Cardiovascular Critical Care II

Medication

Usual Dosing Range

Onset

Duration

Preload

Afterload

Cardiac

Output

Nitroprusside

IV 0.25–10 mcg/kg/min

Titrate by 0.1–0.2 mcg/kg/min q5

min

Seconds

1–2 min

↓

↓↓

↑­

Hydralazine

IV bolus: 10–20 mg q30 min PRN

IV: 10 min

IV: 1–4 hr

↔

↓

­↑

Nicardipine

IV 5–15 mg/hr

Titrate by 2.5 mg/hr

q5–10 min

5–10 min

2–6 hr

↔

↓

­↑

Clevidipine

IV 1–6 mg/hr

Titrate by 1–2 mg/hr q90s or consider

doubling the dose every 90 seconds

Consider max 21 mg/hr averaged over

24 hr

1–4 min

5–15 min

↔

↓

­↑

Nitroglycerin

IV 5–200 mcg/min

Titrate by 5–25 mcg/min q5–10 min

2–5 min

5–10 min

↓↓

↓↔

↔­↑

Esmolol

IV 25–300 mcg/kg/min

(bolus of 500 mcg/kg, not often

required given short onset)

Titrate by 25 mcg/kg/min

q3–5 min

1–2 min

10–20 min

↔

↔

↓

Metoprolol

IV bolus: 5–15 mg q5–15 min PRN

5–20 min

2–6 hr

↔

↔

↓

Labetalol

IV bolus: 20 mg, may repeat

escalating doses of 20–80 mg q5–10

min PRN

IV 1–2 mg/min

Titrate by 1–2 mg/min q2 hr given

longer half-life

2–5 min,

peak 5–15

min

2–6 hr

↔

↓

↓

Enalaprilat

IV bolus: 1.25 mg q6 hr

Titrate no more than q12–24 hr; max

dose 5 mg q6 hr

15–30 min

12–24 hr

↓

↓

­↑

Phentolamine

IV bolus: 1–5 mg PRN

Seconds

15 min

↔

↓

­↑

Fenoldopam

IV 0.03–1.6 mcg/kg/min

Titrate by 0.05–1 mcg/kg/min q15 min

10–15 min

10–15 min

↔↓

↓

↑­

IM = intramuscular; IV = intravenous; PRN = as needed.