Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
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 (105)
- 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.
- serdexmethylphenidate/dexmethylphenidate
hydralazine, serdexmethylphenidate/dexmethylphenidate. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.
hydralazine, serdexmethylphenidate/dexmethylphenidate. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension. - 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 (15)
- 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.
- ruxolitinib topical
hydralazine will increase the level or effect of ruxolitinib topical 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.
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
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
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.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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| hydralazine oral - | 100 mg tablet |  | |
| hydralazine oral - | 50 mg tablet |  | |
| hydralazine oral - | 25 mg tablet |  | |
| hydralazine oral - | 10 mg tablet |  | |
| hydralazine oral - | 10 mg tablet |  | |
| hydralazine oral - | 50 mg tablet |  | |
| hydralazine oral - | 25 mg tablet |  | |
| hydralazine oral - | 10 mg tablet |  | |
| hydralazine oral - | 100 mg tablet |  | |
| hydralazine oral - | 50 mg tablet |  | |
| hydralazine oral - | 25 mg tablet |  | |
| hydralazine oral - | 50 mg tablet |  | |
| hydralazine oral - | 10 mg tablet |  | |
| hydralazine oral - | 50 mg tablet |  | |
| hydralazine oral - | 25 mg tablet |  | |
| hydralazine oral - | 100 mg tablet |  | |
| hydralazine oral - | 100 mg tablet |  | |
| hydralazine oral - | 25 mg tablet |  | |
| hydralazine oral - | 100 mg tablet |  | |
| hydralazine oral - | 10 mg tablet |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  | |
| hydralazine injection - | 20 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
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 as directed by your doctor, usually 2 to 4 times daily. 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 sore throat that doesn't go away, fever, chills), 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 about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).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.Lab and/or medical tests (such as complete blood count) may be done while you are taking this medication. Keep all medical and lab appointments. 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 April 2023. Copyright(c) 2023 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.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
