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What is Hydralazine
Hydralazine is an oral and parenteral antihypertensive agent. Because it is a peripheral vasodilator, hydralazine also has been used to treat congestive heart failure, although ACE inhibitors have largely replaced hydralazine for this use.
In those patients that cannot tolerate ACE inhibitors or angiotensin II blockers, hydralazine in combination with isosorbide dinitrate, ISDN is an acceptable alternative for the treatment of heart failure.
Approved for clinical use by the FDA in 1952, hydralazine was one of the earliest orally active antihypertensive agents available in the United States and has been commonly used for hypertension during pregnancy.
Hydralazine also has been used to treat pulmonary hypertension, but the actions are unpredictable, causing either improved hemodynamic status or symptomatic hypotension.
More recently, hydralazine’s use in the general population has declined due to adverse effects, tachyphylaxis, and the release of newer and better-tolerated agents.
In addition, injectable hydralazine has historically been used as a first-line agent in the treatment of hypertensive emergencies and urgencies including preeclampsia; however, due to unpredictable falls in blood pressure, a prolonged duration of action (up to 12 hours or more), and adverse effects, its use as a first-line agent for these indications is being replaced by newer and more predictable injectable antihypertensives.
Recently, a fixed-dose combination therapy of isosorbide dinitrate and hydralazine (BiDil®) was approved by the FDA for the treatment of heart failure in black patients.
When used in conjunction with standard therapy in black patients, this drug combination was found to improve mortality, rate of first hospitalizations, and quality of life.
Indications
- eclampsia
- heart failure
- hypertension
- hypertensive emergency
- hypertensive urgency
- preeclampsia
Side Effects
- agranulocytosis
- anemia
- angina
- anorexia
- anxiety
- arthralgia
- chills
- confusion
- conjunctivitis
- constipation
- depression
- diarrhea
- dizziness
- dyspnea
- edema
- eosinophilia
- erythema
- fever
- fluid retention
- flushing
- glomerulonephritis
- headache
- hepatitis
- hypotension
- ileus
- lacrimation
- leukopenia
- lupus-like symptoms
- lymphadenopathy
- muscle cramps
- myalgia
- myocardial infarction
- nasal congestion
- nausea
- orthostatic hypotension
- palpitations
- paresthesias
- pericarditis
- peripheral edema
- peripheral neuropathy
- peripheral vasodilation
- pruritus
- purpura
- rash
- sinus tachycardia
- splenomegaly
- syncope
- tremor
- urticaria
- vasculitis
- vomiting
- weakness
- weight gain
Monitoring Parameters
- antinuclear antibody (ANA) titer
- blood pressure
- heart rate
- serum creatinine/BUN
Contraindications
- acute myocardial infarction
- angina
- breast-feeding
- coronary artery disease
- driving or operating machinery
- geriatric
- heart failure
- increased intracranial pressure
- myocardial infarction
- pregnancy
- renal failure
- renal impairment
- rheumatic heart disease
- slow acetylation
- stroke
- systemic lupus erythematosus (SLE)
Interactions
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Pseudoephedrine
- Acrivastine; Pseudoephedrine
- Aldesleukin, IL-2
- Alemtuzumab
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alosetron
- Alprostadil
- Amifostine
- Amobarbital
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amyl Nitrite
- Apomorphine
- Apraclonidine
- Aripiprazole
- Articaine; Epinephrine
- Asenapine
- Baclofen
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benzphetamine
- Bortezomib
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Cabergoline
- Caffeine; Ergotamine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloroprocaine
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Clozapine
- Co-Enzyme Q10, Ubiquinone
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Conjugated Estrogens
- Conjugated Estrogens; Bazedoxifene
- Conjugated Estrogens; Medroxyprogesterone
- Desloratadine; Pseudoephedrine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmedetomidine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Quinidine
- Diazoxide
- Dienogest; Estradiol valerate
- Diethylpropion
- Diethylstilbestrol, DES
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dihydroergotamine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Dobutamine
- Dopamine
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Elagolix; Estradiol; Norethindrone acetate
- Enflurane
- Ephedrine
- Epinephrine
- Epoprostenol
- Ergonovine
- Ergotamine
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estrogens
- Estropipate
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Etomidate
- Fexofenadine; Pseudoephedrine
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Fluoxetine; Olanzapine
- Fospropofol
- General anesthetics
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Haloperidol
- Halothane
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibritumomab Tiuxetan
- Ibuprofen; Pseudoephedrine
- Iloperidone
- Iloprost
- Intravenous Lipid Emulsions
- Isocarboxazid
- Isoflurane
- Isoproterenol
- Isosorbide Dinitrate, ISDN
- Isosorbide Mononitrate
- Ketamine
- Levodopa
- Lisdexamfetamine
- Lofexidine
- Loratadine; Pseudoephedrine
- Lovastatin; Niacin
- Lurasidone
- Mepivacaine; Levonordefrin
- Mesoridazine
- Mestranol; Norethindrone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methohexital
- Methylphenidate
- Midodrine
- Milrinone
- Naproxen; Pseudoephedrine
- Nesiritide, BNP
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nitrates
- Nitroglycerin
- Nonsteroidal antiinflammatory drugs
- Norepinephrine
- Olanzapine
- Oxymetazoline
- Paliperidone
- Pemoline
- Pentoxifylline
- Pexidartinib
- Phendimetrazine
- Phenelzine
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Potassium Phosphate; Sodium Phosphate
- Prazosin
- Prilocaine; Epinephrine
- Procainamide
- Procaine
- Propofol
- Pseudoephedrine
- Quinidine
- Racepinephrine
- Rasagiline
- Riluzole
- Risperidone
- Ritodrine
- Segesterone Acetate; Ethinyl Estradiol
- Selegiline
- Sevoflurane
- Silodosin
- Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
- Sympathomimetics
- Tetracaine
- Thiopental
- Thiothixene
- Tizanidine
- Tranylcypromine
- Trazodone
- Vincristine Liposomal
- Yohimbine
- Zalcitabine, ddC
- Ziprasidone
