Hydralazine

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

  1. eclampsia
  2. heart failure
  3. hypertension
  4. hypertensive emergency
  5. hypertensive urgency
  6. preeclampsia

Side Effects

  1. agranulocytosis
  2. anemia
  3. angina
  4. anorexia
  5. anxiety
  6. arthralgia
  7. chills
  8. confusion
  9. conjunctivitis
  10. constipation
  11. depression
  12. diarrhea
  13. dizziness
  14. dyspnea
  15. edema
  16. eosinophilia
  17. erythema
  18. fever
  19. fluid retention
  20. flushing
  21. glomerulonephritis
  22. headache
  23. hepatitis
  24. hypotension
  25. ileus
  26. lacrimation
  27. leukopenia
  28. lupus-like symptoms
  29. lymphadenopathy
  30. muscle cramps
  31. myalgia
  32. myocardial infarction
  33. nasal congestion
  34. nausea
  35. orthostatic hypotension
  36. palpitations
  37. paresthesias
  38. pericarditis
  39. peripheral edema
  40. peripheral neuropathy
  41. peripheral vasodilation
  42. pruritus
  43. purpura
  44. rash
  45. sinus tachycardia
  46. splenomegaly
  47. syncope
  48. tremor
  49. urticaria
  50. vasculitis
  51. vomiting
  52. weakness
  53. 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
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  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Alosetron
  • Alprostadil
  • Amifostine
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  • Brompheniramine; Pseudoephedrine
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  • Carbetapentane; Diphenhydramine; Phenylephrine
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  • 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
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  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloroprocaine
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  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Clozapine
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  • Dextromethorphan; Quinidine
  • Diazoxide
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  • Estrogens
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  • Haloperidol
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  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
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