Names and pronunciation
(hye-dral′a-zeen) Apresoline
Source page 646
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Individual generic drug information
Extracted information for hydrALAZINE only.
(hye-dral′a-zeen) Apresoline
Source page 646
Func. class.: Antihypertensive, direct- acting peripheral vasodilator
Source page 646
Chem. class.: Phthalazine
Source page 646
Do not confuse: hydrALAZINE/hydrOXYzine
Source page 646
ACTION: Vasodilates arteriolar smooth muscle by direct relaxation; reduction in blood pressure with reflex increases in heart rate, stroke volume, cardiac output
Source pages 646, 647
USES: Essential hypertension; hyper- tensive emergency/urgency
Source page 647
Unlabeled uses: HF
Source page 647
Extracted information for hydrALAZINE only.
CONTRAINDICATIONS: Hyper- sensitivity to hydrALAZINEs, mitral valvu- lar rheumatic heart disease, CAD Precautions: Pregnancy, breastfeeding, geriatric patients, CVA, advanced renal disease, hepatic disease, SLE, dissecting aortic aneurysm
Source page 647
SIDE EFFECTS CNS: Headache, dizziness, drowsiness, peripheral neuritis CV: Palpitations, tachycardia, angina, orthostatic hypotension, shock GI: Nausea, vomiting, anorexia, diar- rhea, hepatotoxicity EENT: Nasal congestion RESP: Dyspnea HEMA: Agranulocytosis GU: Urinary retention INTEG: Rash, pruritus, flushing MISC: Lupuslike symptoms, muscle cramps
Source page 647
INTERACTIONS Increase: Severe hypotension risk—MAOIs Increase: Tachycardia, angina—sympatho- mimetics (EPINEPHrine, norepinephrine) Increase: Hypotension—other antihy- pertensives, alcohol, thiazide diuretics Increase: Effects of beta-blockers (metoprolol, propranolol) Decrease: HydrALAZINE effects—NSAIDs, estrogens Drug/Lab Test Decrease: HB, WBC, RBC, platelets, neutrophils Positive: ANA titer Drug/Food Increase: drug absorption; have patient take with food
Source pages 647, 648
TREATMENT OF OVERDOSE: Administer vasopressors, volume expanders for shock; if PO, lavage if recently ingested, digitalization
Source page 648
Extracted information for hydrALAZINE only.
DOSAGE AND ROUTES Hypertension • Adult: PO 10 mg qid 2-4 days, then 25 mg for rest of 1st wk, then 50 mg qid, max 300 mg/day • Child ≥1 yr (unlabeled): PO 0.75-1 mg/ kg/day in 2-4 divided doses, max 25 mg/ dose, increase over 3-4 wk to max 7.5 mg/ kg/day or 200 mg, whichever is less Hypertensive crisis • Adult: IV BOL 10-20 mg q4-6hr, ad- minister PO as soon as possible; IM 10- 50 mg q4-6hr • Child: IM/IV BOL 0.1-0.2 mg/kg/dose q4hr as needed Preeclampsia/eclampsia Adult female IV 5-10 mg over 2 min HF (unlabeled) • Adult: PO 10-25 mg tid, max 100 mg tid
Source page 647
Available forms: Inj 20 mg/mL; tabs 10, 25, 50, 100 mg
Source page 647
Administer: PO route • Give with meals (PO) to enhance ab- sorption IM route • Do not admix, switch to PO as soon as possible, use only in those that cannot use PO • No dilution needed, inject deeply in large muscle, aspirate Direct IV route • IV undiluted; give through Y-tube or 3-way stopcock, give each 10 mg over ≥1 min • To recumbent patient, keep recum- bent for 1 hr after administration compatibilities: Alemtuzumab, Y-site anidulafungin, argatroban, atenolol, bivali- rudin, bleomycin, DACTINomycin, DAPTO- mycin, dexrazoxone, diltiazem, DOCEtaxel, etoposide, fludarabine, gatifloxacin, gem- citabine, granisetron, HYDROmorphone, IDArubicin, irinotecan, leucovorin, line- zolid, mechlorethamine, metroNIDAZOLE, milrinone, mitoXANtrone, octreotide, oxaliplatin, PACLitaxel, palonosetron, pan- curonium, potassium chloride, tacroli- mus, teniposide, thiotepa, tirofiban, vecuronium, vinorelbine, vitamin B/C, voriconazole H
Source page 647
Extracted information for hydrALAZINE only.
Assess: • Cardiac status: B/P q15min × 2 hr, then q1hr × 2 hr, then q4hr after IV dose; pulse, jugular venous distention q4hr, after IV administration • Electrolytes, blood studies: potassium, sodium, chloride, carbon dioxide, CBC, serum glucose, LE prep, ANA titer before, during treatment; assess for fever, joint pain, rash, sore throat (lupuslike symp- toms); notify prescriber • Number of refills to determine com- pliance (PO) • Weight daily, I&O, edema in feet, legs daily, skin turgor, dryness of mucous membranes for hydration status • For renal disease: dosage and admin- istration are altered in reduced CCr, dialysis • Crackles, dyspnea, orthopnea • IV site for extravasation, rate • Mental status: affect, mood, behavior, anxiety; check for personality changes • Beers: use with caution in older adults; may exacerbate syncope in those with a history of syncope • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; 3rd-trimes- ter toxicity has occurred; use caution in breastfeeding
Source page 648
Evaluate: • Therapeutic response: decreased B/P
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CLINICAL CONSIDERATIONS
Source page 648
Patient and caregiver information: • To take with food to increase bioavail- ability (PO) • To avoid OTC, herbals, supplements unless directed by prescriber • To notify prescriber if chest pain, se- vere fatigue, fever, muscle or joint pain, rash, sore throat; tingling, pain in hands, feet, pyridoxine can be used • To rise slowly to prevent orthostatic hypotension • That follow-up will be needed; to comply with other requirements, such as exercise, weight loss, avoidance of smoking • To notify providers of product use prior to surgery • To avoid driving or other hazardous activities until response is known; drows- iness, dizziness may occur • To weigh 2× per wk and check lower extremities for swelling • To take as prescribed, not to skip or double doses, to take at the same time of the day, if dose is missed, take when remembered, do not discontinue abruptly • To notify prescriber if pregnancy is suspected or planned or if breastfeeding
Source page 648
Extracted information for hydrALAZINE only.
PHARMACOKINETICS Half-life 3-7 hr, metabolized by liver, 12%-14% excreted in urine, protein binding 89%; half of Mexicans, blacks, South Indians, and Caucasians are at risk for toxicity PO: Onset 20-30 min, peak 1-2 hr, dura- tion 2-4 hr IM: Onset 10-30 min, peak 1 hr, duration 2-6 hr IV: Onset 5-30 min, peak 10-80 min, duration up to 12 hr
Source page 647
Filter the extracted dose blocks for this individual drug.
Hypertension
• Adult: PO 10 mg qid 2-4 days, then 25 mg for rest of 1st wk, then 50 mg qid, max 300 mg/day
Candidate age grouping · source page 647
Hypertension
• Child ≥1 yr (unlabeled): PO 0.75-1 mg/ kg/day in 2-4 divided doses, max 25 mg/ dose, increase over 3-4 wk to max 7.5 mg/ kg/day or 200 mg, whichever is less Hypertensive crisis
Candidate age grouping · source page 647
Hypertension
• Adult: IV BOL 10-20 mg q4-6hr, ad- minister PO as soon as possible; IM 10- 50 mg q4-6hr
Candidate age grouping · source page 647
Hypertension
• Child: IM/IV BOL 0.1-0.2 mg/kg/dose q4hr as needed Preeclampsia/eclampsia Adult female IV 5-10 mg over 2 min HF (unlabeled)
Candidate age grouping · source page 647
Hypertension
• Adult: PO 10-25 mg tid, max 100 mg tid
Candidate age grouping · source page 647