Dosing Antihypertensive Meds in Kids

Full update October 2017

In general, children three years and older should have their BP checked yearly (Canada: regularly).1,37 However, check BP at each visit (see footnote d) in kids who are obese or are taking meds that can increase blood pressure, have kidney disease or diabetes, or have a history of aortic arch obstruction or coarctation (AAP).1 Hypertension is diagnosed based on measurements on three or more occasions that are at the 95th percentile or higher for age, height, and sex, or 130/80 mmHg if 13 years or older.1,37 Tables used for this determination are included in the AAP guidelines at http://pediatrics.aappublications.org/content/pediatrics/early/2017/08/21/peds.2017-1904.full.pdf. Lifestyle interventions (e.g., eat five fruit/vegetable servings daily, get an hour of moderate to vigorous physical activity daily, avoid processed or fast food and sugary drinks) are generally indicated before starting antihypertensives, and BP should be checked again in six months.1 Antihypertensive indications include lifestyle modification failure, symptomatic hypertension; stage 2 hypertension (AAP: without modifiable contributor); target organ damage; or diabetes, kidney disease, or heart failure (Canada: even if BP only at 90th percentile).1,37 For patients <12 years of age, Canadian guidelines recommend referral to a pediatric hypertension specialist if pharmacologic treatment is indicated.37 First-line agents in kids include ACEIs, ARBs, and long-acting dihydropyridine calcium channel blockers.1,37 The goal BP is less than the 90th percentile (AAP: and <130/80 mmHg for ages 13 years and older).1,37 Add a second drug if needed (often a thiazide).1 This chart provides antihypertensive dosing, place in therapy, select side effects, liquid availability, and compounding information.

  1. Drugs on chart may not be approved by FDA or Health Canada for treating hypertension in children, or may be approved only for older children.
  2. Doses provided are from ref 1 unless otherwise noted. Doses may differ from product labeling. Do not exceed adult dose. *See additional footnotes after chart*

Abbreviations: AAP = American Academy of Pediatrics; ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin-receptor blocker; BID = twice daily; BP = blood pressure; GFR = glomerular filtration rate; LVH = left ventricular hypertrophy; TID = three times daily; QID = four times daily; QS = quantity sufficient.

Druga

Dosing1,b

Liquid availability; compounding information

Angiotensin-converting enzyme inhibitors: First-line agents.1,37 Preferred agents for kidney disease with proteinuria, or diabetes.1 Contraindicated in pregnancy.1 May cause hyperkalemia or acute kidney injury.1 Benazepril, enalapril, and lisinopril not recommended for children with GFR <30 mL/min/1.73 m2.2,5,6,23,24 Children of African ancestry may need a higher initial dose.1

Benazepril
(Lotensin, generics)

U.S.: approved for ages six years and older.2

Six years and older:
Initial: 0.2 mg/kg, up to 10 mg, once daily

Max: 0.6 mg/kg, up to 40 mg, once daily

Shake 15 Lotensin 20 mg tablets and 75 mL of Ora-Plus in an amber polyethylene terephthalate bottle for two minutes or more. Allow to stand at least one hour. Shake again one minute or more. Add 75 mL Ora-Sweet and shake again to disperse. Refrigerate at 2-8oC. Stable for up to 30 days. Shake before each use. Makes 150 mL of a 2 mg/mL suspension.2

Captopril
(Capoten, generics)

Initial, infants: 0.05 mg/kg/dose, given once daily to QID
Initial, children: 1.5 mg/kg/day, divided TID

Max: 6 mg/kg/day, divided TID or QID (note: usual max total daily adult dose 150 mg17,32)

Dissolve two 50 mg captopril tablets in water in a graduated cylinder, then add a 500 mg ascorbic acid tablet and allow it to dissolve. QS to 100 mL with distilled water. A sulfur odor is normal. Do not filter. Refrigerate at 4oC. Stable for 56 days. Shake before each use. Makes 100 mL of a 1 mg/mL oral solution.3,4

Enalapril
(Vasotec, generics; Epaned oral solution [U.S.])

U.S.: approved for ages one month of age and older.5 (Canada: six years and older23)

One month and older:
Initial: 0.08 mg/kg, up to 5 mg, once daily or divided BID

Max: 0.6 mg/kg, up to 40 mg, once daily or divided BID

U.S.: Epaned (1 mg/mL)

Shake ten enalapril 20 mg tablets and 50 mL of sodium citrate/citric acid solution in a polyethylene terephthalate bottle for two minutes or more. Allow to stand one hour. Shake for an additional minute, then add 150 mL of Ora-Sweet SF and shake to disperse. Refrigerate at 2-8oC. Stable for up to 30 days. Shake before each use. Makes 200 mL of a 1 mg/mL suspension.5

Fosinopril

U.S.: approved for kids 50 kg and over (due to lack of commercially available dosage strength for lighter children)1

Six years and older:
<50 kg: 0.1 mg/kg (up to 5 mg) once daily
50 kg and up, initial: 5 mg once daily

Max: 40 mg once daily

Not available.

Lisinopril
(Prinivil, Zestril, generics; Qbrelis oral solution [U.S.])

U.S. and Canada: approved for ages six years and older.6,24

Six years and older:
Initial: 0.07 mg/kg, up to 5 mg, once daily

Max: 0.6 mg/kg, up to 40 mg, once daily

U.S.: Qbrelis (1 mg/mL)

Shake ten Prinivil 20 mg tablets with 10 mL of purified water in a polyethylene terephthalate bottle for at least one minute. Add 30 mL of sodium citrate/citric acid solution and 160 mL of Ora-Sweet SF and shake gently to disperse. Store at or below 25oC. Stable for four weeks. Shake before each use. Makes 200 mL of a 1 mg/mL suspension.6

Crushed tablets may be reasonably palatable.27

Quinapril
(Accupril, generics)

Initial: 5 mg once dailyc

Max: 80 mg once dailyc

(Adult doses. Consider for older/heavier children and adolescents.)

Crush and dissolve one K-Phos Neutral tablet in 100 mL of sterile water for irrigation. Add 30 mL of this solution to ten Accupril 20 mg tablets in a polyethylene terephthalate bottle. Shake for two minutes or more. Remove cap and let stand for 15 minutes. Shake for one minute. Add 30 mL of sodium citrate/citric acid solution and shake for two minutes. Add 140 mL of Ora-Sweet SF and shake to disperse. Refrigerate at 2-8oC. Stable for up to 28 days. Shake before each use. Makes 200 mL of a 1 mg/mL suspension.28

Ramipril (Altace, generics)

Initial: 1.6 mg/m2 once daily

Max: 6 mg/m2 once daily
(Ages studied=3 to 18 years)29

Can add capsule contents to 120 mL (4 ounces) of applesauce, water, or apple juice. Stable for 24 hours at room temperature or 48 hours in the refrigerator.33

Angiotensin-Receptor Blockers: Preferred agents for kidney disease with proteinuria, or diabetes.1 Contraindicated in pregnancy.1 May cause hyperkalemia or acute kidney injury.1 Losartan not recommended in children with GFR <30 mL/min/1.73 m2.8,9

Candesartan
(Atacand, generics)

U.S.: approved for ages one year and older31 (Canada: six years and older34)

Ages 1 to 5 years:
Initial: 0.02 mg/kg, up to 4 mg, once daily or divided BID

Max: 0.4 mg/kg, up to 16 mg, once daily or divided

6 years and older:

Initial: 4 mg once daily or divided BID (<50kg) or 8 mg once daily or divided BID (50 kg and up)

Max: 16 mg once daily or divided BID (<50 kg) or 32 mg once daily or divided BID (50 kg and up)

Make the vehicle by combining 80 mL Ora-Plus and 80 mL Ora-Sweet SF, or use 160 mL of Ora-Blend SF as the vehicle. Add a small amount of vehicle to five Atacand 32 mg tablets in a mortar and grind to a smooth paste. Add paste to amber polyethylene terephthalate bottle. Rinse remaining paste from mortar using vehicle. Repeat if needed, and add remaining vehicle to bottle. Shake well. Stable at room temperature below 30oC for 100 days, but once opened, must use or discard within 30 days. Shake well before each use. Makes 160 mL of a 1 mg/mL suspension. (Number/strength of tablets and vehicle volume can be adjusted to make concentrations within the range of 0.1 to 2 mg/mL.)31

Irbesartan
(Avapro, generics )

Ages 6 to 12 years:
Initial: 75 mg once daily

Max: 150 mg once daily

13 years and older:
Initial: 150 mg once daily

Max: 300 mg once daily

Capsule can be opened and contents sprinkled on applesauce prior to administration.7

Losartan
(Cozaar, generics)

U.S. and Canada: approved for ages six years and older8,9

Six years and older
Initial: 0.7 mg/kg, up to 50 mg, once daily

Max: 1.4 mg/kg, up to 100 mg, once daily

Shake ten Cozaar 50 mg tablets with 10 mL purified water in a polyethylene terephthalate bottle for two minutes or more. Allow to stand one hour. Shake for an additional minute to disperse. In a separate container, make a 50:50 mixture of Ora-Plus and Ora-Sweet SF. Add 190 mL of this mixture to the bottle and shake for one minute to disperse. Refrigerate at 2-8oC. Stable for four weeks. Shake before each use. Makes 200 mL of a 2.5 mg/mL suspension.8

Olmesartan
(Benicar [U.S.], Olmetec [Canada], generics)

U.S. and Canada: approved for ages six years and older25,26

Six years and older
Initial
: 10 mg once daily (<35 kg) or 20 mg once daily (35 kg and up)

Max: 20 mg once daily

(<35 kg) or 40 mg once daily (35 kg and up)

Add 50 mL of purified water to twenty olmesartan 20 mg tablets in a polyethylene terephthalate bottle. Allow to stand for at least five minutes. Shake for one minute or longer. Allow to stand for at least one minute. Repeat shaking/standing four more times. Add 100 mL of Ora-Sweet and 50 mL of Ora-Plus. Shake well for at least one minute. Refrigerate at 2-8oC. Stable for four weeks. Shake before each use. Makes 200 mL of a 2 mg/mL suspension.25

Valsartan (Diovan, generics)

U.S.: approved for ages six years and older30

Six years and older
Initial
: 1.3 mg/kg, up to 40 mg, once daily

Max: 2.7 mg/kg, up to 160 mg, once daily

Add 80 mL of Ora-Plus to eight Diovan 80 mg tablets in an amber glass bottle. Shake for two minutes or more. Allow to stand at least one hour. Shake for at least one minute. Add 80 mL Ora-Sweet SF and shake for at least 10 seconds to disperse. Stable for 30 days at room temperature below 30oC, or 75 days refrigerated at 2-8oC. Shake for at least 10 seconds before each use. Makes 160 mL of a 4 mg/mL suspension.30

Alpha agonist (central): Can cause dry mouth or sedation. Third-line agent.1

Clonidine (oral)

12 years and older36

Initial: 0.1 mg BID

Max: 1.2 mg BID

Crush 30 clonidine 0.2 mg tablets to a fine powder with a glass mortar and pestle. Add 2 mL purified water slowly and triturate to make a paste. Add 15 mL simple syrup with trituration, and pour into an amber glass bottle. Rinse mortar with another 15 mL of vehicle. Repeat as necessary and QS to 60 mL. Store at 4oC. Stable for 28 days. Shake before each use. Makes 60 mL of a 0.1 mg/mL suspension.10

Transdermal patch available.

Alpha Blockers (peripheral): Caution regarding dizziness and fainting, especially with first dose, post-exercise, or in volume-depleted patients.35 Third-line agents.1

Doxazosin
(Cardura, generics)

Initial: 1 mg once daily36

Max: 4 mg once daily36

(Adult doses. Consider for older/heavier children and adolescents.)

Not available.

Prazosin
(Minipress, generics)

Initial: 0.05 to 0.1 mg/kg/day, divided TID36

Max: 0.5 mg/kg/day (up to 15 mg) divided TID35,36

Not available.

Terazosin
(Hytrin, generics)

Initial: 1 mg once daily36

Max: 20 mg once daily36

(Adult doses. Consider for older/heavier children and adolescents.)

Not available.

Alpha/Beta-Blockers: Relatively contraindicated in asthma or overt heart failure.1 May cause bradycardia and impair athletic performance.37 May cause insulin resistance and new onset diabetes.37 May mask hypoglycemia in children with diabetes.37 Third-line.1

Labetalol
(Trandate, generics)

Initial: 1 to 3 mg/kg/day, divided BID35

Max: 10 to 12 mg/kg/day, up to 1,200 mg, divided BID35

Pulverize 16 labetalol 300 mg tablets to a fine powder with a mortar and pestle. Add 20 mL of vehicle (cherry syrup, Ora-Sweet:Ora Plus [50:50], or Ora-Sweet SF:Ora Plus [50:50]) and mix to a uniform paste. Add vehicle geometrically to almost 120 mL. Pour into a calibrated bottle and QS with vehicle to 120 mL. Dispense in amber polyethylene terephthalate bottle. Store at 5-25oC. Protect from light. Stable for 60 days. Shake well before each use. Makes 120 mL of a 40 mg/mL product.11

Beta-Blockers: Not as well-studied in children as ACEIs and ARBs.37 May cause bradycardia and impair athletic performance.37 May cause insulin resistance and new onset diabetes.37 May mask hypoglycemia in children with diabetes.37 Not first-line due to side effect profile and lack of improved outcomes compared to other antihypertensives in studies in adults.1,37

Atenolol
(Tenormin, generics)

Initial: 0.5 to 1 mg/kg once daily or divided BID36

Max: 2 mg/kg, up to 100 mg, once daily or divided BID36

Pulverize four atenolol 50 mg tablets with a mortar and pestle. Levigate with glycerin to a uniform paste. Add vehicle (Ora-Sweet SF) geometrically almost to 100 mL. Transfer to amber bottle. Rinse mortar with more vehicle. QS to 100 mL. Refrigerate. Stable 90 days. Shake well. Makes a 100 mL of a 2 mg/mL suspension.12

Bisoprolol/hydrochlorothiazide
(Ziac [U.S. only])

Initial: 2.5 mg/6.25 mg once daily36

Max: 10 mg/6.25 mg once daily36

(Ages studied=6 to 17 years)20

Not available. Crushed tablets may be less palatable than crushed chlorthalidone, hydrochlorothiazide, or lisinopril.27

Metoprolol succinate

U.S.: approved for ages six years and older38

Six years and older
Initial
: 1 mg/kg, up to 50 mg, once daily38

Max: 2 mg/kg, up to 200 mg, once daily38

Not applicable (extended-release formulation).

Metoprolol tartrate

Initial: 1 to 2 mg/kg/day, divided BID35

Max: 6 mg/kg/day, up to 200 mg, divided BID35

Pulverize 12 metoprolol tartrate 100 mg tablets to a fine powder with a mortar and pestle. Add 20 mL of the vehicle (cherry syrup, Ora-Sweet:Ora Plus [50:50], or Ora-Sweet SF:Ora Plus [50:50]) and mix to a uniform paste. Add vehicle geometrically to almost 120 mL. Pour into a calibrated bottle and QS with vehicle to 120 mL. Dispense in amber polyethylene terephthalate bottle. Store at 5-25oC. Protect from light. Stability is 60 days. Shake well before each use. Makes 120 mL of a 10 mg/mL suspension.11

Propranolol

Initial: 1 to 2 mg/kg/day, divided BID or TID36 (sustained-release formulation dosed once daily)

Max: 4 mg/kg/day, up to 640 mg, divided BID or TID36 (sustained-release formulation dosed once daily)

Oral solution (U.S. only): 4mg/mL, 8 mg/mL

Calcium Channel Blockers (long-acting dihydropyridine): First-line agents.1,37 Side effects include flushing, peripheral edema, and dizziness.1 May be a good choice in diabetes or metabolic syndrome because they improve insulin sensitivity.18 Amlodipine has the most pediatric data.19

Amlodipine
(Norvasc, generics)

U.S.: approved for ages six years and older39

Ages one to five years
Initial:
0.1 mg/kg once daily

Max: 0.6 mg/kg, up to 5 mg, once daily

Six years and older
Initial
: 2.5 mg once daily

Max: 10 mg once daily

Pulverize 50 amlodipine 5 mg tablets to a fine powder with a mortar and pestle. Add vehicle (Ora-Sweet:Ora Plus [50:50]) to a total volume of 250 mL per usual compounding techniques. Dispense in an amber plastic bottle. Store refrigerated at 4oC. Stable for 91 days. Stable 56 days at 25oC. Shake well before each use. Makes 250 mL of a 1 mg/mL suspension.13

Felodipine
(Plendil, Renedil [Canada], generics)

Six years and older
Initial
: 2.5 mg once daily

Max: 10 mg once daily

(Ages studied=6 to 12 years old)21

Not applicable (extended-release formulation).

Isradipine
(generics, Dynacirc ER [U.S. only])

Initial: 0.05 to 0.1 mg/kg/day, divided BID or TID (once daily for sustained-release formulation)

Max: 0.6 mg/kg/day, up to 10 mg, divided BID or TID or QID (once daily for sustained-release formulation)

Open ten isradipine 5 mg immediate-release capsules into a glass mortar. Triturate with glycerin to make a fine paste. Add 15 mL simple syrup and triturate. Transfer to a 60 mL amber glass bottle. Rinse the mortar with 10 mL of simple syrup and pour into amber glass bottle. Repeat. QS to 50 mL with simple syrup. Refrigerate at 4oC. Stable for 35 days. Shake well before each use. Makes 50 mL of a 1 mg/mL suspension.14

Nifedipine extended-release
(Procardia XL, Adalat CC, Adalat XL [Canada], generics)

Initial: 0.2 to 0.5 mg/kg once daily or divided BID

Max: 3 mg/kg, up to 120 mg, once daily or divided BID

Not applicable (extended-release formulation).

Diuretics: Consider thiazide as an add-on.1 Other diuretics are third-line agents.1 Diuretics can cause electrolyte disturbances or dehydration, especially with illness (even minor).37 Check electrolytes at each visit.1

Amiloride

Initial: 0.4 to 0.625 mg/kg once daily36

Max: 20 mg once daily36

Not available.

Chlorothiazide (U.S.)

U.S.: approved for infants and children40

Initial: 10 mg/kg once daily or divided BID

Max: 20 mg/kg, up to 375 mg, once daily or divided BID

250 mg/5 mL suspension available (Diuril U.S.)

Chlorthalidone

Initial: 0.3 mg/kg once daily

Max: 2 mg/kg, up to 50 mg, once daily

Not available. Crushed tablets may be reasonably palatable.27

Furosemide

Initial: 0.5 to 2 mg/kg/dose, given once daily or BID

Max: 6 mg/kg once daily or divided BID (note: usual adult dose 40 mg BID41)

Oral solution: 8 mg/mL (U.S. only) and 10 mg/mL.

Hydrochlorothiazide

U.S. and Canada: approved for use in infants and children42,44

Initial: 1 mg/kg once daily or divided BID

Max: 2 mg/kg, up to 37.5 mg, once daily or divided BID

Crush ten hydrochlorothiazide 50 mg tablets in a glass mortar. Triturate to a fine powder. Wet the powder with the vehicle (Ora-Blend or 1:1 mixture of Ora-Plus/Ora-Sweet) and levigate to make a paste. Add vehicle via geometric dilution. Transfer to a graduated cylinder, rinsing the mortar with vehicle, then QS to 100 mL. Dispense in an amber glass bottle. Store at room temperature. Stable for 60 days. Shake well before each use. Makes 100 mL of a 5 mg/mL suspension.43

Crushed tablets may be reasonably palatable.27

Spironolactone

Initial: 1 mg/kg once daily or divided BID36

Max: 3.3 mg/kg, up to 100 mg, once daily or divided BID36

Pulverize 24 spironolactone 25 mg tablets to a fine powder in a glass mortar. Triturate with 12 mL of purified water to form paste. Add 76 mL cherry syrup, triturate, and pour into a stainless steel container. Repeat twice. Homogenize 10 min with laboratory mixer on medium speed. Transfer to amber glass bottle while stirring. Store in refrigerator. Stable for 28 days. Shake well before each use. Makes 120 mL of a 5 mg/mL suspension.15

Triamterene

Initial: 1 to 2 mg/kg/day, divided BID36

Max: 3 to 4 mg/kg/day, up to 300 mg, divided BID36

Not available.

Vasodilators: Third-line.1

Hydralazine

U.S.: approved for use in pediatric patients45

Initial: 0.75 mg/kg/day, divided QID

Max: 7.5 mg/kg/day, up to 200 mg, divided QID

Extemporaneously prepared hydralazine oral liquid dosage forms have limited stability. Consider pulverizing the tablets and dispensing as powders for caregiver to mix with one teaspoon of vehicle prior to administration of each dose.16

Minoxidil

U.S.: approved for use in pediatric patients46

Age <12 years:36
Initial
: 0.2 mg/kg once daily or divided BID or TID

Max: 50 mg once daily or divided BID or TID

12 years and older:36
Initial
: 5 mg once daily or divided BID or TID

Max: 100 mg once daily or divided BID or TID

Not available.

  1. Quinapril 0.2 mg/kg/day in children 2.5 months to 6.8 years is pharmacokinetically similar to 10 mg in adults (10 mg to 20 mg is usual starting dose in adults not taking diuretics).22
  2. Use an appropriately sized cuff: the cuff bladder length should be 80% to 100% of the arm circumference. The width should be at least 40% of the arm circumference.1

Project Leader in preparation of this clinical resource (331006): Melanie Cupp, Pharm.D., BCPS

References

  1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guidelines for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904.
  2. Product information for Lotensin. Validus Pharmaceuticals LLC. Parsippany, NJ 07054. August 2017.
  3. Nahata MC, Morosco RS, Hipple TF. Stability of captopril in three liquid dosage forms. Am J Hosp Pharm 1994;51:95-6.
  4. Nahata MC, Morosco RS, Hipple TF. Stability of captopril in liquid containing ascorbic acid or sodium ascorbate. Am J Hosp Pharm 1994;51:1707-8.
  5. Product information for Vasotec. Valeant Pharmaceuticals North America LLC. Bridgewater, NJ 08807. July 2017.
  6. Product information for Prinivil. Merck & Co., Inc. Whitehouse Station, NJ 08889. October 2016.
  7. Sakarcan A, Tenney F, Wilson JT, et al. The pharmacokinetics of irbesartan in hypertensive children and adolescents. J Clin Pharmacol 2001;41:742-9.
  8. Product information for Cozaar. Merck & Co., Inc. Whitehouse Station, NJ 08889. December 2015.
  9. Product monograph for Cozaar. Merck Canada Inc. Kirkland, Quebec H9H 4M7. March 2013.
  10. Levinson ML, Johnson CE. Stability of an extemporaneously compounded clonidine hydrochloride oral liquid. Am J Hosp Pharm 1992;49:122-5.
  11. Allen LV Jr., Erickson MA 3rd. Stability of Labetalol hydrochloride, metoprolol tartrate, verapamil hydrochloride, and spironolactone with hydrochlorothiazide in extemporaneously compounded oral liquids. Am J Health Syst Pharm 1996;53:2304-9.
  12. Patel D, Doshi DH, Desai A. Short-term stability of atenolol in oral liquid formulations. Int J Pharm Compd 1997;1:437-9,442.
  13. Nahata MC, Morosco RS, Hipple TF. Stability of amlodipine besylate in two liquid dosage forms. J Am Pharm Assoc 1999;39:375-7.
  14. MacDonald JL, Johnson CE, Jacobson P. Stability of isradipine in extemporaneously compounded oral liquid. Am J Hosp Pharm 1994;51:2409-11.
  15. Mathur LK, Wickman A. Stability of extemporaneously compounded spironolactone suspensions. Am J Hosp Pharm 1989;46:2040-2.
  16. Allen LV, Erickson MA. Stability of extemporaneously prepared pediatric formulations using Ora-Plus with Ora-Sweet and Ora-Sweet SF-part III. Secundum Artem Vol. 6., No. 2. https://www.perrigo.com/business/pdfs/Sec%20Artem%206.2.pdf. (Accessed August 30, 2017).
  17. Product information for captopril. Sandoz, Inc. Princeton, NJ 08540. May 2016.
  18. Puri M, Flynn JT. Management of hypertension in children and adolescents with the metabolic syndrome. J Cardiometab Syndr 2006;1:259-68.
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  20. Sorof JM, Cargo P, Graepel J, et al. Beta-blocker/thiazide combination for treatment of hypertensive children: a randomized, double-blind, placebo-controlled trial. Pediatr Nephrol 2002;17:345-50.
  21. Trachtman H, Frank R, Mahan JD, et al. Clinical trial of extended-release felodipine in pediatric essential hypertension. Pediatr Neprhol 2003;18:548-53.
  22. Blumer JL, Daniels SR, Dreyer WJ, et al. Pharmacokinetics of quinapril in children: assessment during substitution for chronic angiotensin-converting enzyme inhibitor treatment. J Clin Pharmacol 2003;43:128-32.
  23. Product monograph for Vasotec. Merck Canada, Inc. Kirkland, QC H9H 4M7. March 2017.
  24. Product monograph for Prinivil. Merck Canada, Inc. Kirkland, QC H9H 4M7. August 2016.
  25. Product information for Benicar. Daiichi Sankyo, Inc. Parsippany, NJ 07054. November 2016.
  26. Product monograph for Olmetec. Merck Canada, Inc. Kirkland, QC H9H 4M7. December 2016.
  27. Zgraggen L, Fare PB, Lava SA, et al. Palatability of crushed beta-blockers, converting enzyme inhibitor and thiazides. J Clin Pharm Ther 2012;37:544-46.
  28. Freed AL, Silbering SB, Kolodsick KJ, et al. The development and stability assessment of extemporaneous pediatric formulations of Accupril. Int J Pharm 2005;304:135-44.
  29. Meyers RS, Siu A. Pharmacotherapy review of chronic pediatric hypertension. Clin Ther 2011;33:1331-56.
  30. Product information for Diovan. Novartis Pharmaceuticals Corp. East Hanover, NJ 07936. February 2017.
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  32. Product monograph for Apo-capto. Apotex, Inc. Weston, ON M9L 1T9. November 2013.
  33. Product information for Altace. Pfizer, Inc. New York, NY 10017. April 2017.
  34. Product monograph for Atacand. AstraZeneca Canada, Inc. Mississauga, ON L4Y 1M4. February 2016.
  35. Clinical Pharmacology [database online]. Tampa, FL: Gold Standard, Inc; 2017. http://www.clinicalpharmacology.com. (Accessed August 29, 2017).
  36. Rao G. Diagnosis, epidemiology, and management of hypertension in children. Pediatrics 2016;138:e20153616.
  37. Dionne JM, Harris KC, Benoit G, et al. Hypertension Canada’s 2017 guidelines for the diagnosis, assessment, prevention, and treatment of pediatric hypertension. Can J Cardiol 2017;33:577-85.
  38. Product information for Toprol XL. AstraZeneca Pharmaceuticals LP. Wilmington, DE 19850. June 2016.
  39. Product information for Norvasc. Pfizer, Inc. New York, NY 10017. March 2017.
  40. Product information for Diuril. Salix Pharmaceuticals. Bridgewater, NJ 08807. June 2016.
  41. Product monograph for furosemide. Sanis Health, Inc. Dieppe, NB E1A 1P2. March 2015.
  42. Product information. Hydrochlorothiazide. Heritage Pharmaceuticals, Inc. Eatontown, NJ 07724. September 2016.
  43. Nationwide Children’s. Hydrochlorothiazide oral suspension. March 2, 2010. www.nationwidechildrens.org/Document/Get/78799. (Accessed August 30, 2017).
  44. Product monograph. Mint-hydrochlorothiazide. Mint Pharmaceuticals, Inc. Mississauga, ON L5T 1J6. June 2014.
  45. Product information for hydralazine. Nivagen Pharmaceuticals, Inc. Sacramento, CA 95827. August 2016.
  46. Product information for minoxidil. Actavis Pharma, Inc. Parsippany, NJ 07054. March 2016.

Cite this document as follows: Clinical Resource, Dosing Antihypertensive Meds in Kids. Pharmacist’s Letter/Prescriber’s Letter. October 2017.

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