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.