| Name: |
HYDRALAZINE (ApresolineR) |
| Classification: |
Vasodilator - antihypertensive agent
- Reduces systemic vascular resistance by direct relaxation of vascular smooth muscle
- Rreduces pulmonary vascular resistance
- Dilates renal arterioles
|
| Dose: |
Intermittent doses
- 5-40 mg IV direct (every 3-6 hours as needed)
- Eclampsia: 5-10 mg every 20-30 minutes as needed
- Maximum dose 300-400 mg/24 hours
- Increase dosing intervals in renal failure:
- Creatinine Clearance 10-50 mL/min, increase frequency to Q8H
- Creatinine Clearance less than 10 mL/min, increase frequency to Q8-16 hours
Infusions
- Loading dose: 0.1 mg/kg
- Continuous infusion 1.5-5 mcg/kg/min
|
| Administration: |
- IV Direct:
- Maximum rate of injection 5 mg/min
- IV Infusion:
- Hypovolemia should be corrected concurrently with therapy
- Should be weaned off
DO NOT DILUTE IN DEXTROSE CONTAINING SOLUTIONS
|
| Contraindications: |
- Hypersensitivity to hydralazine or its components
- Systemic Lupus Erythematosus
- Tachycardia and heart failure with high cardiac output
- Myocardial insufficiency due to mechanical obstruction
- Acute dissecting aneurysm of the aorta, coronary artery disease, rheumatic mitral valve disease,cor pulmonale
|
| Adverse Effects: |
- Tachycardias
- Arrhythmias, palpitations
- Hypovolemia
- Hypotension, orthostatic hypotension
- Edema
- Malaise, fever, headache, dizziness
- Rash
- Anorexia, nausea, vomiting, diarrhea
- Arthralgia, weakness, pyridoxine deficiency-induced peripheral neuropathy
- rheumatoid syndrome---systemic lupus erythematosus like syndrome, positive ANA, positive LE cells
- Risk of hemorrhage in patients with cerebral or abdominal aneurysms due to speed of blood flow
- May worsen a pulmonary shunt
|
| Monitoring Therapy: |
- Continuous heart rate and ECG rhythm
- Blood pressure
- Hourly urine output
- Lactate
- Skin
- Joint appearance and mobility
|
| Adult Critical Care Protocol: |
- May be administered by IV infusion by a nurse in Adult Critical Care.
- May be administered IV direct by an approved nurse in the CCTC at a rate < 5mg/min.
- May be titrated by a nurse in Adult Critical Care.
- Central line is preferred.
- Patient requires placement of an arterial line to monitor BP when administered by continuous infusion.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.
- Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).
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