Table 2

Medications used for treatment of pulmonary hypertension in the intensive care unit

DrugDoseComment
Epoprostenol intravenousStart with 1–3 ng/kg/min, increase gradually to 60 (and more) ng/kg/min intravenousCaution: systemic arterial hypotension.
Need to change drug vial/delivery system every 12–24 h
Iloprost inhaled, intravenous0.25 µg/kg inhal, max. 10 µg; 6×/day or
1–5 ng/kg/min intravenous
Caution: systemic arterial hypotension
iNO2–40 ppm inhal
Sildenafil intravenous,

oral
0.4 mg/kg bolus over 3hrs IV (optional), then 1.6−2.4 mg/kg/day continous infusion
8–20 kg: 3×10 mg oral
>20 kg: 3×20 mg oral
do not exceed 30mg/d. Higher sildenafil doses up to 7.2mg/kg/day IV have been used in newborn infants with PPHN associated with congenital diaphragmatic hernia
In children weighing less than 8 kg, dosage of 1 mg/kg three time a day (oral not approved)
Epinephrine0.01–1 µg/kg/min intravenousPositive inotropy. Increases myocardial oxygen consumption, tachycardia. Moderate effects on PVR and SVR
Norepinephrine0.01–1 µg/kg/min intravenousIncreases SVR and PVR
Vasopressin0.0003–0.002 IU/kg/min intravenousProbably does not increase PVR (advantage vs norepinephrine)
Terlipressin5–10 ng/kg/min intravenousProbably does not increase PVR (advantage vs norepinephrine)
Dobutamine5–20 µg/kg/min intravenousIncreases myocardial oxygen consumption, tachycardia. Probably does not increase PVR
Milrinone0.375–1.0 µg/kg/min intravenousLowers PVR.
Caution: systemic arterial hypotension
Levosimendan0.1 µg/kg/min intravenousLowers PVR. Caution: systemic arterial hypotension
  • iNO, inhaled nitric oxide; PPHN, persistent pulmonary hypertension in the newborn; PVR, pulmonary vascular resistance; SVR, systemic vascular resistance.