Table 2.

Intravenous antihypertensive agents for acute intracerebral hemorrhage

Drug	Mechanism	Dose	Cautions
Labetalol	Alpha-1, beta-1, beta-2 receptor antagonist	20–80 mg bolus every 10 minutes, up to 300 mg; 0.5 to 2.0 mg/minute infusion	Bradycardia, congestive heart failure, bronchospasm, hypotension
Esmolol	Beta-1 receptor antagonist	0.5 mg/kg bolus; 50 to 300 μg/kg/minute	Bradycardia, congestive heart failure, bronchospasm
Nicardipine	L-type calcium channel blocker (dihydropyridine)	5 to 15 mg/h infusion	Severe aortic stenosis, myocardial ischemia, hypotension
Enalaprilat	ACE inhibitor	0.625 mg bolus; 1.25 to 5 mg every 6 h	Variable response, precipitous fall in blood pressure with high-renin states
Fenoldopam	Dopamine-1 receptor agonist	0.1 to 0.3 μg/kg/minute	Tachycardia, headache, nausea, flushing, glaucoma, portal hypertension
Nitroprusside*	Nitrovasodilator (arterial and venous)	0.25 to 10 μg/kg/minute	Increased intracranial pressure, variable response, myocardial ischemia, thiocyanate and cyanide toxicity, hypotension

*Nitroprusside is not recommended for use in acute intracerebral hemorrhage because of its tendency to increase intracranial pressure. Modified with permission from Mayer SA, Rincon F: Management of intracerebral hemorrhage. Lancet Neurol 2005, 4: 662–672. ACE, angiotensin-converting enzyme.