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(high-DRAL-uh-zeen HIGH-droe-KLOR-ide)
Apresoline,  Apo-Hydralazine, Novo-Hylazin, Nu-Hydral
Class: Antihypertensive/Vasodilator

 Action Directly relaxes vascular smooth muscle to cause peripheral vasodilation, decreasing arterial BP and peripheral vascular resistance.

 Indications Treatment of essential hypertension (oral form). Treatment of severe essential hypertension (parenteral form). Unlabeled use(s): Reduction of overload in treatment of CHF, severe aortic insufficiency, and after valve replacement.

 Contraindications Coronary artery disease; mitral valvular rheumatic heart disease.

 Route/Dosage

Adjust individually. ADULTS: PO Begin with 10 mg qid for 2 to 4 days; then 25 mg qid for 3 to 5 days; then 50 mg qid (maximum 300 mg/day). IV/IM 20 to 40 mg repeated prn. CHILDREN: PO 0.75 mg/kg/day in 4 divided doses initially; increase gradually over 3 to 4 wk to maximum of 7.5 mg/kg/day or 200 mg/day. IV/IM 0.1 to 0.2 mg/kg/dose q 4 to 6 hr prn.

 Interactions

Beta-blockers: May increase effect of hydralazine or effect of beta-blockers. NSAIDs: Effects of hydralazine may be decreased.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia; angina pectoris; edema. CNS: Headache; peripheral neuritis with paresthesias, numbness and tingling; dizziness; tremors; depression; disorientation; anxiety. EENT: Lacrimation; conjunctivitis. GI: Anorexia; nausea; vomiting; diarrhea; constipation. HEMA: Blood dyscrasias; decreased hemoglobin; decreased RBC; leukopenia; agranulocytosis. OTHER: Hypersensitivity (eg, rash, urticaria, pruritus, fever, chills, arthralgia, eosinophilia); systemic lupus erythematosus.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy have not been established by controlled clinical trials, but there is experience with its use. Lupus erythematosus: Drug may produce clinical picture similar to that with systemic lupus erythematosus (eg, arthralgia, dermatoses, fever, splenomegaly), including glomerulonephritis, when > 50 mg/day is given for long periods. Symptoms usually reverse when drug is discontinued, but treatment may be required. Renal impairment: Use drug with caution in patients with advanced renal damage. Tartrazine sensitivity: Some of these products contain tartrazine, which can cause allergic-type reactions in susceptible individuals, especially those who have aspirin hypersensitivity.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer oral form of drug with food.
  • Use parenteral form immediately after drawn into syringe.
  • Parenteral solution discolors after contact with metal filter.
  • Store at room temperature.

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies. Note use of other medications (particularly beta-blockers and NSAIDs), coronary artery disease, mitral valvular rheumatic heart disease, renal impairment, lupus erythematosus, pregnancy, lactation.
  • Monitor BP prior to and frequently during IV administration.
  • Monitor CBC and antinuclear antibody titer.
  • Monitor for orthostatic hypotension.
  • If decreased hemoglobin or RBC, leukopenia, agranulocytosis or purpura occur, report to health care provider.
  • If symptoms of lupus erythematosus or positive antinuclear antibody titer occur, notify health care provider.
  • If hypotension occurs during therapy, caution patient to sit or lie down (with head in low position). Discontinue drug and notify health care provider.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension, tachycardia, headache, flushing, MI, myocardial ischemia, cardiac arrhythmias, profound shock

 Patient/Family Education

  • Instruct patient to take medication with meals to enhance absorption.
  • Caution patient to avoid abrupt discontinuation of drug to prevent sudden increase in BP.
  • Encourage patient to make lifestyle changes: Weight reduction, sodium and alcohol restriction, discontinuance of smoking, regular exercise, and behavior modification.
  • Advise patient to monitor BP and weight regularly.
  • Instruct patient to report sudden weight gain caused by fluid retention.
  • Advise patient to follow health care provider’s orders for monitoring of CBC and other laboratory values.
  • Advise patient to avoid sudden changes in position or very hot baths to avoid orthostatic hypotension.
  • Caution patient not to take otc medications without consulting health care provider.
  • Instruct patient to report these symptoms to health care provider: Prolonged tiredness, muscle or joint pain, chest pain, fever, numbness or tingling of hands or feet, rash.
  • Explain that drug may cause drowsiness and to use caution when driving or performing other tasks requiring mental alertness.

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