Top 300 Pharmacy Drug Cards

HYDRALAZINE: Apresoline, Various

Class: Peripheral Vasodilator

Dosage Forms. Tablet: 10 mg, 25 mg, 50 mg, 100 mg; Solution: 20 mg/mL

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Common FDA Label Indication, Dosing, and Titration.

1. Hypertension: Adults: initial, 10 mg po qid for 2-4 d; increase to 25 mg po qid for 3-5 d; increase to 50 mg po qid, titrate to lowest effective dose at intervals of 1 wk (max 300 mg/d). Peds: 0.75 mg/kg/d po in 4 divided doses; increase dose gradually over 3-4 wk (max dose 7.5 mg/kg or 200 mg/d)

Off-Label Uses.

1. Congestive heart failure: Adults: 200-300 mg po daily in 2-4 divided doses

MOA. Hydralazine is a vasodilator that reduces total peripheral resistance by direct action on vascular smooth muscle, with an effect greater on arterioles than on veins.

Drug Characteristics: Hydralazine

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Medication Safety Issues: Hydralazine

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Drug Interactions: Hydralazine

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Adverse Reactions: Hydralazine

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Efficacy Monitoring Parameters. Decrease in systolic and diastolic BP, improvement in signs/symptoms of heart failure.

Toxicity Monitoring Parameters. Signs/symptoms of hypotension or liver damage. CBC and antinuclear antibody titers at baseline and periodically during prolonged treatment.

Key Patient Counseling Points. Patient should not drink alcohol while taking drug. Advise patient against sudden discontinuation of drug as this may cause rebound hypertension. This medicine may cause dizziness. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Patient should report chest pain, palpitations, signs/symptoms of tachyarrhythmia, hypotension, agranulocytosis, systemic lupus erythematosus, or hepatotoxicity.

Clinical Pearls. Hydralazine may be beneficial in patients intolerant of ACEIs or ARBs and when added ACEIs or ARBs in African Americans.