Makker S P, Moorthy B
J Pediatr. 1980 Apr;96(4):762-6. doi: 10.1016/s0022-3476(80)80763-3.
Minoxidil, a potent peripheral vasodilator, was used concomitantly with other antihypertensive drugs for severe hypertension in three children for 47 to 158 weeks at the dosage of 40 to 50 mg/day. Two patients had three and two courses of minoxidil, respectively. Attempts were made to withdraw minoxidil in all children because of severe hypertrichosis. Minoxidil was withdrawn over periods varying from four to 12 weeks. Rebound hypertension manifesting as hypertensive encephalopathy occurred in all when minoxidil was withdrawn rapidly. The occurrence of rebound hypertension correlated with the total cumulative dose of minoxidil in mg/kg/week given prior to the withdrawal (P less than 0.05) and the rapidity (four to eight weeks) with which minoxidil was withdrawn (P less than 0.05), but not with the total duration of therapy, duration at maximal dosage, or the amount of minoxidil in mg/kg on the day prior to withdrawal. Rebound hypertension also did not occur when minoxidil was withdrawn gradually (12 weeks) or if the patient was receiving a small dose (2.5 to 5 mg/day). Pretreatment with an alpha-blocking agent (prazosin) or the discontinuation of the concomitantly administered beta-blocker (propranolol) prior to the withdrawal seemed to prevent rebound hypertension. We suggest that the dosage of minoxidil should be decreased very gradually.
米诺地尔是一种强效的外周血管扩张剂，曾与其他抗高血压药物联合用于治疗3例重症高血压患儿，用药剂量为每日40至50毫克，疗程为47至158周。2例患儿分别接受了3个和2个疗程的米诺地尔治疗。由于严重多毛症，所有患儿均尝试停用米诺地尔。米诺地尔的撤药时间为4至12周不等。快速停用米诺地尔时，所有患儿均出现了表现为高血压脑病的反跳性高血压。反跳性高血压的发生与撤药前以毫克/千克/周为单位计算的米诺地尔总累积剂量相关（P<0.05），也与米诺地尔的撤药速度（4至8周）相关（P<0.05），但与治疗总时长、最大剂量用药时长或撤药前一日以毫克/千克为单位计算的米诺地尔用量无关。当米诺地尔逐渐撤药（12周）或患者接受小剂量（每日2.5至5毫克）治疗时，也未发生反跳性高血压。撤药前用α阻滞剂（哌唑嗪）预处理或停用同时服用的β阻滞剂（普萘洛尔）似乎可预防反跳性高血压。我们建议应非常缓慢地减少米诺地尔的剂量。
