Participants in this group will receive 10mg of hydralazine intravenously. When used parenterally, hydralazine should be started at a low dose (5 mg given as an intravenous bolus every 4 to 6 hours), and increased gradually up to 25 to 30 mg, as tolerated. Serious - Use Alternative (4)lofexidine lofexidine, hydralazine. Either increases effects of the other by pharmacodynamic synergism. ...lonafarnib hydralazine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ...pexidartinib hydralazine and pexidartinib both increase Other (see comment). ...pretomanid hydralazine, pretomanid. ... (2) Dose Oral Starting dose: 0.25 to 1 mg/kg/dose 6-8 hourly. May repeat every 4 to 6 hours as needed (maximum 300-400 mg/24 hours). Mechanism: inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule. * Maximum cumulative IV administered doses should not exceed 25 mg hydralazine; 220 mg labetalol in 24 hours. Nicardipine 5 mg/hour IV infusion as initial dose; titrate to desired effect by increasing rate by 2.5 mg/hour every 5-15 minutes to maximum of 15 mg/hour. The … to 50 mg PO qid; Max: 300 mg/day PO; Alt: 10-20 mg IM/IV q4-6h prn, switch to PO ASAP; Info: adjust to lowest effective dose for maintenance Results: Labetalol was more effective than Hydralazine in lowering diastolic BP in the first hour from the baseline BP (p-value 0.009). Administer with constant ECG monitoring. For oral dosage form (tablets): Adults—At first, 10 milligrams (mg) four times a day. Maximum IV DOSE Hydralazine = 25 mg in 24 hours *Nifedpine: effects seen within 10 minutes (max. In addition, hydralazine may be safely administered to pregnant patients with heart failure 77 or severe hypertension. Continuous IV infusion: 0.9-1 mg/hour . Initially 2.5 mg, dose may be repeated after 12 hours if necessary up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk; continued use should be … Change to oral therapy as soon as possible. dose of 0.35 mg/kg in 15 min. Hydralazine, at an average dose of 215 mg/day, …. 1 mg BP, HR, RR Eptifibatide (Integrilin) CC, IMC, C-T, CVPR, Antiplatelet Agent 1 to 2 mins 22.6 mg Do not dilute Monitor for Hgb/Hct, and platelets. Infants, Children, and Adolescents: Initially, 0.2-0.6 mg/kg/dose IV (up to 20 mg) every 4 hours as needed for blood pressure control. Maximum infusion rate based on weight and renal function. Reconstituted vial stable for 24 hours in the fridge or 8 hours at room temperature. Effects on uteroplacental blood flow are unclear, likely because of variation in the degree of reflex sympathetic activation, and fetal distress may result via a precipitous drop in maternal pressure. ii. Isosorbide dinitrate Start 20 mg q8hr. • Maximum dose 80 mg Hydralazine • 5–10 mg IV over 3–10 minutes • Repeated doses 5 mg IV every 20 minutes if required • Maximum dose 30 mg • Infusion may be required • May require plasma expansion #Labetalol • Initially 20 mg IV bolus over 2 minutes • Repeated doses 40–80 mg IV every 10 minutes to maximum of 300 mg if required Max: 1.7—3.5 mg/kg/day IV, given in divided doses every 4 hours as needed. * Maximum cumulative IV administered doses should not exceed 25 mg hydralazine; 220 mg labetalol in 24 hours. After Seizure Assess neurologic status every 15 minutes PEC labs: CBC, Chem 7, LFT, Uric Acid, LDH, T&S, PT/ PTT, Fibrinogen, Magnesium Foley catheter (Hourly I&O. (1,3) Dose may be titrated up to 7.5 mg/kg/day. For systolic 180 or diastolic 105 give labetalol 10 mg IV over 1-2 minutes, Hydralazine 10-20 mg IV, or Nicardipine infusion, 5 mg/hour, titrate up by 2.5 mg/hour at 5-15 minute intervals, maximum dose 15 mg/hour. It was not teratogenic in rats or rabbits. Also refer to Procedure: Observations – Birth Centre – Adult Escalation Criteria and Response Framework. Repeat BP in 20 min 7. Maximum IV DOSE Hydralazine = 25 mg in 24 hours *Procardia: effects seen within 10 A loading dose of 0.1 mg/kg IV (minimum 1 mg IV) followed by a continuous IV infusion of 0.1 mg/kg/hour has been studied for short durations (24 hours or less) in postoperative cardiac patients. q Continue for 24 hours after the last convulsion or delivery combined intramuscular (iM) and intravenous (iV) regimen intravenous (iV) regimen Do not exceed 9g total IV dose of MgSO 4 during the first hour q If convulsions still continue, consult medical staff and consider diazepam 5mg or lorazepam 1mg (IV or IM) q Be aware of risk of respiratory Has vasoppressor and antidiuretic effects. pressure every 15 minutes for 2 hours, than every 30 minutes for 6 hours, and then every hour for 16 hours. IV Hydralazine 10 mg IV over 5 min (mix 20mg of hydralazine with ... every 15-20 mins to a maximum dose of 20 mg/hr ... Give two doses of betamethasone 12 mg intramuscularly 24 hours apart in women between 24 and 36 weeks. Adenosine First dose: 0.1mg/kg IV (max. Drug: Name, Dosage and Route Recommended Dosage Times Action of Drug Nursing Interventions Major Side Effects Maximum dose is 4,000 mg in 24 hours. Peak plasma concentrations are attained after 0.5 to 1.5 hours. Plasma protein binding is of the order of 90%. Dose: 0.5-1 mg/ dose IV push over 1-2 mins; maximum 10 mg/day . • The dose of hydralazine which you will have to inject will vary from 2 mg to 20 mg for this response to occur. Dextrose (5%) and Sodium Chloride (0.45%) Injection, USP Your doctor may adjust your dose as needed. Dosage All Indications: IV: Initial dose: 100-500 microgram/ kg/ dose 6 to 8 hours Dose may be gradually increased as required Maximum 2mg/kg/dose every 6 hours Continuous IV infusion: 12.5microgram to 50 microgram/kg/hour Oral: Initial dose: 250 microgram to 1mg/kg/dose every 6 to 8 hours Increase gradually to 2mg/kg/dose every 8 hours Dosage Pharmacologic therapy of heart failure with reduced ejection fraction: Mechanisms of action. This can be repeated every 4-6 hours as needed. A significant beta-blocking effect of atenolol, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. (1) A significant beta-blocking effect of atenolol, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. • Give 5-20mg boluses slowly IV at 10 minute intervals to a maximum of 50mg. Due to its unpredictable response and prolonged duration of action, hydralazine is not a desirable first-line agent for acute treatment. • May be given orally (dose: 100-200mg PO hourly, until BP controlled - maintenance dose is given 12 hourly). (See Appendix X, pg. In general, enalaprilat is administered as an IV injection of 1.25 mg over 5 minutes every 6 hours, titrated by increments of 1.25 mg at 12- to 24-hour intervals up to … Hydralazine may increase risk of maternal hypotension. minutes and has its maximum effect after 5 minutes. • Alternatively, start IV infusion at 20 mg/hour. 137). (some patients may require 15 mg IV Q 3 - 6 hours) Hydralazine 10 - 20 mg IV Q 4-6 hours PRN to achieve goal BP (maximum recommended single dose 40 mg) Enalaprilat 1.25 mg IV Q6 hours PRN to achieve goal BP (reduce initial dose to 0.625 mg for patients receiving diuretic) PrecautionsGeneral. Myocardial stimulation produced by Hydralazine can cause anginal attacks and ECG changes of myocardial ischemia.Laboratory Tests. ...Drug Interactions. ...Carcinogenesis, Mutagenesis, Impairment of Fertility. ...Pregnancy. ...Nursing Mothers. ...Pediatric Use. ... Loading dose of 4 to 6 g administered per infusion pump over 20 to 30 minutes (i.e., slowly) followed by a maintenance dose of 1 to 2 g per hour as a continuous intravenous infusion; IM option if IV access limited 10 g initially as a loading dose (5 g IM in each buttock) followed by 5 g every 4 hours; Mix with 1 mL xylocaine 2% to alleviate pain Intermittent infusion 50mg over 30minutes, and then 35mg over 60minutes. Monitor fetus if viable 2. • Occasionally injection of the whole 20 mg of hydralazine will fail to treat the severe hypertension. Mix: may be given undiluted . Reconstituted vial stable for 24 hours in the fridge or 8 hours at room temperature. Other features: oliguria (less than 500 mL of urine in 24 hours), cerebral or visual disturbances, pulmonary edema or cyanosis, epigastric … Maximum dose is 300 mg/24 hours. Initially 30–300 micrograms/kg, dose to be given in steps of 1–2.5 mg every 2 minutes, then (by slow intravenous injection or by continuous intravenous infusion) 30–200 micrograms/kg/hour, reduce dose (or reduce or omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia, lower doses may be adequate if opioid analgesic also used. The practitioner orders IV hydralazine. During 15 distinct periods of 24 hours or less, the mean dose of labetalol given was 623 8 ±6 mg. Labetalol 20 mg IV over 2 minutes Repeat BP in 10 minutes If SBP ≥ 160 or DBP ≥ 110, administer labetalol 40 mg IV over 2 minutes; Use IV route only if PO is not feasible. Hydralazine Start 25-37.5 mg q8hr. Do not store in the bathroom. IV: Apresoline powder for injection 20mg ampoule (preferred), Hydralazine Link solution for injection - 20mg/mL vial. The maximum hypotensive effect occurs from 2 to 4 hours after ingestion and may persist for up to 24 hours (Barker, 1995). Hydralazine Adult IV - 10 to 20 mg (may increase to 40 mg per dose if required). Max dose 40 mg q8hr. 2. 5 This group (Hydralazine;Group B) received intravenous Hydralazine and served control. The usual dose is 20 to 40 mg, repeated as necessary. Mechanism: inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule. Elimination: renal Half-life: 1-1.5 hours Diastolic BP must not fall below 90 mmHg. 1 to 1.5 mg/kg/dose IV load then 1 to 4 mg/minute (0.02 to 0.05 mg/kg/minute in the average 70 kg adult) IV infusion. This effect is maximal at about 2 to 4 hours, and persists for at least 24 hours. intravenous fluid (see . If continues to exceed threshold, hydralazine 10mg (2 min) 8. Repeat blood pressures in 20 minutes, if severe hypertension persists, give a 20 mg dose of po Hydralazine. The safety of administering high doses of intravenous labetalol (greater than 300 mg in 24 hours) was evaluated in neurosurgical patients (n=9). In this case, start an intravenous infusion of hydralazine. Use: For the treatment of severe essential hypertension when this drug cannot be given orally or when there is an urgent need to lower blood pressure. The infusion was doubled every 2 hours to a maximum of 0.4 mg/kg/hour continuous IV in patients whose urine output remained less than 1 mL/kg/hour. …rationale for the combined use of hydralazine and nitrate therapy is to reduce cardiac preload and afterload by achieving both venous and arterial vasodilation. Nicardipine hydrochloride injection has been found compatible and stable in polyvinyl chloride containers for 24 hours at controlled room temperature with: Dextrose (5%) Injection, USP . If SBP threshold of 160 mm Hg or DBP 110 mm Hg was still reached after 20 minutes, then second bolus was repeated. 19 (47%) patients in Labetalol and 8 (20%) patients in hydralazine had a reduction in diastolic BP. 20 mg IV over 2 minutes initially, then 40-80 mg IV q10min; total dose not to exceed 300 mg. Distribution. labetalol is contraindicated, the use and administration of intravenous hydralazine. hours after delivery and/or outpatient surveillance (e.g., visiting nurse evaluation) within 3 days and again 7-10 days after delivery or earlier if persistent symptoms. MISSED DOSE: If you miss a dose, take it as soon as you remember. May rarely cause allergic reactions. Teratogenic effects observed were cleft palate and malformations of facial and cranial bones. Intermittent infusion 50mg over 30minutes, and then 35mg over 60minutes. Maximum IV dose Labetalol= 300 mg in 24 hours Patient must be on continuous pulse ox. Dosage should be adjusted according to blood pressure (BP). Clonidine transdermal form is the preferred method of administration as the oral forms can increase the risk of rebound hypertension. Use IV route only if PO is not feasible. If after 24 hours with IV medication weight not decreased by ≥ 2lbs consider admission. 20-30 times the maximum human daily dose. Hydralazine 5 or 10 mg IV over 2 min 4. However, the dose is usually not more than 50 mg four times a day. NOTE: Delivered in lipid emulsion. urinary protein-to … The study was performed as a randomised clinical trial on 201 pregnant women with a gestational age of 26-34 weeks. Terminate IV infusion as soon as the cardiac rhythm stabilizes or if toxicity occurs. Hydralazine for Initial First-Line Management 1. • … Note: IV preparation may be given orally either neat or diluted with water if required. -Initial dose: 0.75 mg/kg/day in 4 divided doses-May increase gradually over 3 to 4 weeks to a maximum of 7.5 mg/kg/day or 200 mg/day Comments:-Safety and effectiveness have not been established in pediatric patients in controlled clinical trials, however, there is experience with use of this drug in children at the provided doses. However the reduction of diastolic BP in second and third hours was not significant (p values 0.446, 0.314). Rapid IV push. of both male and female mice given hydralazine continuously in their drinking water at a dosage of about 250 mg/kg per day (about 80 times the maximum recommended human dose). Consider combining with a beta-blocker since hydralazine is associated with reflex tachycardia (ACC/AHA [Whelton 2017]; Elliott 2019; Rhoney 2009; manufacturer's labeling). Usual Pediatric Dose for Hypertension. * Maximum cumulative IV-administered doses should not exceed 300 mg labetalol or 25 mg hydralazine in 24 hours . Reconstituted vial stable for 24 hours in the fridge or 8 hours at room temperature. Use IV route only if PO is not feasible. Dose: 0.5-1 mg/ dose IV push over 1-2 mins; maximum 10 mg/day . b. Report urine Maximum dose of 15 mg/hr. * Maximum cumulative IV-administered doses should not exceed 220 mg labetalol or 25 mg hydralazine in 24 hours If first line agents unsuccessful, emergency consult with specialist (MFM, internal medicine, OB anesthesiology, critical care) is recommended Anticonvulsant Medications For recurrent seizures or when magnesium sulfate Following hydralazine, BP was reduced by 24/9 ± 29/15 mmHg and heart rate increased by 4 ± 13 beats per minute. – By IV infusion • Dilute 100 mg (5 vials of reconstituted hydralazine solution) in 500 ml of 0.9% sodium chloride or Ringer lactate, to obtain a solution containing 200 micrograms/ml. Dose: 12.5–50 micrograms/kg/hour (maximum 3 mg/kg in 24 hours for children >1 month), by intravenous infusion; Side-effects: tachycardia, headache, flushing, vomiting; Disadvantage: may require the introduction of a β-blocker; Labetalol. Action: Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor. Adult Dosing . Therapeutic: induction of labor. Monitor: reperfusion arrhythmias, increased risk of bleeding. Maximum dose 7.5 mg twice daily . If intravenous therapy was necessary the drug was given as a continuous infusion of 1.5 mg/hourly with a maximum infusion rate of 6 mg/hourly. The initial hydralazine dose is 10mg given IV push over 2 minutes. Do not freeze liquid forms of this medication. IM, IV: 10 to 20 mg every 4 to 6 hours as needed; may increase dose to a maximum of 40 mg/dose if necessary; some experts recommend a maximum of 20 mg/dose. A loading dose of 0.1 mg/kg IV (minimum 1 mg IV) followed by a continuous IV infusion of 0.1 mg/kg/hour has been studied for short durations (24 hours or less) in postoperative cardiac patients. Intermittent infusion 50mg over 30minutes, and then 35mg over 60minutes. Switch to oral therapy as soon as possible, usually within 24-48 hours. Hypertensive Emergency. Alternative: 1-2 mg/min by continuous IV infusion; total dose of 300 mg has been used. Switch to oral therapy as soon as possible, usually with 24—48 hours. Most patients respond to 4 to 6 mg/hour and are treated with maximum doses of 16 mg/hour or less. Metoprolol 1.25 - 5 mg IV Q6 - 12 hours; Adjust dose to BP response. Hydralazine: 5mg as a slow bolus dose administered intravenously and repeated 10mg every 20-minutes until the desired effect was achieved up to a maximum of 5 doses: Labetalol: 20mg intravenous bolus dose followed by 40mg if not effective within 10-minutes followed by 80mg every 10-minutes up to a maximum dose of 300mg (5 doses) below), resulting in 250 mL of solution at a concentration of 0.1 mg/mL. -Most patients can be transferred to the oral formulation within 24 to 48 hours. Hydralazine doses up to 300 mg per day (75 mg four times a day) were used in the first Veterans Heart Failure Trial demonstrating a reduction of mortality when used in combination with nitrates in patients with chronic congestive heart failure. BP ≥ 160/110 mmHg on 2 occasions over 15 min 3. Hydralazine 25 mg 3× daily 75 mg 3× daily ... Ivabradine 2.5–5 mg twice daily Titrate to heart rate 50–60 beats/min. B)HYDRALAZINE: First dose of 5 mg slow intravenously over 2 minutes, if required followed at 20 minutes intervals by subsequent doses of 5 mg, repeated upto a maximum of 4 more times (total 5 doses, ,maximum cumulative dose 25 mg) till primary end point i.e Systolic blood pressure <160 mm Hg and diastolic blood pressure 110 mm Hg was reached. Notify provider after one severe BP value is obtained Institute fetal surveillance if viable Hold IV labetalol for maternal pulse under 60 Maximum cumulative IV-administered dose of labetalol should not exceed 220 mg in 24 hours The hydralazine group received 5 mg as an initial IV bolus in not less than five minutes. The fall in blood pressure begins within 10 to 30 minutes and lasts 2 to 4 hours. Actual body weight should be used to calculate creatinine clearance and the Doses may be staggered every four hours (i.e., alternating doses of hydralazine and isosorbide dinitrate every four hours) to avoid causing an excessive drop in blood pressure. 126) will assist in the initiation of rapid delivery of medication. 2. Max: 1.7-3.5 mg/kg/day IV, given in divided doses every 4 hours as needed. Pulse and blood pressure were checked every 10 minutes interval. Hydralazine Hydrochloride Injection should be used only when the drug cannot be given orally. Hydralazine. Increasing the dose, there is a non-proportional increase in the serum levels, possibly because of saturation in the metabolic pathways of hydralazine. 6 mg) Second dose: 0.2mg/kg IV (max. The onset of action after IV administration is 5 to 20 minutes, with a duration of 1 to 4 hours. While hydralazine's half-life is variable, its effect on BP generally persists for 2 to 4 hours. Read complete answer here. Similarly, does hydralazine work immediately? The order says to administer an initial dose of 50 mg IV for BP over 160/110 mm Hg. Bolus doses of 5 mg administered over 2 minutes, at 20 minutes interval. IV infusion should not be used for longer than 24 hours. Use. maximum dose of 300mg. If continues to exceed threshold, hydralazine 10mg (2 min) 6. Monitor: reperfusion arrhythmias, increased risk of bleeding. Hydralazine 10-20 mg IV every 10 min, or iii. If it is near the time of the next dose, skip the missed dose. Adverse hemodynamic and biochemical effects were minor and easily reversible. dose 12 mg) Amiodarone 10–15mg/kg/day Loading: 2.5–5mg/kg or a maximum of 300mg IV over 5–10 min. Diphenhydramine (Benadryl®) Maximum rate is 25 mg/min. Administer hydralazine 5 mg or 10 mg IV over 2 minutes Repeat BP in 20 minutes If SBP ≥ 160 or DBP ≥ 110, administer hydralazine 10 mg IV over 2 minutes Dosing Modifications. dose. Administer initial dose PO (usual dose 10 mg). * Maximum cumulative IV-administered doses should not exceed 220 mg labetalol or 25 mg hydralazine in 24 hours Note: If first line agents unsuccessful, emergency consult with specialist (MFM, internal medicine, 0B anesthesiology, critical … Dosage forms: TAB: 10 mg, 25 mg, 50 mg, 100 mg; INJ: 20 mg per mL HTN, mod-severe [10-50 mg PO qid] Start: 10 mg PO qid x2-4 days, then may incr. Children ages 2 to 11 weighing less than 50 kg: 10 to 15 mg/kg/dose PO or PR every 4 hours up to 90 mg/kg daily. When switching from IV to oral therapy, the IV dose should generally be doubled and administered orally; titrate the oral dose to response. Usual dosage range: 200-400 mg PO q12hr; not to exceed 2400 mg/day. An IV loading dose of 0.05, 0.1, or 0.2 mcg/kg, followed by a continuous infusion of 0.05, 0.1, or 0.2 mcg/kg/hour IV adequately sedated mechanically-ventilated premature neonates (n = 18; gestational age: 28 to 36 weeks) for 6 to 24 hours, with no additional sedative agents given, in … Blood Pressure Management in Patients eligible for thrombolytics: a. Prethrombolytics: i. Infusion rate = 10 – 15 mg/hr. Every 12 hours assess for level of consciousness, headache, visual disturbances, epigastric pain, and edema. 2. Duration of ~8 hours. ... Hydralazine IV 5-10 mg every 10 min (Max dose 25 mg). Clinical judgement should prevail. The maximum hydralazine oral dose is 300 mg daily. Starting dosage: 0.75 mg per kg of body weight per day taken by mouth in four divided doses Dosage adjustments: Your doctor may slowly increase your dose over 3–4 weeks. See algorithm for second line medication. Infusion: 0.05 to 0.3 mg/min OR 0.1 mg/kg IV loading dose, then 1.5 to 5 mcg/kg/min IM - 10 to 50 mg per dose Pediatric 0.1 to 0.2 mg/kg (maximum 20 mg)IV or IM every 2 to 4: 5 to 15 May increase to 40 mg/dose (generally speaking – do not exceed 20mg/dose). Animal studies indicate that hydralazine is teratogenic in mice at 20 to 30 times the maximum daily human dose of 200 to 300 mg and possibly in rabbits at 10 to 15 times the maximum daily human dose, but that it is nonteratogenic in rats. Dose adjustments based on renal function. Control of postpartum bleeding. Continuous IV infusion: 0.9-1 mg/hour . Labetalol is given as a 20-mg intravenous bolus, followed by 40 mg after 10 minutes if the first dose is not effective; then 80 mg is administered every 10 minutes (maximum total dose: 220 mg). B. Administer the hydralazine as soon as possible. In patients who tolerate the full intravenous dose (15 mg), initiate Lopressor tablets, 50 mg every 6 hours, 15 minutes after … When there is urgent need, therapy in the hospitalized patient may be initiated intramuscularly or as a rapid intravenous bolus injection directly into the vein. Maximum daily dose: 600mg/day IV administration 2 mg/mL may be given undiluted or diluted with equal volume of D5W ... 7 mg/kg/dose every 24 hours ≤29 0-7 8-28 ≥29 5 4 5 48 36 24 30-34 0-7 ≥8 4.5 4 36 24 Oral: Immediate release: Initial: 20 to 30 mg 3 or 4 times daily in combination with hydralazine 3 or 4 times daily; titrate dose every 2 to 4 weeks; maximum dose: 120 mg/day in divided doses (ACCF/AHA [Yancy 2013]). Repeat blood pressures in 20 minutes, if severe hypertension persists, give another 20 mg dose of po Hydralazine. Thereafter repeated doses were given for 1 hour/ till blood pressure control. The normal dosage for adults is 0.143 to 0.357 mg/kg per 6 hours orally to start, then after many weeks 0.143 to 0.357 mg/kg per 6 hours as needed. Report output < 30 ml/hour) Strict I&O (no less than every 2 hours). Clinical judgement should prevail. Max: 1.7-3.5 mg/kg/day IV, given in divided doses every 4 hours as needed. May rarely cause allergic reactions. The maximum hypotensive effect occurs from 2 to 4 hours after ingestion and may persist for up to 24 hours. Peak plasma levels are achieved in about 60 minutes after ingestion. maximum doses are reached and further escalation of treatment is needed. • Maximum cumulative IV-administered dose of labetalol should not exceed 220 mg in 24 hours • There may be adverse effects and contraindications. Animal studies indicate that hydralazine is teratogenic in mice at 20 to 30 times the maximum daily human dose of 200 mg to 300 mg and possibly in rabbits at 10 to 15 times the maximum daily human dose, but that it is nonteratogenic in rats. Transdermal maximum clonidine dose is 0.3 mg weekly, while oral immediate-release form maximum dose is 0.3 mg three times daily. intravenous bolus injection directly into the vein. iv. Aim for a 10-15% reduction in BP. Onset within ~1-2 hours. ... Labetalol: (If used as the first-line medication; maximum dose is 300 mg/24 hours) IV Push: • Administer initial dose IV push over 2 minutes (Usual dose is 10-20 mg). Monitor: reperfusion arrhythmias, increased risk of bleeding. Hydralazine Labetalol Immediate Release Oral Nifedipine Onset 5 to 10 minutes Administration 10 to 20 mg orally Repeat in 20 minutes if needed Then 10 to 20 mg every 2 to 6 hours Maximum dose: 180 mg Medication Risks Maternal tachycardia and headaches IV Hydralazine Onset 10 to 20 minutes Administration IV 5 to 10 mg IV (or IM) Ninety-four patients (mean age, 69 ± 18 years, 48% women, 89% with known hypertension) received 201 intravenous hydralazine doses (mean dose of 11.4 ± 4.3 mg). Elimination: renal Half-life: 1-1.5 hours Note that the maximum dose for 24 hours is 300mg.

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