Name /bks_53161_deglins_md_disk/hydralazine 02/14/2014 02:44PM Plate # 0-Composite pg 1 # 1

1 Use Cautiously in: Cardiovascular or cerebrovascular disease; Severe renal and

hepatic disease (dose modification may be necessary); OB, Lactation: Has been
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hydrALAZINE (hye-dral-a-zeen) used safely during pregnancy.
Apresoline
Adverse Reactions/Side Effects
Classification CNS: dizziness, drowsiness, headache. CV: tachycardia, angina, arrhythmias,
Therapeutic: antihypertensives edema, orthostatic hypotension. GI: diarrhea, nausea, vomiting. Derm: rash. F
Pharmacologic: vasodilators and E: sodium retention. MS: arthralgias, arthritis. Neuro: peripheral neuropa-
Pregnancy Category C thy. Misc: drug-induced lupus syndrome.

Indications Interactions
Moderate to severe hypertension (with a diuretic). Unlabeled Use: HF unrespon- Drug-Drug: q hypotension with acute ingestion of alcohol, other anti-
sive to conventional therapy with digoxin and diuretics. hypertensives, or nitrates. MAO inhibitors may exaggerate hypotension. Mayp
pressor response to epinephrine. NSAIDs maypantihypertensive response. Beta
Action blockersptachycardia from hydralazine (therapy may be combined for this rea-
Direct-acting peripheral arteriolar vasodilator. Therapeutic Effects: Lowering of son). Metoprolol and propranololqhydralazine levels.qblood levels of meto-
BP in hypertensive patients and decreased afterload in patients with HF. prolol and propranolol.
Pharmacokinetics Route/Dosage
Absorption: Rapidly absorbed following oral administration; well absorbed from PO (Adults): Hypertension 10 mg 4 times daily initially. After 2 4 days mayqto
IM sites. 25 mg 4 times daily for the rest of the 1st week; may thenqto 50 mg 4 times daily (up
Distribution: Widely distributed. Crosses the placenta; enters breast milk in mini- to 300 mg/day). Once maintenance dose is established, twice-daily dosing may be
mal concentrations. used. HF 25 37.5 mg 4 times daily; may bequp to 300 mg/day in 3 4 divided
Metabolism and Excretion: Mostly metabolized by the GI mucosa and liver by doses.
N-acetyltransferase (rate of acetylation is genetically determined [slow acetylators PO (Children 1 mo): Initial 0.75 1 mg/kg/day in 2 4 divided doses, not to
haveqhydralazine levels andqrisk of toxicity; fast acetylators havephydralazine lev- exceed 25 mg/dose; mayqgradually to 5 mg/kg/day in infants and 7.5 mg/kg/day in
els andpresponse]). children (not to exceed 200 mg/day) in 2 4 divided doses.
Half-life: 2 8 hr. IM, IV (Adults): Hypertension 5 40 mg repeated as needed. Eclampsia 5
TIME/ACTION PROFILE (antihypertensive effect) mg q 15 20 min; if no response after a total of 20 mg, consider an alternative agent.
ROUTE ONSET PEAK DURATION IM, IV (Children 1 mo): Initial 0.1 0.2 mg/kg/dose (not to exceed 20 mg) q
PO 45 min 2 hr 24 hr
4 6 hr as needed, up 1.7 3.5 mg/kg/day in 4 6 divided doses.
IM 1030 min 1 hr 38 hr
IV 520 min 1530 min 26 hr
NURSING IMPLICATIONS
Assessment
Contraindications/Precautions Monitor BP and pulse frequently during initial dose adjustment and periodically
Contraindicated in: Hypersensitivity; Some products contain tartrazine and during therapy. About 50 65% of Caucasians, Black, South Indians, and Mexi-
should be avoided in patients with known intolerance. cans are slow acetylators at risk for toxicity, while 80 90% of Eskimos, Japanese,
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.