Drugs contraindicated in hypertensive emergencies
Are there some drugs that should not be used to treat hypertensive emergencies?
Generally drugs that can cause precipitous hypotension and cannot be recalled or stopped should be avoided.
Nifedipine capsules once were widely used for hypertensive urgencies and even emergencies, but the US Food and Drug Administration did not grant this indication, because the blood pressure lowering was unpredictable and sometimes caused serious hypotension, shock, and death. Most physicians prefer to use drugs that have a short “time to effect,” can be easily titrated, and have a short “off-time” just in case the blood pressure drops, and the medication has to be reduced in dosage or stopped altogether. Drugs with a long elimination half-life, even when given intravenously, are more likely to cause a problem in these conditions.