hydralazine hydrochloride

CLINICAL USE

Vasodilator antihypertensive agent

DOSE IN NORMAL RENAL FUNCTION

Oral: Hypertension: 25–50 mg twice daily; —maximum daily dose 100 mg in women and slow acetylators, 200 mg in fast acetylatorsHeart failure: 25–75 mg 3–4 times daily —IV: slow IV injection: 5–10 mg over 20 minutes; repeat after 20–30 minutes if necessaryInfusion: 200–300 micrograms/minute initially, reducing to 50–150 micrograms/minute

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :196.6

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :87

%Excreted unchanged in urine &nbsp &nbsp : 2–14

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.5–0.9

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2–4/16

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Start at low dose and adjust in accordance with response

10 to 20 &nbsp &nbsp : Start at low dose and adjust in accordance with response

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Start at low dose and adjust in accordance with response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: increased hypotensive effects

ADMINISTRATION

Reconstition

20 mg with 1 mL water for injection then dilute with 10 mL sodium chloride 0.9% for IV injection or 500 mL sodium chloride 0.9% for

IV infusion

Route

Oral, IV peripherally

Rate of Administration

As above

Comments

Minimum volume of 60 mg in 60 mL.

OTHER INFORMATION

Avoid long-term use in severe renal insufficiency and dialysis patients, due to accumulation of metaboliteshydralazine hydrochloride.

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