Hydralazine
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Trade Name
Apresoline (primary brand name); generic hydralazine
Classification
Antihypertensive; direct-acting vasodilator
Dosage/Route
- * Dosage: Tablets: 10 mg, 25 mg, 50 mg, 100 mg; Injection: 20 mg/mL
- * Route: Oral (PO), intravenous (IV), intramuscular (IM)
Usual Dosage
- * Oral (Hypertension): Start 10 mg PO 4 times daily (QID); increase gradually to 25-50 mg QID; max 300 mg/day
- * IV/IM (Hypertensive Emergency): 10-20 mg every 4-6 hours as needed; max 40 mg/dose or 400 mg/day
- * Dose adjustments based on response; often combined with other antihypertensives
Mechanism of Action
Directly relaxes arterial smooth muscle, causing vasodilation and reducing peripheral resistance. Lowers blood pressure by decreasing afterload; minimal effect on veins. Reflex tachycardia often occurs due to baroreceptor response
Side Effects & Adverse Effects
- * Side Effects: Headache, tachycardia, palpitations, nausea, flushing
- * Adverse Effects:
- – Hypotension (esp. IV; can be severe)
- – Lupus-like syndrome (rare, with prolonged high doses; joint pain, rash, fever)
- – Angina (due to tachycardia in CAD patients)
- – Fluid retention (edema)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor BP and pulse frequently (esp. IV; q5-15 min during administration)
- – Assess for orthostatic hypotension (position changes)
- – Watch for lupus symptoms (arthralgia, rash) with long-term use
- – IV: Give undiluted, slow push over 1-2 min; change to PO when stable
- * Teachings:
- – Take with food to reduce GI upset
- – Rise slowly to avoid dizziness/fainting
- – Report chest pain, fast heartbeat, or joint pain
- – Avoid skipping doses; may be paired with beta-blocker/diuretic
Indication for This Patient
- * Hypertension (moderate to severe; often adjunctive).
- * Hypertensive emergency (IV; e.g., preeclampsia, acute BP spikes).
- * Heart failure (with nitrates, esp. in patients intolerant to ACE inhibitors)
Time
- * Timing: PO: 4 times daily; IV/IM: every 4-6 hours PRN in emergencies
- * Onset: PO: 20-30 min; IV: 5-20 min
- * Peak: PO: 1-2 hours; IV: 10-80 min
- * Duration: PO: 6-12 hours; IV: 3-6 hours
