Hydralazine

Indications
 Oral
Hypertension
Adult: 40-50 mg daily in divided doses, increased according to response. Max: 200 mg/day.
Renal impairment: Reduce dose or prolong dosage interval.
Hepatic impairment: Reduce dose or prolong dosage interval.
Intravenous
Hypertensive crisis
Adult: 5-10 mg via slow IV inj, repeated if necessary after 20-30 min. Alternatively, as continuous IV, initial dose is 200-300 mcg/min. Maintenance: 50-150 mcg/min.

Special Populations: Dose reduction in renal and hepatic impairment.
Contraindications
 Severe tachycardia, dissecting aortic aneurysm, heart failure with high cardiac output, cor pulmonale, myocardial insufficiency due to mechanical obstruction, coronary artery disease, idiopathic SLE. Patients with recent MI.
Warnings / Precautions
 Cerebrovascular disorders. Ischaemic heart disease. Hepatic or renal impairment. May deplete pyridoxine in the body. May impair ability to drive or operate machinery. Monitor for postural hypotension if given to patients with heart failure. Withdraw gradually. CBC and antinuclear antibody tests should be carried out every 6 mth during long-term therapy. Urine analysis is also recommended. Pregnancy and lactation. Daily doses >100 mg may increase the risk of SLE especially in women and slow acetylators.
Adverse Reactions
 Tachycardia; palpitations; angina pectoris; haemolytic anaemia; paralytic ileus; severe headache; GI disturbances; flushing, dizziness; nasal congestion; peripheral neuropathy with numbness and tingling of extremities; lupus erythematosus-like syndrome; postural hypotension; fluid retention; hepatotoxicity; blood dyscrasias; difficulty in urinating; glomerulonephritis; constipation; depression; anxiety; hypersensitivity reactions; conjunctivitis; lachrymation, tremor; muscle cramps.
Overdose Reactions
 Symptoms include hypotension, tachycardia, headache and generalised skin flushing. Other complications may include myocardial ischaemia and subsequent MI, cardiac arrhythmia, and profound shock. Treatment is supportive and symptomatic.
Drug Interactions
 Hypotensives, diazoxide, NSAIDs, oestrogens, sympathomimetics.
See Below for More hydralazine Drug Interactions
Lab Interactions
 May produce positive results in Coomb's test.
Mechanism of Actions
 Hydralazine is a direct-acting vasodilator which acts predominantly on the arterioles. It reduces BP and peripheral resistance but produces fluid retention. Hydralazine tends to improve renal and cerebral blood flow and its effect on diastolic pressure is more marked than on systolic pressure.
Onset: Oral: 45 min. IV: 10-20 min.
Duration: Oral and IV: 3-8 hr.
Absorption: Rapidly absorbed from the GI tract after oral admin.
Distribution: About 90% bound to plasma proteins.
Metabolism: Undergoes considerable first-pass metabolism by acetylation in the GI mucosa and liver.
Excretion: Mainly excreted in urine as metabolites.
Administration
 Should be taken with food.
ATC Classification
 C02DB02 - hydralazine ; Belongs to the class of hydrazinophthalazine derivatives. Used in the treatment of hypertension.
Available As
  • Dihydralazine Sulphate 10 mg
  • Dihydralazine Sulphate 25 mg
  • Hydralazine 25 mg
  • Hydralazine Hcl 25 mg

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