Drug reference

Hydralazine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 214

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Moderate to severe hypertension (adjunct) ▶BY MOUTH ▶Adult: Initially 25 mg twice daily, increased if necessary up to 50 mg twice daily Heart failure (with long acting nitrate) (initiated in hospital or under specialist supervision) ▶BY MOUTH ▶Adult: Initially 25 mg 3–4 times a day, subsequent doses to be increased every 2 days if necessary; usual maintenance 50–75 mg 4 times a day Hypertensive emergencies (including during pregnancy) | Hypertension with renal complications ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 200–300 micrograms/minute; usual maintenance 50–150 micrograms/minute ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 5–10 mg, to be diluted with 10 mL sodium chloride 0.9%; dose may be repeated after 20–30 minutes

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Contra Indications

Acute porphyrias p. 1120. cor pulmonale. dissecting aortic aneurysm. high output heart failure. idiopathic systemic lupus erythematosus. myocardial insufﬁciency due to mechanical obstruction. severe tachycardia

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Cautions

Cerebrovascular disease. coronary artery disease (may provoke angina, avoid after myocardial infarction until stabilised). occasionally blood pressure reduction too rapid even with low parenteral doses

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Safety

Interactions

→Appendix 1: hydralazine

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Side Effects

▶Common or very common Angina pectoris. diarrhoea. dizziness. ﬂushing. gastrointestinal disorders. headache. hypotension. joint disorders. lupus-like syndrome (after long-term therapy with over 100 mg daily (or less in women and in slow acetylator individuals)). myalgia. nasal congestion. nausea. palpitations. tachycardia. vomiting ▶Rare or very rare Acute kidney injury. agranulocytosis. anaemia. anxiety. appetite decreased. conjunctivitis. depression. dyspnoea. eosinophilia. eye disorders. fever. glomerulonephritis. haematuria. haemolytic anaemia. hallucination. heart failure. hepatic disorders. leucocytosis. leucopenia. lymphadenopathy. malaise. nerve disorders. neutropenia. oedema. pancytopenia. paradoxical pressor response. paraesthesia. pleuritic pain . proteinuria. skin reactions. splenomegaly. thrombocytopenia. urinary retention. vasculitis. weight decreased SIDE-EFFECTS, FURTHER INFORMATION The incidence of side-effects is lower if the dose is kept below 100mg daily, but systemic lupus erythematosus should be suspected if there is unexplained weight loss, arthritis, or any other unexplained ill health.

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Pregnancy

Neonatal thrombocytopenia reported, but risk should be balanced against risk of uncontrolled maternal hypertension. Manufacturer advises avoid before third trimester.

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Breast Feeding

Present in milk but not known to be harmful. Monitoring Monitor infant in breast-feeding.

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Hepatic Impairment

Manufacturer advises caution (risk of accumulation). Dose adjustments Manufacturer advises adjust dose or dosing interval according to clinical response.

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Renal Impairment

Dose adjustments Reduce dose if eGFR less than 30 mL/minute/1.73 m2.

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Monitoring Requirements

Manufacturer advises test for antinuclear factor and for proteinuria every 6 months and check acetylator status before increasing dose above 100 mg daily, but evidence of clinical value unsatisfactory.

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Dose and formulations

Directions For Administration

For intravenous infusion (Apresoline ®) give continuously in Sodium chloride 0.9%. Suggested infusion volume 500 mL.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: tablet, oral suspension, oral solution Tablet EXCIPIENTS: May contain Gluten, propylene glycol ▶Hydralazine hydrochloride (Non-proprietary) Hydralazine hydrochloride 10 mg Apo-Hydralazine 10mg tablets | 100 tablet P s Hydralazine hydrochloride 25 mg Hydralazine 25mg tablets | 56 tablet P £7.37 DT = £5.64 | 84 tablet P £14.00 Hydralazine hydrochloride 50 mg Hydralazine 50mg tablets | 56 tablet P £15.46 DT = £8.11 ▶Apresoline (Advanz Pharma) Hydralazine hydrochloride 25 mg Apresoline 25mg tablets | 84 tablet P £3.38 Powder for solution for injection ▶Hydralazine hydrochloride (Non-proprietary) Hydralazine hydrochloride 20 mg Hydralazine 20mg powder for concentrate for solution for injection ampoules | 5 ampoule P £74.17

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Dose text by age group

Adult

Initially 25 mg twice daily, increased if necessary

First-line fragment. Read the complete Indications and Dose section above.

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Adult

Initially 25 mg 3–4 times a day, subsequent

First-line fragment. Read the complete Indications and Dose section above.

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Adult

Initially 200–300 micrograms/minute; usual

First-line fragment. Read the complete Indications and Dose section above.

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Adult

5–10 mg, to be diluted with 10 mL sodium

First-line fragment. Read the complete Indications and Dose section above.

PDF page 214

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Hydralazine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 214

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 214

Contra Indications

PDF page 214

Cautions

PDF page 214

Safety

Interactions

→Appendix 1: hydralazine

PDF page 214

Side Effects

PDF page 214

Pregnancy

Neonatal thrombocytopenia reported, but risk should be balanced against risk of uncontrolled maternal hypertension. Manufacturer advises avoid before third trimester.

PDF page 214

Breast Feeding

Present in milk but not known to be harmful. Monitoring Monitor infant in breast-feeding.

PDF page 214

Hepatic Impairment

Manufacturer advises caution (risk of accumulation). Dose adjustments Manufacturer advises adjust dose or dosing interval according to clinical response.

PDF page 214

Renal Impairment

Dose adjustments Reduce dose if eGFR less than 30 mL/minute/1.73 m2.

PDF page 214

Monitoring Requirements

PDF page 214

Dose and formulations

Directions For Administration

For intravenous infusion (Apresoline ®) give continuously in Sodium chloride 0.9%. Suggested infusion volume 500 mL.

PDF page 214

Medicinal Forms

PDF page 214

Dose text by age group

Adult

Initially 25 mg twice daily, increased if necessary

First-line fragment. Read the complete Indications and Dose section above.

PDF page 214

Adult

Initially 25 mg 3–4 times a day, subsequent

First-line fragment. Read the complete Indications and Dose section above.

PDF page 214

Adult

Initially 200–300 micrograms/minute; usual

First-line fragment. Read the complete Indications and Dose section above.

PDF page 214

Adult

5–10 mg, to be diluted with 10 mL sodium

First-line fragment. Read the complete Indications and Dose section above.

PDF page 214

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.