Usual Adult Dose for Hypertension

Initial dose: 1 to 2 mg/hour IV infusion

Dose titration: Dose may be doubled at short (90 second) intervals initially. As blood pressure approaches goal, dose increases should be less than doubling and intervals between dose adjustments should increase to every 5 to 10 minutes. An increase of approximately 1 to 2 mg/hour generally produces an additional 2 to 4 mmHg decrease in systolic pressure.

Maintenance dose: The desired therapeutic response for most patients occurs at doses of 4 to 6 mg/hour. Patients with severe hypertension may require doses up to 32 mg/hour.

Maximum dose: Most patients were treated with maximum doses of 16 mg/hour or less; however, there is limited short-term experience with doses up to 32 mg/hour. Due to lipid load restrictions, no more than 1000 mL (or an average of 21 mg/hour) is recommended per 24-hour period.

Duration of therapy: There is little experience with infusion durations beyond 72 hours at any dose.

Transition to an oral antihypertensive agent: Discontinue this drug or titrate downward while appropriate oral treatment is established.

Use: Reduction of blood pressure when oral treatment is not feasible or not desirable.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

No adjustment recommended.

Precautions

CONTRAINDICATIONS:

• Allergy to soybeans, soy products, eggs, or egg products
• Defective lipid metabolism (e.g., pathologic hyperlipemia, lipoid nephrosis, or acute pancreatitis if it is accompanied by hyperlipidemia)
• Severe aortic stenosis

Dialysis

Data not available

Other Comments

Administration advice:

• Use an infusion device that allows for calibrated infusion rates.
• Commercially-available standard plastic cannulae may be used.
• Administer via a central or peripheral line.

• Refrigerate at 2C to 8C (36F to 46F). Do not freeze.
• Vials in cartons may be transferred to 25C (77F) for a period not to exceed 2 months. Do not return to refrigeration after beginning room temperature storage.
• Protect from light.
• Discard any unused product within 12 hours of stopper puncture.

• Do not dilute.
• Invert vial gently several times before use to ensure uniformity.

• Do not administer in the same line as other medications.
• May be administered with the following: Water for Injection, USP; Sodium Chloride (0.9%) Injection, USP; Dextrose (5%) Injection, USP; Dextrose (5%) in Sodium Chloride (0.9%) Injection, USP; Dextrose (5%) in Ringer's Lactate Injection, USP; Lactated Ringer's Injection, USP; 10% amino acid.

• Cardiovascular: Blood pressure and heart rate (continuously during infusion and until vital signs stabilize; for patients who receive prolonged infusions and are not transitioned to other antihypertensive agents, monitor for at least 8 hours post-infusion for the possibility of rebound hypertension)