| Drug | Dose (IV) | Onset / Duration | Preferred For | Avoid If |
|---|---|---|---|---|
| Labetalol α+β blocker |
20 mg IV bolus q10min or 0.5–2 mg/min infusion |
5 min / 3–6 h | HTN encephalopathy, ACS, aortic dissection, eclampsia | Acute HF, asthma, bradycardia, AV block |
| Nicardipine CCB (DHP) |
5 mg/h; titrate 2.5 mg/h q5–15min max 15 mg/h |
5–10 min / 1–4 h | Stroke, SAH, post-op HTN, AKI, eclampsia | Acute HF with decompensation |
| Clevidipine CCB (ultra-short) |
1–2 mg/h; double q90sec max 32 mg/h |
2–4 min / 5–15 min | Perioperative, ICU, rapid titration needed | Egg/soy allergy, lipid metabolism disorders |
| Hydralazine Direct vasodilator |
10–20 mg IV over 20 min repeat q4–6h PRN |
10–30 min / 3–8 h | Eclampsia, pregnancy-related HTN | Aortic dissection, ischemic heart disease |
| Sodium Nitroprusside Vasodilator |
0.25–0.5 mcg/kg/min max 10 mcg/kg/min (short-term) |
Seconds / 1–2 min | Hypertensive crisis — most potent, immediate effect | Renal/hepatic failure (cyanide toxicity), ↑ICP, pregnancy |
| Esmolol β-1 blocker |
500 mcg/kg bolus → 50–300 mcg/kg/min | 1–2 min / 10–20 min | Aortic dissection (with nitroprusside), periop tachycardia | Asthma, bradycardia, heart block, decompensated HF |
| Phentolamine α-blocker |
2.5–5 mg IV bolus q5–15min or 0.5–1 mg/min infusion |
1–2 min / 10–15 min | Pheochromocytoma crisis, cocaine-induced HTN | Renal failure, coronary artery disease |