Table 2 Intravenous antihypertensive agents for acute intracerebral hemorrhage
From: Clinical review: Critical care management of spontaneous intracerebral hemorrhage
Drug | Mechanism | Dose | Cautions |
|---|---|---|---|
Labetalol | Alpha-1, beta-1, beta-2 receptor antagonist | 20–80 mg bolus every 10 minutes, up to 300 mg; 0.5 to 2.0 mg/minute infusion | Bradycardia, congestive heart failure, bronchospasm, hypotension |
Esmolol | Beta-1 receptor antagonist | 0.5 mg/kg bolus; 50 to 300 μg/kg/minute | Bradycardia, congestive heart failure, bronchospasm |
Nicardipine | L-type calcium channel blocker (dihydropyridine) | 5 to 15 mg/h infusion | Severe aortic stenosis, myocardial ischemia, hypotension |
Enalaprilat | ACE inhibitor | 0.625 mg bolus; 1.25 to 5 mg every 6 h | Variable response, precipitous fall in blood pressure with high-renin states |
Fenoldopam | Dopamine-1 receptor agonist | 0.1 to 0.3 μg/kg/minute | Tachycardia, headache, nausea, flushing, glaucoma, portal hypertension |
Nitroprusside* | Nitrovasodilator (arterial and venous) | 0.25 to 10 μg/kg/minute | Increased intracranial pressure, variable response, myocardial ischemia, thiocyanate and cyanide toxicity, hypotension |