Çocuklarda Antihipertansif İlaç Dozları
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| İlaç Sınıfı |
İlaçlar |
Doz aralığı |
Yan Etkiler/Özel Durumlar |
| Angiotensin Converting Enzyme Inhibitor (ACEi) |
Captopril** |
Initial: 0.3 to 0.5 mg/kg per dose (tid)
Maximum: 6 mg/kg per day |
All ACEis are contraindicated in pregnancy
Periodically measure serum creatinine and potassium concentrations
Cough and angioedema are less common with new ACEis
Some agents can be made into a suspension
United States Food and Drug Administration (FDA) approval is limited to children >= 6 yrs of age and creatinine clearances >= 30 mL/min per 1.73m2
Consider for renoprotective effect for renal disease with proteinuria and diabetes mellitus |
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Enalapril** |
Initial: 0.08 mg/kg per day up to 5 mg/d (once daily-bid)
Maximum: 0.6 mg/kg per day up to 40 mg/d |
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Benazepril |
Initial: 0.2 mg/kg per day up to 10 mg/d
Maximum: 0.6 mg/kg per day up to 40 mg/d |
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Lisinopril |
Initial: 0.07 mg/kg per d up to 5 mg/d
Maximum: 0.6 mg/kg per d up to 40 mg/d |
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Fosinopril |
Children >50 kg: Initial: 5 to 10 mg/d Maximum: 40 mg/d |
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Quinapril |
Initial: 5 to 10 mg/d
Maximum: 80 mg/d |
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| Angiotensin Receptor Blocker (ARB) |
Irbesartan |
6 to 12 y: 75 to 150 mg/d (once daily)
>= 13 y: 150 to 300 mg/d |
All ARBs are contraindicated in pregnancy
Periodically measure serum creatinine and potassium concentrations
Losartan can be made into a suspension
FDA approval is limited to children >= 6 y of age and creatinine clearances >= 30 mL/min per 1.73m2 |
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Losartan |
Initial: 0.7 mg/kg per day up to 50 mg/d (once daily)
Maximum: 1.4 mg/kg per day up to 100 mg/d |
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| Calcium Channel Blocker |
Amlodipine** |
Children 6 to 17 y: 2.5 to 5 mg once daily |
Amlodipine and isradipine can be compounded into stable extemporaneous suspensions
Felodipine and extended-release nifedipine tablets must be swallowed whole
May cause tachycardia and edema |
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Felodipine |
Initial: 2.5 mg/d
Maximum: 10 mg/d |
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Isradipine** |
Initial: 0.15 to 0.2 mg/kg per day (tid-qid)
Maximum: 0.8 mg/kg per day up to 20 mg/d |
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Extended-release nifedipine |
Initial: 0.25 to 0.5 mg/kg per day (once daily-bid)
Maximum: 3 mg/kg per day up to 120 mg/d |
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| Alpha and Beta Blocker |
Labetalol** |
Initial: 1 to 3 mg/kg per d (bid)
Maximum: 10 to 12 mg/kg per day up to 1,200 mg/d |
Asthma and overt heart failure are contraindications
Heart rate is dose-limiting
May impair athletic performance
Should not be used in those who have insulin-dependent diabetes |
| Beta Blocker |
Atenolol** |
Initial: 0.5 to 1 mg/kg per day (once daily-bid)
Maximum: 2 mg/kg per day up to 100 mg/d |
Noncardioselective agents (propranolol) are contraindicated in those who have asthma and heart failure
Heart rate is dose-limiting
May impair athletic performance
Should not be used in those who have diabetes mellitus |
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Metoprolol** |
Initial: 1 to 2 mg/kg per day (bid)
Maximum: 6 mg/kg per day up to 200 mg/d |
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Propranolol** |
Initial: 1 to 2 mg/kg per day (bid-tid)
Maximum: 4 mg/kg per day up to 640 mg/d |
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| Central Alpha Blocker |
Clonidine |
Children >= 12 y: Initial: 0.2 mg/d (bid) Maximum: 2.4 mg/d |
May cause dry mouth or sedation
Transdermal preparation is available
Sudden cessation of therapy can lead to severe rebound hypertension |
| Vasodilator |
Hydralazine** |
Initial: 0.75 mg/kg per day (qid)
Maximum: 7.5 mg/kg per day up to 200 mg/d |
Tachycardia and fluid retention are common
Contraindicated with pericardial effusion, supraventricular tachycardia, and tachydysrhythmias Hydralazine can cause lupus-like syndrome
Prolonged use of minoxidil can causehypertrichosis
Minoxidil usually is reserved for patients who have hypertension that is resistant to multiple drugs |
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Minoxidil** |
Children <12 y: Initial: 0.2 mg/kg per day (once daily-tid)
Maximum: 50 mg/day
Children >= 12 y: Initial: 5 mg/kg per day (once daily-tid)
;Maximum: 100 mg/day
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| Diuretics |
Hydrochlorothiazide |
Initial: 1 mg/kg per day (once daily)
Maximum: 3 mg/kg per day up to 50 mg/day |
All patients taking diuretics should have electrolytes monitored after initiation of therapy and periodically
Potassium-sparing diuretics (spironolactone, triamterene) may cause severe hyperkalemia, especially in conjunction with ACEi or ARB
Furosemide is useful adjunctive therapy for patients who have renal disease
Some agents may be useful in low renin forms of hypertension |
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Furosemide |
Initial: 0.5 to 2 mg/kg per day (once daily-bid)
Maximum: 6 mg/kg per day |
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Spironolactone** |
Initial: 1 mg/kg per day (once daily-bid)
Maximum: 3.3 mg/kg per day up to 100 mg/d |
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Triamterene |
Initial: 1 to 2 mg/kg per day (bid)
Maximum: 3 to 4 mg/kg per day up to 300 mg/d |
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Modified from The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics. 2004;114:555–576.
* Check pediatric labeling and safety information on all agents. Also, see http://www.fda.gov/oc/opt/default.htm for complete United States Food and Drug Administration labeling and levels of evidence for dosing recommendations. Comments apply to all members of each drug class except where otherwise stated. The table does not include all available drugs in each category. Some drugs require adjustment for renal disease or specific glomerular filtration rates. These medications should be used by physicians experienced in the treatment/management of children who have hypertension.
** Extemporaneous formulations (liquid) may be prepared by a pharmacy.
Kaynak: Feld LG, Corey H. Hypertension in Childhood. Pediatrics in Review. 2007;28:283-298.
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