily | Tablet: 40, 80, 160, 320 mg (generic) |
| Extemporaneous liquid: 4 mg/mL | |||||
| Thiazide diuretics | |||||
| Contraindications: anuria | |||||
| Common adverse effects: dizziness, hypokalemia | |||||
| Severe adverse effects: cardiac dysrhythmias, cholestatic jaundice, new onset diabetes mellitus, pancreatitis | |||||
| Chlorthalidone | Child | 0.3 mg/kg | 2 mg/k per d (50 mg) | Daily | Tablet: 25, 50, 100 mg (generic) |
| Chlorothiazide | Childa | 10 mg/kg per d | 20 mg/kg per d (up to 375 mg per d) | Daily to twice a day | Tablet: 250, 500 mg (generic) |
| Suspension: 250/5 mL | |||||
| Extemporaneous liquid: 1 mg/mL | |||||
| Hydrochlorothiazide | Childa | 1 mg/kg per d | 2 mg/kg per d (up to 37.5 mg per d) | Daily to twice a day | Tablet: 12.5, 25, 50 mg |
| Calcium channel blockers | |||||
| Contraindications: hypersensitivity to CCBs | |||||
| Common adverse effects: flushing, peripheral edema, dizziness | |||||
| Severe adverse effects: angioedema | |||||
| Amlodipine | 1–5 y | 0.1 mg/kg | 0.6 mg/kg (up to 5 mg per d) | Daily | Tablet: 2.5, 5,10 mg |
| ≥6 ya | 2.5 mg | 10 mg | Extemporaneous liquid: 1 mg/mL | ||
| Felodipine | ≥6 y | 2.5 mg | 10 mg | Daily | Tablet (extended release): 2.5,5,10 mg (generic) |
| Isradipine | Child | 0.05–0.1 mg/kg | 0.6 mg/kg (up to 10 mg per d) | Capsule: twice daily to 3 times a day; extended-release tablet: daily | Capsule: 2.5, 5 mg |
| Extended-release tablet: 5, 10 mg | |||||
| Nifedipine extended release | Child | 0.2–0.5 mg/kg per d | 3 mg/kg/d (up to 120 mg per d) | Daily to twice a day | Tablet (extended-release): 30, 60, 90 mg (generic) |
| Drug . | Age . | Initial Dose . | Maximal Dose . | Dosing Interval . | Formulations . |
|---|---|---|---|---|---|
| ACE inhibitors | |||||
| Contraindications: pregnancy, angioedema | |||||
| Common adverse effects: cough, headache, dizziness, asthenia | |||||
| Severe adverse effects: hyperkalemia, acute kidney injury, angioedema, fetal toxicity | |||||
| Benazepril | ≥6 ya | 0.2 mg/kg per d (up to 10 mg per d) | 0.6 mg/kg per d (up to 40 mg per d) | Daily | Tablet: 5, 10, 20, 40 mg (generic) |
| Extemporaneous liquid: 2 mg/mL | |||||
| Captopril | Infants | 0.05 mg/kg per dose | 6 mg/kg per d | Daily to 4 times a day | Tablet: 12.5, 25, 50, 100 mg (generic) |
| Children | 0.5 mg/kg per dose | 6 mg/kg per d | Three times a day | Extemporaneous liquid: 1 mg/mL | |
| Enalapril | ≥1 moa | 0.08 mg/kg per d (up to 5 mg per d) | 0.6 mg/kg per d (up to 40 mg per d) | Daily to twice a day | Tablet: 2.5, 5, 10, 20 mg (generic) |
| Solution: 1 mg/mL | |||||
| Fosinopril | ≥6 y | 0.1 mg/kg per d (up to 5 mg per d) | 40 mg per d | Daily | Tablet: 10, 20, 40 mg (generic) |
| <50 kg | |||||
| ≥50 kga | 5 mg per d | 40 mg per d | |||
| Lisinopril | ≥6 ya | 0.07 mg/kg per d (up to 5 mg per d) | 0.6 mg/kg per d (up to 40 mg per d) | Daily | Tablet: 2.5, 5, 10, 20, 30, 40 mg (generic) |
| Solution: 1 mg/mL | |||||
| Ramipril | — | 1.6 mg/m2 per d | 6 mg/m2 per d | Daily | Capsule: 1.25, 2.5, 5 10 mg (generic) |
| Quinapril | — | 5 mg per d | 80 mg per d | Daily | Tablet: 5, 10, 20, 40 mg (generic) |
| ARBs | |||||
| Contraindications: pregnancy | |||||
| Common adverse effects: headache, dizziness | |||||
| Severe adverse effects: hyperkalemia, acute kidney injury, fetal toxicity | |||||
| Candesartan | 1–5 ya | 0.2 mg/kg per d (up to 4 mg per d) | 0.4 mg/kg per d (up to 16 mg per d) | Daily to twice a day | Tablet: 4, 8, 16, 32 mg |
| ≥6 ya | Extemporaneous liquid: 1 mg/mL | ||||
| <50 kg | 4 mg per d | 16 mg per d | |||
| ≥50 kg | 8 mg per d | 32 mg per d | |||
| Irbesartan | 6–12 y | 75 mg per d | 150 mg per d | Daily | Tablet: 75, 150, 300 mg (generic) |
| ≥13 | 150 mg per d | 300 mg per d | |||
| Losartan | ≥6 ya | 0.7 mg/kg (up to 50 mg) | 1.4 mg/kg (up to 100 mg) | Daily | Tablet: 25, 50 100 (generic) |
| Extemporaneous liquid: 2.5 mg/mL | |||||
| Olmesartan | ≥6 ya | — | — | Daily | Tablet: 5, 20, 40 mg |
| <35 kg | 10 mg | 20 mg | Extemporaneous liquid: 2 mg/mL | ||
| ≥35 kg | 20 mg | 40 mg | |||
| Valsartan | ≥6 ya | 1.3 mg/kg (up to 40 mg) | 2.7 mg/kg (up to 160 mg) | Daily | Tablet: 40, 80, 160, 320 mg (generic) |
| Extemporaneous liquid: 4 mg/mL | |||||
| Thiazide diuretics | |||||
| Contraindications: anuria | |||||
| Common adverse effects: dizziness, hypokalemia | |||||
| Severe adverse effects: cardiac dysrhythmias, cholestatic jaundice, new onset diabetes mellitus, pancreatitis | |||||
| Chlorthalidone | Child | 0.3 mg/kg | 2 mg/k per d (50 mg) | Daily | Tablet: 25, 50, 100 mg (generic) |
| Chlorothiazide | Childa | 10 mg/kg per d | 20 mg/kg per d (up to 375 mg per d) | Daily to twice a day | Tablet: 250, 500 mg (generic) |
| Suspension: 250/5 mL | |||||
| Extemporaneous liquid: 1 mg/mL | |||||
| Hydrochlorothiazide | Childa | 1 mg/kg per d | 2 mg/kg per d (up to 37.5 mg per d) | Daily to twice a day | Tablet: 12.5, 25, 50 mg |
| Calcium channel blockers | |||||
| Contraindications: hypersensitivity to CCBs | |||||
| Common adverse effects: flushing, peripheral edema, dizziness | |||||
| Severe adverse effects: angioedema | |||||
| Amlodipine | 1–5 y | 0.1 mg/kg | 0.6 mg/kg (up to 5 mg per d) | Daily | Tablet: 2.5, 5,10 mg |
| ≥6 ya | 2.5 mg | 10 mg | Extemporaneous liquid: 1 mg/mL | ||
| Felodipine | ≥6 y | 2.5 mg | 10 mg | Daily | Tablet (extended release): 2.5,5,10 mg (generic) |
| Isradipine | Child | 0.05–0.1 mg/kg | 0.6 mg/kg (up to 10 mg per d) | Capsule: twice daily to 3 times a day; extended-release tablet: daily | Capsule: 2.5, 5 mg |
| Extended-release tablet: 5, 10 mg | |||||
| Nifedipine extended release | Child | 0.2–0.5 mg/kg per d | 3 mg/kg/d (up to 120 mg per d) | Daily to twice a day | Tablet (extended-release): 30, 60, 90 mg (generic) |
—, not applicable.
FDA pediatric labeling.