Apresazide

1 What is Apresazide?

Brand: Apresazide

Generic: Hydralazine and Hydrochlorothiazide

Apresazide is often used to lower blood pressure in hypertension. Hypertension is a very common disorder, particularly past middle age. It is not a disease in itself but is an important risk factor for cardiovascular mortality and morbidity.

If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. These problems may be less likely to occur if blood pressure is controlled.

Hydralazine is used as a second-line alternative only in combination with a diuretic and/or beta blocker for patients not achieving target blood pressure with first line drugs. It works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload.

On the contrary, hydrochlorothiazide is a type of medicine known as a thiazide diuretic and helps reduce the amount of water in the body by inhibiting the reabsorption of sodium and chloride in the distal tubules causing increased excretion of water.

This medicine is available only with your doctor's prescription. This product is available in the following dosage forms:

  • Capsule
  • Tablet

2 What to Know Before Using

Before using Apresazide, you must know all about the risks and complications associated with it. The suitable drug therapy is usually chosen by a doctor with the active participation of the patient.

There are some important factors such as drug interactions, the presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. which may alter the desired therapeutic effects of a medicine.

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. If you have had any allergic reactions to any medicine then you must tell your doctor about that.

The use of this combination drug is contraindicated in those who are hypersensitive to this drug or any of the components of the formulation.

Make sure you inform your doctor if you have any other medical problems, especially:

  • Cardiovascular disease (e.g., coronary artery disease)
  • Electrolyte imbalance (e.g., hypochloremia, hypokalemia, hypomagnesemia, hyponatremia)
  • History of gout
  • Hyperuricemia (high uric acid in the blood)—Hydrochlorothiazide may increase the amount of uric acid in the blood, which can lead to gout.
  • Stroke—Lowering blood pressure may make problems resulting from these conditions worse.
  • Parathyroid disease
  • Systemic lupus erythematosus—Use with caution. This medicine may make these conditions worse.
  • Kidney disease—Hydrochlorothiazide may worsen this condition. Also, the blood pressure lowering effects may be increased because of slower removal of hydralazine from the body.
  • Liver disease—If hydrochlorothiazide causes loss of too much water from the body, liver disease can become much worse.
  • Sympathectomy—Use with caution. The effects of this medicine may be increased.
  • Type 2 diabetes mellitus—Hydrochlorothiazide may change the amount of diabetes medicine needed.

Because of drug-drug interactions, certain medicines should not be used along with this medicine. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects.

The following drug interactions should be kept in mind:

  • Profound hypotensive episodes may occur when diazoxide injections and hydralazine are used concomitantly.
  • Concurrent administration of some nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the diuretic, natriuretic and antihypertensive effects of hydrochlorothiazide.
  • Hydrochlorothiazide may decrease arterial responsiveness to norepinephrine, but not enough to preclude effectiveness of the pressor agent for therapeutic use.
  • Hydrochlorothiazide may increase the responsiveness to tubocurarine.
  • Hypokalemia may develop during concomitant use of steroids or ACTH.
  • Hypokalemia can sensitize or exaggerate the response of the heart to the toxic effects of digitalis (e.g., increased ventricular irritability).
  • Insulin requirements in diabetic patients may be increased, decreased, or unchanged.
  • Lithium renal clearance is reduced by hydrochlorothiazide, increasing the risk of lithium toxicity.
  • There have been rare reports in the literature of hemolytic anemia occurring with the concomitant use of hydrochlorothiazide and methyldopa.

Animal reproduction studies have shown an adverse effect, and there are no adequate and well-controlled studies in pregnant women. Thus, this drug should be used during pregnancy only if clearly needed.

Besides, caution should be exercised when used in lactating women because there are no adequate studies in women for determining infant risk when using this medication during breastfeeding.

3 Proper Usage

To use Apresazide properly, you must follow all instructions given by your doctor. The dosage schedule and the duration of drug therapy should be individualized and determined based on the physician’s advice.

The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well. This medicine comes with patient information.

You should read and follow the instructions carefully before using this medicine; however, the dosage schedule to control high blood pressure is listed below:

For oral dosage forms (capsules):

  • Adults—1 capsule two times a day.
  • Children—Use and dose must be determined by your doctor.

Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down.

You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Above all, you should use this medicine following the directions were given by your doctor. If you miss a dose of this medicine, take it as soon as possible. But, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Do not use this drug in larger amounts, more often, or for a longer time than your doctor ordered. Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light.

All kinds of medicines should be kept out of the reach of children. However, outdated medicines should be disposed of by an appropriate way.

4 Precautions to Take

Before using Apresazide, there are some precautions you must take. Firstly, regular visits to your doctor are recommended to check that this medicine is working properly or not.

Additionally, the following guidelines should be followed to prevent unwanted complications as well as for the better prognosis of the patients:

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. This is more likely to occur in the morning. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.

The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for a long time, exercise, or if the weather is hot. While you are taking this medicine, be careful in the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for a long time.

This medicine may cause a loss of potassium from your body. To help prevent this, your doctor may want you to eat or drink foods that have a high potassium content (e.g., orange or other citrus fruit juices), or take a potassium supplement, or take another medicine to help prevent the loss of the potassium in the first place.

Hydrochlorothiazide may decrease serum levels of protein-bound iodine without signs of thyroid disturbance. This drug should be discontinued before tests for parathyroid function are made.

When other potent parenteral antihypertensive drugs, such as diazoxide, are used in combination with hydralazine, patients should be continuously observed for several hours for any excessive fall in blood pressure.

Thiazide diuretics (e.g., hydrochlorothiazide) may raise blood sugar levels. While you are using this medicine, be especially careful in testing for sugar in your blood or urine.

Some people who take this medicine may become more sensitive to sunlight than they are normal. Exposure to sunlight, even for brief periods of time, may cause severe sunburn; skin rash, redness, itching, or discoloration; or vision changes.

When you begin taking this medicine, you should stay out of direct sunlight. You can wear protective clothing, including a hat and sunglasses. Also, you can apply a sun block product that has a skin protection factor (SPF) of at least 15.

In addition to the use of the medicine, your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Check with your doctor if you become sick and have severe or continuing nausea, vomiting, or diarrhea. These problems may cause you to lose additional water and potassium.

5 Potential Side Effects

Make sure you meet with your doctor in using Apresazide to avoid unwanted potential side effects. Along with the beneficial effects, this medicine may cause some unwanted effects that may not need any medical attention.

These side effects usually go away during the treatment episode as your body adjusts to the medicine. Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects.

Sometimes you may need to consult with the doctor if you notice any of the following toxic effects:

Signs and symptoms suggesting decreased potassium level:

  • Dryness of mouth
  • Increased thirst
  • Irregular heartbeats
  • Mood or mental changes
  • Muscle cramps or pain
  • Weak pulse

Signs and symptoms suggesting decreased sodium level:

  • Confusion
  • Convulsions
  • Decreased mental activity
  • Irritability
  • Muscle cramps
  • Unusual tiredness or weakness

More common:

Less common:

  • Blisters on skin
  • Chest pain
  • Constipation
  • Decreased sexual ability
  • Generalized weakness
  • Joint pain
  • Increased sensitivity of skin to sunlight
  • Numbness, tingling, pain, or weakness in hands or feet
  • Redness or flushing of face
  • Shortness of breath with exercise or work
  • Stuffy nose
  • Skin rash or itching
  • A sore throat and fever
  • Swelling of the lymph glands
  • Watering or irritated eyes

Rare:

  • Lower back or side pain
  • Severe stomach pain with nausea and vomiting
  • Unusual bleeding or bruising
  • Yellow eyes or skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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