hydralazine (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL

tablets

  • 10mg
  • 25mg
  • 50mg
  • 100mg

Severe Essential Hypertension

10 mg PO q6hr for 2-4 days; 25 mg q6hr daily for the first week; increase to 50 mg q6hr from second week on; adjust dose to lowest effective levels

20-40 mg IM/IV; repeat as necessary

Dosing considerations

  • Change to oral therapy as soon as possible

Hypertension (Chronic)

Initial: 10 mg PO q6hr for 2-4 days; may increase gradually by 10-25 mg/dose every 2-5 days up to 50 mg PO q6hr (some patients require 300 mg/day)

See also combo with isosorbide dinitrate

Hypertensive Crisis

10-40 mg IV/IM; not to exceed 20 mg/dose; repeat PRN

Pregnancy-associated

  • 5-10 mg IV/IM initially, THEN 5-10 mg q20-30min PRN, OR
  • 0.5-10 mg/hr IV infusion

Congestive Heart Failure

Initial dose: 10-25 mg PO q6-8hr; titrate dose q2-4weeks

Maintenance dose: 225-300 mg/day PO divided q6-8hr

Dosing considerations

  • Adjust dose per individual response

Dosage Forms & Strengths

injectable solution

  • 20mg/mL

tablets

  • 10mg
  • 25mg
  • 50mg
  • 100mg

Severe Essential Hypertension

1.7-3.5 mg/kg/day IM or IV divided in 4-6 doses.  

Heart Failure, Afterload Reduction

Infants: 0.1-0.5 mg/kg/dose IV q6-8hr; not to exceed 2 mg/kg/dose

Children and adolescents: 0.15-0.2 mg/kg/dose IV q4-6hr; not to exceed 20 mg/dos  

Oral administration

  • Infants and older: 0.75-3 mg/kg/day PO divided q6-12hr; not to exceed 200 mg/day or 7 mg/kg/day

Hypertensive Crisis

Infants or older: 0.1-0.2 mg/kg IV/IM q4-6hr PRN initially; may increase to usual dose of 1.7-3.5 mg/kg/day divided q4-6hr; not to exceed 20 mg/dose IM or IV or 2 mg/kg q3-6hr with cumulative dose not to exceed 9 mg/kg  

Hypertension (Chronic)

Initial: 0.75-1 mg/kg/day PO divided q6-12hr  

Maximum dose in infants (<1 year): 5 mg/kg/day PO divided q6-12hr

Maximum dose in children (>1 year): 7.5 mg/kg/day PO divided q6-12hr; not to exceed 200 mg/day

Increase gradually over 3-4 weeks

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Interactions

Interaction Checker

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              Serious - Use Alternative (4)

              • lofexidine

                lofexidine, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              • lonafarnib

                hydralazine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              • pexidartinib

                hydralazine and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • pretomanid

                hydralazine, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              Monitor Closely (104)

              • acebutolol

                hydralazine increases effects of acebutolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • aceclofenac

                aceclofenac decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • acemetacin

                acemetacin decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • aldesleukin

                aldesleukin increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • amifostine

                amifostine, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • aspirin

                aspirin decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • aspirin rectal

                aspirin rectal decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • atenolol

                hydralazine increases effects of atenolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • atogepant

                hydralazine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • avanafil

                avanafil increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • axitinib

                hydralazine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • benzphetamine

                hydralazine, benzphetamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • betaxolol

                hydralazine increases effects of betaxolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • bisoprolol

                hydralazine increases effects of bisoprolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • bretylium

                hydralazine, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • carbidopa

                carbidopa increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • carvedilol

                hydralazine increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                carvedilol increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • celecoxib

                celecoxib decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • dexfenfluramine

                hydralazine, dexfenfluramine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • dexmethylphenidate

                hydralazine, dexmethylphenidate. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • dextroamphetamine

                hydralazine, dextroamphetamine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • diclofenac

                diclofenac decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • diethylpropion

                hydralazine, diethylpropion. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • diflunisal

                diflunisal decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • dobutamine

                hydralazine, dobutamine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • dopamine

                hydralazine, dopamine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • ephedrine

                hydralazine, ephedrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • epinephrine

                hydralazine, epinephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • epoprostenol

                epoprostenol, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • esmolol

                hydralazine increases effects of esmolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • etodolac

                etodolac decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • fenfluramine

                hydralazine, fenfluramine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • fenoldopam

                fenoldopam, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • fenoprofen

                fenoprofen decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • finerenone

                hydralazine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

              • flibanserin

                hydralazine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

              • flurbiprofen

                flurbiprofen decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • ibuprofen

                ibuprofen decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • ibuprofen IV

                ibuprofen IV decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • iloprost

                hydralazine, iloprost. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • indomethacin

                indomethacin decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • isavuconazonium sulfate

                hydralazine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • isocarboxazid

                hydralazine, isocarboxazid. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • isoproterenol

                hydralazine, isoproterenol. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • ivacaftor

                hydralazine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

              • ketoprofen

                ketoprofen decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • ketorolac

                ketorolac decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • ketorolac intranasal

                ketorolac intranasal decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • labetalol

                hydralazine increases effects of labetalol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • lemborexant

                hydralazine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

              • levodopa

                levodopa increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • linezolid

                hydralazine, linezolid. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • lisdexamfetamine

                hydralazine, lisdexamfetamine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • lomitapide

                hydralazine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              • lornoxicam

                lornoxicam decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • meclofenamate

                meclofenamate decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • mefenamic acid

                mefenamic acid decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • meloxicam

                meloxicam decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • methamphetamine

                hydralazine, methamphetamine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • methylenedioxymethamphetamine

                hydralazine, methylenedioxymethamphetamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • methylphenidate

                hydralazine, methylphenidate. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • metoprolol

                hydralazine increases effects of metoprolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • midazolam intranasal

                hydralazine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

              • midodrine

                hydralazine, midodrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • minoxidil

                hydralazine, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • mipomersen

                mipomersen, hydralazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

              • nabumetone

                nabumetone decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • nadolol

                hydralazine increases effects of nadolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • naproxen

                naproxen decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • nebivolol

                hydralazine increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • nitroglycerin rectal

                nitroglycerin rectal, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

              • norepinephrine

                hydralazine, norepinephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • oxaprozin

                oxaprozin decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • parecoxib

                parecoxib decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • penbutolol

                hydralazine increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • phendimetrazine

                hydralazine, phendimetrazine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • phenelzine

                hydralazine, phenelzine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • phentermine

                hydralazine, phentermine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • phenylephrine

                hydralazine, phenylephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • phenylephrine PO

                hydralazine, phenylephrine PO. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • pindolol

                hydralazine increases effects of pindolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • piroxicam

                piroxicam decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • procarbazine

                hydralazine, procarbazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • propranolol

                hydralazine increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • propylhexedrine

                hydralazine, propylhexedrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • pseudoephedrine

                hydralazine, pseudoephedrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

              • salicylates (non-asa)

                salicylates (non-asa) decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • salsalate

                salsalate decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • sotalol

                hydralazine increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • sulfasalazine

                sulfasalazine decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • sulindac

                sulindac decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • tadalafil

                tadalafil increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • tazemetostat

                hydralazine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • timolol

                hydralazine increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • tinidazole

                hydralazine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tolfenamic acid

                tolfenamic acid decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • tolmetin

                tolmetin decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • tranylcypromine

                hydralazine, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • treprostinil

                hydralazine, treprostinil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • xipamide

                xipamide increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor.

              • xylometazoline

                hydralazine, xylometazoline. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

              • yohimbine

                hydralazine, yohimbine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              Minor (14)

              • agrimony

                agrimony increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

              • celiprolol

                hydralazine increases effects of celiprolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • cornsilk

                cornsilk increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

              • diazoxide

                diazoxide, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • forskolin

                forskolin increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

              • maitake

                maitake increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown. Maitake mushroom has anti-tumor effects (animal/in vitro research).

              • pyridoxine

                hydralazine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                hydralazine decreases levels of pyridoxine (Antidote) by unspecified interaction mechanism. Minor/Significance Unknown.

              • reishi

                reishi increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

              • ruxolitinib

                hydralazine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, hydralazine. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • tizanidine

                tizanidine increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                treprostinil increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              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

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              Warnings

              Contraindications

              Hypersensitivity to hydralazine

              Coronary artery disease

              Mitral valve rheumatic heart disease

              Cautions

              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

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              Pregnancy & Lactation

              Pregnancy category: C

              Lactation: Excreted in breast milk; use caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Direct vasodilator; dilates arterioles with little effect on vein; decreases systemic resistance, which subsequently decreases blood pressure.

              Absorption

              Bioavailability: Slow acetylator: 30-50%; rapid acetylator: 22-30%

              Onset: 5-20 min, maximum effect 10-80 min (IV); 20-30 min (PO)

              Duration: 3-8 hr (PO); 1-4 hr (IV)

              Distribution

              Protein bound: 85-90%

              Vd: 0.3-8.2 L/kg

              Metabolism

              Significantly metabolized in liver by acetylation; slow and rapid acetylator

              Metabolites: Phthalazine and pyruvic acid hydrazone metabolites (inactive metabolite)

              Elimination

              Half-life: 2-8 hr (normal renal function); 7-16 hr (end-stage renal disease)

              Excretion: Urine (14%; unchanged)

              Pharmacogenomics

              HLA-DRw4 appears in 73% of patients experiencing hydralazine-associated SLE

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              Administration

              IV Incompatibilities

              Solution: D5W, D10/LR, fructose 10%, fructose 10%/NS

              Additive: Aminophylline, ampicillin, chlorothiazide, dobutamine, CaNa2EDTA, ethacrynate, hydrocortisone sodium succinate, mephentermine, methohexital, nitroglycerin, phenobarbital, verapamil

              Y-site: Aminophylline, ampicillin, diazoxide, furosemide

              IV Compatibilities

              Solution: Dextrose-Ringer combinations, D5/LR, dextrose 2.5%/½LR, dextrose-saline combinations, D10W, Ringer, LR, ½NS, NS, Na-lactate 1/6M

              Y-site: Heparin, hydrocortisone sodium succinate, nitroglycerin (compatible for 3 hr; may form slight ppt), KCl, verapamil, vit B/C

              IV Preparation

              Prepare immediately before use

              Minimize contact with metal parts during preparation and administration

              IV/IM Administration

              Administer undiluted IM or as slow IV push directly into vein; in children maximum rate is 5 mg/min; may also administer as continuous infusion

              Avoid adding drug to infusion solution

              Storage

              Store at controlled room temp

              Do not refrigerate

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              hydralazine injection
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              20 mg/mL vial
              hydralazine injection
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              20 mg/mL vial
              hydralazine injection
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              20 mg/mL vial
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              20 mg/mL vial
              hydralazine injection
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              20 mg/mL vial
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              20 mg/mL vial
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              20 mg/mL vial
              hydralazine oral
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              100 mg tablet
              hydralazine oral
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              50 mg tablet
              hydralazine oral
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              25 mg tablet
              hydralazine oral
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              10 mg tablet
              hydralazine oral
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              50 mg tablet
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              25 mg tablet
              hydralazine oral
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              10 mg tablet
              hydralazine oral
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              50 mg tablet
              hydralazine oral
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              50 mg tablet
              hydralazine oral
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              50 mg tablet
              hydralazine oral
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              25 mg tablet
              hydralazine oral
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              10 mg tablet
              hydralazine oral
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              100 mg tablet
              hydralazine oral
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              25 mg tablet
              hydralazine oral
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              100 mg tablet
              hydralazine oral
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              10 mg tablet
              hydralazine oral
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              100 mg tablet
              hydralazine oral
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              25 mg tablet
              hydralazine oral
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              100 mg tablet
              hydralazine oral
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              10 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              hydralazine oral

              HYDRALAZINE - ORAL

              (hye-DRAL-a-zeen)

              COMMON BRAND NAME(S): Apresoline

              USES: Hydralazine is used with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Hydralazine is called a vasodilator. It works by relaxing blood vessels so blood can flow through the body more easily.

              HOW TO USE: Take this medication by mouth with or without food, usually 2 to 4 times daily or as directed by your doctor. The dosage is based on your medical condition and response to treatment. Your doctor may start you at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick. It may take up to several weeks before you get the full benefit of this drug.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.Tell your doctor if your condition worsens (for example, your routine blood pressure readings increase).

              SIDE EFFECTS: Headache, pounding/fast heartbeat, loss of appetite, nausea, vomiting, diarrhea, or dizziness may occur as your body adjusts to the medication. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may rarely cause nerve problems. Tell your doctor promptly if you experience numbness or tingling. Your doctor may recommend a vitamin B6 supplement (pyridoxine).Tell your doctor right away if you have any serious side effects, including: severe tiredness, aching/swollen joints, rash on nose and cheeks, swollen glands, signs of kidney problems (such as change in the amount of urine, bloody/pink urine), signs of infection (such as fever, chills, persistent sore throat), easy bruising/bleeding.Get medical help right away if you have any very serious side effects, including: chest/jaw/left arm pain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking hydralazine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as coronary artery disease, recent heart attack, rheumatic heart disease of the mitral valve), blood vessel problems, previous stroke, kidney problems.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist that you are taking this medication.Older adults may be more sensitive to the side effects of this medication, especially dizziness, which can increase the risk of falls.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine).Some products have ingredients that could raise your heart rate or blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting, flushing, chest/jaw/left arm pain, irregular heartbeat.

              NOTES: Do not share this medication with others.Lifestyle changes such as stress reduction programs, exercise, and dietary changes may help this medication work better. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.Laboratory and/or medical tests (such as complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Have your blood pressure checked regularly while taking this medication. Learn how to monitor your own blood pressure, and share the readings with your doctor.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.