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Therapeutic class: Antihypertensive; vasodilator
Generic Name: Hydralazine
Trade Name: Apresoline (only available in Canada)

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This drug is used to manage moderate to severe hypertension (high blood pressure).

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Routes: IV (slow push), oral, IM (undiluted)
Doses:  Dosing is specific to the reason for taking this drug-

For chronic hypertension:  The usual dosage range is between 100 to 200 mg/day in divided doses. The maximum dose is 300 mg/day in divided doses.

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Onset: The effects begin within 45 minutes when administered IV and within 10 minutes when administered PO.
Duration: The drug effects last 2-4 hours when given IV and 6 hours or more when administered orally (PO).
Absorption: Rapid absorption (oral)
Metabolism: Hydralazine has an extensive first-pass effect when administered PO. Eliminated with a half life of 3-7 hours.
Excretion: This drug is excreted through the urine.

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Prior to medication administration: To confirm indication for administration, assess patient for signs and symptoms of hypertension, pre-eclampsia, eclampsia, or hypertensive crisis. If pregnant, assess baseline maternal vital signs and the fetal heart rate (FHR) pattern (Elsevier, 2021). Conduct a medication review to ensure that the patient is not currently taking MAOIs.  A complete blood count (CBC) and antinuclear antibody (ANA) titer should be obtained prior to administration and periodically during therapy (Elsevier, 2021).

During medication administration:  If administered orally, the drug may be ingested with meals, as food enhances bioavailability (Lexicomp, 2022). Orthostatic precautions should be observed and BP monitored closely during and following infusion.  Monitor for signs and symptoms of hydralazine toxicity such as hypotension, tachycardia, headache, and skin flushing (FDA, 2013). Vital signs should be assessed frequently until BP stabilizes to the desired level. If the patient is pregnant, monitor the FHR pattern during administration (Elsevier, 2021).

Post medication administration:  Monitor the patient's input and output, as Hydralazine may cause diarrhea and dehydration. In pregnant patients, maternal vital signs and FHR should be closely monitored because of the potential adverse and allergic reactions. Educate the patient on the importance of changing positions slowly to prevent orthostatic hypotension (Elsevier, 2021). CBC and ANA test should be assessed periodically after administration and monitored for possible blood dyscrasias and other abnormalities (FDA, 2013).

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Burchum, J. & Rosenthal, L. (2019). Lehne's pharmacology for nursing care. Saunders

Food and Drug Administration (FDA) (2013). Hydralazine Hydrochloride Injection, USP Rx Only. American Regent, Inc. Shirley, NY https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/040136s005lbl.pdf

Elsevier (29 July,2021), Hydralazine (Maternal-Newborn)-CE, Clinical Skills https://elsevier.health/en-US/preview/hydralazine

Lexicomp. (September 21, 2022). Hydralazine (Lexi-Drugs). https://online-lexi-com.proxygw.wrlc.org/lco/action/doc/retrieve/docid/patch_f/7034?cesid=0cSm0ZAdRdq&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DhydrALAZINE%26t%3Dname%26acs%3Dtrue%26acq%3Dhydral#

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Common: You may experience a headache, weakness, dizziness, or fatigue.
Serious:

Signs of lupus- rash on cheeks, easily sunburned, muscle/joint pain, shortness of breath, swelling in arms or legs

Chest pain or pressure

Fast or abnormal heartbeat

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What is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving Hydralazine?
a) Pain
b) I&O
c) Vision
d) Family history

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The exact mechanism of action is unknown. This drug works by widening, or dilating, the small branches of the arteries that lead into capillaries (arterioles).  By dilating these resistance vessels (arterioles), this decreases the cardiac afterload. This allows your heart to pump more blood with each contraction.

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