TABLE 11.

Selected Antihypertensive Drugs for Children Who Have Chronic Renal Failure

DrugFormulationDose (oral)Adjustment in CRFEffect on Renin
DiureticsIncrease
    Hydrochlorothiazide25, 50, 100 mg tabs0.5 to 2.0 mg/kg per dose qd or bidThiazides not effective at GFR <30% of normal
    Hydrochlorothiazide50 mg/5 mL, 100 mg/mL
    Furosemide20, 40, 80 mg tabs; 10 mg/mL0.5 to 4.0 mg/kg per dose qd or bidNone
    Bumetanide0.5, 1, 2 mg tabs0.01 to 0.03 mg/dose qdUnknown
    Metolazone2.5, 5, 10 mg tabs; 0.1 mg/mL0.2 mg/kg per dose qd or bidUnknown
    Chlorthalidone25, 50 mg tabs25 to 50 mg qd in single doseNoneNone
    Chlorthiazide250, 500 mg tabs; 250 mg/ 5 mL suspension<6 mo: up to 30 mg/kg per day in bid dosage with maximum 375 mg/dDecrease or discontinueNone
2 to 12 y: 10 to 20 mg/kg per day with maximum 1 g/d in single or divided doses
Beta blockersDecrease
    Acebutolol200, 400 mg tabs200 to 800 mg qd (adults)Decrease dose
    Atenolol25, 50, 100 mg tabs50 to 100 mg (adults)Decrease 50% at GFR <50 mL/min/1.73 m2, give qid GFR <10 mL/min/1.73 m2
    Labetolol100, 200, 300 mg tabs50 to 100 mg bid (>10 y)None
    Metoprolol50, 100 mg tabs100 to 200 mg qd or bid (adults)None
    Propranolol10, 20, 50, 100 mg tabs; 20, 40, 80 mg/mL0.5 to 1.0 mg/dose bidNone
VasodilatorsIncrease
    Hydralazine10, 25, 50, 100 mg tabs; 0.2 mg/mL0.5 to 2.0 mg/kg per dose bid or qidNone
    Minoxidil2.5, 10 mg tabs0.1 to 0.5 mg/kg per dose bid to qdNone
Central sympatholyticDecrease
    Clonidine0.1, 0.2, 0.3 mg tabs or patch0.05 to 0.3 mg/dose bid or tidNone
    Methyldopa125, 250, 500 mg tabs10 mg/kg per day in 2 to 4 doses; maximum 65 mg/kg or 3 g dailyPatients may be sensitive to lower dosagesDecrease
Angiotensin-converting enzyme inhibitorsIncrease
    Captopril12.5, 25, 50, 100 mg tabs0.5–2.0 mg/kg per day bidCaution with all ACE when GFR <50 mL/min/1.73 m2
    Enalapril2.5, 5, 10, 20 mg tabs0.15 mg/kg per day bid
    Fosinopril10, 20 mg tabs5 to 20 mg qd (adults)
    Lisinopril2.5, 5, 10, 20, 40 mg tabs2.5 to 20 mg/day bid or qd (adults)
Calcium channel blockersNone
    Nifedipine10, 20 mg caps0.25 to 2.0 mg/kg per dose bid to qidMay need to limit dose
30, 60, 90 sustained releasesustained release qd or bid
    Diltiazem30, 60, 90, 120 tabs; 120, 180, 240, 300 mg caps0.4 to 1.25 mg/kg per dose qid; sustained release qd to bidUnknown
    Verapamil120, 180, 240 mg4 to 10 mg/kg per day tidWith caution
    Amlodipine2.5, 5, and 10 mg tabs2.5 mg qd 10 mg qd maximumNoneNone
    Nicardipine (cardene)20, 30 mg caps20 mg tidPatients should be closely monitoredSmall, temporary increase
    Isradipine2.5, 5 mg caps0.1 mg/kg per dose initially increase to maximum of 1.2 mg/kg per dayPatients should be closely monitoredSmall, temporary increase
  • Updated from Feld L, Lieberman E, Mendoza SA, Springate JE. Management of hypertension in the child with chronic renal disease. J Pediatr. 1996;129:S18–S26.