From the Guidelines
For patients receiving intravenous methylprednisolone, nicardipine is a suitable antihypertensive medication due to its effectiveness in controlling blood pressure without significant interactions with corticosteroids, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1. When considering antihypertensive therapy in patients on IV methylprednisolone, it's essential to choose medications that do not interact significantly with corticosteroids.
- Calcium channel blockers, such as nicardipine, are preferred first-line options because they effectively control blood pressure without major interactions with corticosteroids.
- The usual dose range for nicardipine is an initial 5 mg/h, increasing every 5 min by 2.5 mg/h to a maximum of 15 mg/h, as outlined in the guideline 1.
- Other options like ACE inhibitors (e.g., enalaprilat) or vasodilators (e.g., sodium nitroprusside) may also be considered, but their use should be tailored to the individual patient's condition and potential side effects, as noted in the guideline 1.
- It's crucial to monitor blood pressure regularly during IV methylprednisolone therapy and adjust the antihypertensive regimen as needed to prevent steroid-induced hypertension, which can occur due to mineralocorticoid effects causing sodium and water retention.
- The choice of antihypertensive medication should prioritize minimizing potential interactions with methylprednisolone and managing the patient's overall condition, including any comorbidities or risk factors, as emphasized in the guideline 1.
From the FDA Drug Label
7 DRUG INTERACTIONS 7.1 Antihypertensive Agents
- No information is provided about interactions with methylprednisolone. The FDA drug label does not answer the question.
From the Research
Antihypertensive Medication Options
When considering antihypertensive medication for a patient receiving intravenous (IV) methylprednisolone (Solumedrol), several options are available:
- Labetalol: a rapid-acting intravenous antihypertensive agent 2
- Esmolol: a rapid-acting intravenous antihypertensive agent 2
- Fenoldopam: a rapid-acting intravenous antihypertensive agent 2
- Nicardipine: a dihydropyridine calcium channel blocker that provides unique benefits for blood pressure control 3
- Clevidipine: a dihydropyridine calcium channel blocker that may hold considerable advantages in the management of hypertensive crises 2, 3
Considerations for Selection
The choice of antihypertensive medication should be based on the individual patient's needs and diseases, the potential for adverse events, the monitoring required, drug costs, and the expected duration of therapy 4. Additionally, the patient's clinical presentation and the presence of any end-organ damage should be taken into account 2.
Suitable Options
Nicardipine and clevidipine are both suitable options for blood pressure control in hypertensive crises 3. Nicardipine has been shown to achieve a systolic blood pressure (SBP) goal of <160 mm Hg at 2-6 h significantly more often than clevidipine 3. Labetalol is also a suitable option, as it is a rapid-acting intravenous antihypertensive agent 2.
Avoiding Certain Medications
Sodium nitroprusside, nifedipine, nitroglycerin, and hydralazine should not be considered first-line therapies in the management of hypertensive crises due to their significant toxicities and/or adverse effects 2.