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Hydralazine
Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure
⚠️ Slow acetylators are at greater risk of hydralazine toxicity. 💡 In these patients, adverse effects such as profound hypotension or a lupus-like syndrome are more common.
💊 About: Always check the BNF link here
- 🔹 Potent arterial vasodilator.
- 📈 Causes reflex tachycardia and increased cardiac output.
⚙️ Mode of Action
- 🧪 Direct vascular smooth muscle relaxant.
- ⬆️ Increases intracellular cGMP, enhancing nitric oxide–mediated vasodilation.
- 📉 Lowers afterload, useful in resistant hypertension and heart failure (when combined with nitrates).
🎯 Indications
- 💔 Congestive cardiac failure (CCF) – usually in combination with nitrates (e.g. hydralazine + isosorbide dinitrate in HFrEF, esp. in Afro-Caribbean patients per NICE/ESC guidelines).
- 📉 Severe or resistant hypertension (not first-line).
- 🤰 Hypertension in pregnancy (can be used IV in pre-eclampsia emergencies).
📊 Dose (BNF guidance – check individualisation)
- ➡️ Oral: 25 mg PO BD, titrate up to 50 mg BD.
- ➡️ IV (acute use): 5–10 mg slow IV in normal saline (may repeat as needed under close monitoring).
🔄 Interactions
- ⬇️ Additive hypotension with other antihypertensives, nitrates, or alcohol.
- ⚠️ May potentiate reflex tachycardia if used with vasodilators.
⛔ Contraindications
- ⚠️ Ischaemic heart disease – can worsen angina due to reflex tachycardia.
- 🚫 Severe tachycardia or high-output states.
⚠️ Side Effects
- ❤️ Reflex tachycardia (often requires co-administration of a beta-blocker).
- 🦋 Drug-induced lupus-like syndrome (check ANA, monitor urine for proteinuria) – risk higher with prolonged use, high doses, and in slow acetylators.
- 🤕 Headache, dizziness, flushing.
- 📉 Postural hypotension.
- 💩 Diarrhoea, GI upset.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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