From the Guidelines
For a patient who is NPO and on losartan, Imdur (isosorbide mononitrate), and hydralazine, I recommend replacing losartan with IV nicardipine or clevidipine, Imdur with IV nitroglycerin, and continuing hydralazine as an IV formulation. The patient's current medications can be converted to IV alternatives as follows:
- Losartan can be replaced with IV nicardipine, starting at 5 mg/h and increasing every 5 min by 2.5 mg/h to a maximum of 15 mg/h, or IV clevidipine, starting at 1-2 mg/h and doubling every 90 s until BP approaches target, then increasing by less than double every 5-10 min, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
- Imdur can be replaced with IV nitroglycerin, starting at 5 mcg/min and increasing in increments of 5 mcg/min every 3-5 min to a maximum of 20 mcg/min, as outlined in the same guideline 1.
- Hydralazine can be continued as an IV formulation, with an initial dose of 10 mg via slow IV infusion (maximum initial dose 20 mg) and repeated every 4-6 h as needed, according to the guideline 1. These IV alternatives should be adjusted based on the patient's blood pressure response, and their effects should be closely monitored due to their immediate onset and potential for more rapid changes in blood pressure compared to oral medications.
From the FDA Drug Label
When there is urgent need, therapy in the hospitalized patient may be initiated intramuscularly or as a rapid intravenous bolus injection directly into the vein. The usual dose is 20 to 40 mg, repeated as necessary The IV version of hydralazine can be given as a 20 to 40 mg dose, repeated as necessary, to help match the oral schedule, in an NPO patient 2.
- Losartan and Imdur do not have direct IV alternatives mentioned in the provided information.
- Hydralazine can be administered intravenously when the oral form cannot be given.
From the Research
Medication Options for NPO Patient
The patient is currently taking losartan, imdur, and hydralazine, and is NPO (nothing by mouth). To match their current medication regimen, the following IV options can be considered:
- Losartan is an angiotensin II receptor antagonist, and there is no direct IV equivalent. However, studies have shown that losartan is effective in treating hypertension and heart failure 3, 4, 5.
- Imdur is an oral medication, and its IV equivalent is not directly available. However, the medication contains isosorbide mononitrate, which can be administered intravenously in the form of isosorbide dinitrate.
- Hydralazine can be administered intravenously, and is often used to treat severe hypertension.
Administration Considerations
When administering these medications intravenously, it is essential to consider the patient's individual needs and medical history. The patient's NPO status should be taken into account, and the medications should be administered according to the patient's specific requirements.
- The 2021 Infusion Therapy Standards of Practice Updates provide guidance on infusion therapy, including medication administration and patient care 6.
- Studies have shown that losartan and other angiotensin II receptor antagonists can be effective in treating hypertension and heart failure, and may have benefits in terms of reducing mortality and morbidity 3, 4, 5, 7.