Hydralazine
APRESOLINE
Pronunciation: hye-DRAL-a-zeen
“Hydraulic Ape pressure”
What it isArteriolar vasodilator of uncertain primary mechanism; resistant hypertension and, with nitrates, systolic heart failure.
Why this oneWith isosorbide dinitrate, improves heart-failure survival in Black patients; usable in pregnancy when RAAS blockers are not.
What limits itReflex tachycardia and fluid retention require companion therapy; frequent dosing hurts adherence. Long use can cause lupus and neuropathy.
Pearls
- Cap maintenance at 200 mg/day to limit lupus risk.
- Can aggravate angina; pair with a beta blocker and diuretic.
Hydralazine prescription history
Animated chart of estimated U.S. prescriptions per year, Antihypertensives (1953–2026). Hydralazine enters in 1953 (estimated).
FDA-approved for
- hypertension (~1953)
Off-label
- heart failure (with nitrates)
Principal riskReflex tachycardia; drug-induced lupus with prolonged use
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | adult | 10 mg QID x2-4 days | 50 mg QID | 300 mg/day (resistant cases) |
Titration Increase after 2-4 days (to 25 mg QID), then at 1 week (to 50 mg QID)
Renal Undefined
Hepatic Undefined
Instructions
- Titrate to individual response; maintain lowest effective dose
Available strengths
- tab 10, 25, 50, 100 mg
- inj 20 mg/mL
Contraindications
- Coronary artery disease
- Mitral valvular rheumatic heart disease
Cautions
- Systemic lupus erythematosus-like syndrome with high/prolonged dosing
- Peripheral neuritis (paresthesia, numbness)
- Blood dyscrasias (agranulocytosis, leukopenia, purpura)
- May precipitate angina / paradoxical pressor response
Adverse reactions
- Headache
- Anorexia, nausea, vomiting, diarrhea
- Palpitations, tachycardia
- Angina pectoris
Pregnancy Category C; use only if expected benefit justifies fetal risk
Lactation Undefined
Cost
Generic entry1982
Open Hydralazine in the interactive console ↗
Memory aids: interaction avatars
Open Hydralazine in the interactive console ↗
Self-check
- Which partner gives hydralazine a heart-failure survival role?
A nitrate. - Which autoimmune syndrome can long-term hydralazine cause?
Lupus.