Пероральні препарати для дітей з безсимптомною тяжкою гіпертензією

Clonidine (central alpha-agonist)

For children < 12 years of age, use weight-based dosing: Initial dose 2–5 mcg/kg every 6 to 8 hours adjusted up to 10 mcg/kg; maximum dose may be given up to 4 times a day

For children ≥ 12 years of age, use fixed dosing schedule: 0.1 mg 2 times a day increased by 0.1 mg a day as needed up to 0.4 mg 2 times a day

Significant drowsiness, fatigue, dizziness, dry mouth

Clonidine should not be abruptly stopped.

Hydralazine (vasodilator)

Initial dose 0.25 mg/kg every 6 to 8 hours increased as needed up to maximum 25 mg every 6 hours

Tachycardia, headache

Hydralazine has a variable half-life that is genetically determined.

Dosage adjustments are needed for children who have renal dysfunction.

Isradipine (calcium channel blocker)

Initial dose 0.05 to 0.1 mg/kg every 6 to 8 hours up to 5 mg using the immediate-release capsules

Common adverse effects: Flushing, peripheral edema

Severe adverse effects: Angioedema

Isradipine causes an exaggerated response in patients taking azole antifungals.

Minoxidil (direct vasodilator)

0.1 to 0.2 mg/kg once a day up to 10 mg (may increase to every 8 to 12 hours)

Common adverse effects: Dizziness, prolonged hypotension, fluid retention

Severe adverse effects: Heart failure, pulmonary edema, Stevens-Johnson syndrome

Minoxidil is the most potent oral vasodilator with a very long length of action and its effects are difficult to reverse.

Minoxidil is contraindicated in acute myocardial infarction or pheochromocytoma.

This drug causes significant reflex tachycardia and fluid retention, so may need to use with a beta-blocker and diuretic.

Dosage adjustments are needed for children who have renal dysfunction.