What is the appropriate dosage of Totilac (generic name) for a 60‑year‑old male weighing 80 kg with acute intracerebral hemorrhage secondary to severe hypertension?

Totilac Dosing in Intracerebral Hemorrhage

I cannot provide a dosage recommendation for "Totilac" in this clinical scenario because no medication by this name exists in the provided evidence or in standard medical references for treating intracerebral hemorrhage. 1, 2, 3

Critical Management Priorities for This Patient

This 60-year-old male with intracerebral hemorrhage secondary to severe hypertension requires immediate blood pressure control, not a medication called "Totilac." 1, 2

Immediate Blood Pressure Management

Target systolic blood pressure of 140–160 mmHg within 6 hours of symptom onset using intravenous nicardipine as the first-line agent. 1, 2

• Start nicardipine at 5 mg/hour IV infusion, titrating by 2.5 mg/hour every 15 minutes up to a maximum of 15 mg/hour to achieve the target blood pressure. 1, 2, 3
• Avoid reducing systolic blood pressure by more than 70 mmHg within the first hour, as excessive drops increase the risk of acute kidney injury and neurological deterioration. 1, 2
• Maintain cerebral perfusion pressure at or above 60 mmHg at all times, especially if intracranial pressure is elevated. 1, 2

Alternative First-Line Agent

Labetalol can be used if nicardipine is unavailable or contraindicated, with dosing of 10–20 mg IV bolus over 1–2 minutes, repeated or doubled every 10 minutes to a maximum cumulative dose of 300 mg, or as a continuous infusion at 2–8 mg/minute. 1, 2, 3

Critical Safety Parameters

• Initiate treatment within 2 hours of symptom onset and reach target blood pressure within 1 hour to reduce hematoma expansion. 1
• Use continuous smooth titration to minimize blood pressure variability, which independently worsens functional outcomes. 1
• Monitor blood pressure every 15 minutes until stabilized, then every 30–60 minutes for the first 24–48 hours. 1

Common Pitfalls to Avoid

• Do not delay blood pressure reduction beyond 2–6 hours from symptom onset, as the therapeutic window for preventing hematoma expansion is narrow. 1, 2
• Do not allow systolic blood pressure to remain above 160 mmHg, as this increases hematoma expansion risk. 1, 2
• Do not use glyceryl trinitrate or other venous vasodilators, as these are associated with greater hematoma growth and poorer outcomes. 1

Clarification Needed

If "Totilac" refers to a specific medication available in your region, please provide the generic name or active ingredient so appropriate dosing guidance can be given. The evidence provided focuses exclusively on antihypertensive management with nicardipine and labetalol for acute intracerebral hemorrhage. 1, 2, 3, 4, 5