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Hydralazine

    Brands

    DEA Class; Rx

    Common Brand Names; Apresoline

    • Vasodilators
    Oral and parenteral vasodilator; used for HTN and CHF, although ACE inhibitors have largely replaced hydralazine for CHF; used for HTN during pregnancy; also used to treat pulmonary hypertension; its use in the general population for HTN has declined due to adverse effects and tachyphylaxis.

    Indicated for the treatment of hypertension.

    For the treatment of hypertensive emergency or hypertensive urgency.
    For the treatment of heart failure.

    Hypersensitivity to hydralazine

    Coronary artery disease

    Mitral valve rheumatic heart disease

    • Hypotension
    • Palpitations
    • Conjunctivitis
    • Tachycardia
    • Headache
    • Peripheral edema
    • Vascular collapse
    • Peripheral neuropathy
    • Anorexia
    • Diarrhea
    • Nausea
    • Vomiting
    • Psychotic reaction
    • Agranulocytosis
    • Leukopenia
    • Hepatotoxicity
    • Chest pain
    • Dyspnea
    • Nasal congestion
    • Paralytic ileus
    • Dysurea
    • Thrombocytopenia
    • Peripheral neuritis
    • Rheumatoid arthritis
    • Agranulocytosis
    • Arthralgia
    • SLE syndrome

    May induce SLE-type syndrome (usually at >200 mg/day); instruct patients to report joint/chest pain or fever; discontinue therapy unless benefits outweigh risks; steroid therapy may be necessary long-term

    Use caution in CVA, severe renal impairment, volume depletion, preexisting hypotension, concurrency with other hypotensive agents, CAD (potential contraindication)

    Use caution in mitral valvular disease; may increase pulmonary artery pressure

    Discontinue slowly to avoid rapid rise in blood pressure

    Use with caution in patients with pulmonary hypertension; may cause hypotension

    Increases fluid and sodium retention; may require treatment or increase in diutretic dose

    Peripheral neuritis, including numbness, paresthesia, and tingling, reported; treat symptoms with pyridoxine

    Blood dyscarsias, including reduction in red blod cell count, agranulocytosis, leukopenia, reported with therapy; discontinue therapy if any of the hematologic effects occur

    Pregnancy category: C

    Lactation: Excreted in breast milk; use caution

    Adults

    300 mg/day PO for hypertension. Higher doses have been used to treat patients with heart failure; however, doses greater than 200—300 mg/day PO are associated with a higher risk of drug-induced systemic lupus erythematosus. Titrate IV and IM dosage as needed for blood pressure control.

    Geriatric

    300 mg/day PO for hypertension. Higher doses have been used to treat patients with heart failure; however, doses greater than 200—300 mg/day PO are associated with a higher risk of drug-induced systemic lupus erythematosus. Titrate IV and IM dosage as needed for blood pressure control.

    Adolescents

    Safety and efficacy not established; however, doses up to 7.5 mg/kg/day PO or 200 mg/day PO, whichever is less, or 3.5 mg/kg/day IV or IM have been used.

    Children

    Safety and efficacy not established; however, doses up to 7.5 mg/kg/day PO or 200 mg/day PO, whichever is less, or 3.5 mg/kg/day IV or IM have been used.

    Infants

    Safety and efficacy not established; however, doses up to 7.5 mg/kg/day PO or 3.5 mg/kg/day IV or IM have been used.

    Neonates

    Safety and efficacy not established; however, doses up to 7.5 mg/kg/day PO or 0.6 mg/kg/dose IV have been used.

    Hydralazine hydrochloride

    injectable solution

    • 20mg/mL

    tablets

    • 10mg
    • 25mg
    • 50mg
    • 100mg