TABLE 4

Antihypertensive Medications With Pediatric Experience

ClassDrugInitial DoseMaximal DoseDosing IntervalEvidence for EffectivenessFDA Approved
Angiotensin-converting enzyme inhibitor (ACE)Benazepril0.2 mg/kg/day up to 10 mg/day0.6 mg/kg/day up to 40 mg/dayqdRandomized controlled trialYes
Angiotensin-converting enzyme inhibitor (ACE)Captopril0.3–0.5 mg/kg/dose (>12 mo)6 mg/kg/daytidRandomized controlled trial, Case seriesNo
Angiotensin-converting enzyme inhibitor (ACE)FosinoprilChildren >50 kg: 5–10 mg/day40 mg/dayqdRandomized controlled trialYes
Angiotensin-converting enzyme inhibitor (ACE)Lisinopril0.07 mg/kg/day up to 5 mg/day0.6 mg/kg/day up to 40 mg/dayqdRandomized controlled trialYes
Angiotensin-converting enzyme inhibitor (ACE)Quinapril5–10 mg/day80 mg/dayqdRandomized controlled trial, Expert opinionNo
Angiotensin-receptor blocker (ARB)Irbesartan6–12 y: 75–150 mg/day; ≥13 y: 150–300 mg/day300 mg/dayqdCase seriesYes
Angiotensin-receptor blocker (ARB)Losartan0.7 mg/kg/day up to 50 mg/day1.4 mg/kg/day up to 100 mg/dayqd-bidRandomized controlled trialYes
Angiotensin-receptor blocker (ARB)Valsartan5–10 mg/day 0.4 mg/kg/day40–80 mg/day 3.4 mg/kg/dayqdRandomized controlled trialNo
α- and β-antagonistLabetalol1–3 mg/kg/day10–12 mg/kg/day up to 1200 mg/daybidCase series, Expert opinionNo
β-antagonistAtenolol0.5–1 mg/kg/day2 mg/kg/day up to 100 mg/dayqd-bidCase seriesNo
β-antagonistBisoprolol/HCTZ2.5–6.25 mg/day10/6.25 mg/dayqdRandomized controlled trialNo
β-antagonistMetoprololChildren >6 y: 1 mg/kg/day (12.5–50 mg/day)2 mg/kg/day up to 200 mg/daybidCase seriesYes
β-antagonistPropranolol1-2 mg/kg/day4 mg/kg/day up to 640 mg/daybid-tidRandomized controlled trial, Expert opinionYes
Calcium channel blockerAmlodipineChildren 6-17 y: 2.5 mg/day5 mg/dayqdRandomized controlled trialYes
Calcium channel blockerFelodipine2.5 mg/day10 mg/dayqdRandomized controlled trial, Expert opinionNo
Calcium channel blockerIsradipine0.15-0.2 mg/kg/day0.8 mg/kg/day up to 20 mg/daytid-qidCase series, Expert opinionNo
Calcium channel blockerExtended-release nifedipine0.25-0.5 mg/kg/day3 mg/kg/day up to 120 mg/dayqd-bidCase series, Expert opinionNo
Central α-agonistClonidineChildren ≥12 y: 0.2 mg/day2.4 mg/daybidExpert opinionYes
DiureticHCTZ1 mg/kg/day3 mg/kg/day up to 50 mg/dayqdExpert opinionYes
DiureticChlorthalidone0.3 mg/kg/day2 mg/kg/day up to 50 mg/dayqdExpert opinionNo
DiureticFurosemide0.5-2.0 mg/kg/ dose6 mg/kg/dayqd-bidExpert opinionNo
DiureticSpironolactone1 mg/kg/day3.3 mg/kg/day up to 100 mg/dayqd-bidExpert opinionNo
DiureticTriamterene1-2 mg/kg/day3-4 mg/kg/day up to 300 mg/daybidExpert opinionNo
DiureticAmiloride0.4-0.625 mg/kg/day20 mg/dayqdExpert opinionNo
Peripheral α-antagonistDoxazosin1 mg/day4 mg/dayqdExpert opinionNo
Peripheral α-antagonistPrazosin0.05-0.1 mg/kg/ day0.5 mg/kg/daytidExpert opinionNo
Peripheral α-antagonistTerazosin1 mg/day20 mg/dayqdExpert opinionNo
VasodilatorHydralazine0.75 mg/kg/day7.5 mg/kg/day up to 200 mg/dayqidExpert opinionYes
VasodilatorMinoxidilChildren <12 y: 0.2 mg/kg/ day; children ≥ 12 y: 5 mg/dayChildren <12 y: 50 mg/day; children >12 y: 100 mg/dayqd-tidCase series, expert opinionYes
  • Reprinted with permission from US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report, pp 35–37. Available at: https://www.nhlbi.nih.gov/files/docs/peds_guidelines_sum.pdf. Accessed January 15, 2016.