1 What is Apresoline?

Brand: Apresoline, Novaplus, HydrALAZINE, Hydrochloride

Generic: Hydralazine

Apresoline is generally 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 now 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.

It is one of the preferred antihypertensive drugs during pregnancy, especially preeclampsia, because of decades of safety record. Parenterally, it is occasionally employed in hypertensive emergencies.

This medicine is to be given only by or under the direct supervision of your doctor. This product is available in the following dosage forms:

  • Solution

2 What to Know Before Using

Before using Apresoline, 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 hydralazine is contraindicated in those who are hypersensitive to this drug or any of the ingredients of the formulation. Also, this drug is contraindicated in older patients and in those with ischemic heart disease.

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

  • Angina (severe chest pain)
  • Blood disease
  • Cardiac rhythm problems
  • Coronary artery disease
  • Hypotension (low blood pressure)
  • Peripheral neuritis (nerve problem)
  • History of stroke
  • Systemic lupus erythematosus—may make these conditions worse.
  • Mitral valvular rheumatic heart disease—should not be used in patients with these conditions.
  • Myocardial infarction (history and/or recent)
  • Kidney disease—the effects may be increased because of slower removal of the medicine from the body.

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:

  • MAO inhibitors should be used with caution in patients receiving hydralazine.
  • Profound hypotensive episodes may occur when diazoxide injections and hydralazine are used concomitantly.

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 studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

3 Proper Usage

To use Apresoline 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; however, this medicine is usually given to the patients by a nurse or other trained health professional at your doctor’s chamber, hospital, or clinic. This injection is intended for intravenous or intramuscular use.

Hydralazine injection should be used only when the drug cannot be given orally. The usual dose is 20-40 mg, repeated as necessary. Certain patients (especially those with marked renal damage) may require a lower dose.

Blood pressure should be checked frequently. It may begin to fall within a few minutes after injection, with the average maximal decrease occurring in 10-80 minutes.

In cases where there has been increased intracranial pressure, lowering the blood pressure may increase cerebral ischemia. Most patients can be transferred to oral hydralazine hydrochloride within 24-48 hours.

Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. The product should be used immediately after the vial is opened.

It should not be added to infusion solutions. 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 Apresoline, 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:

Myocardial stimulation produced by hydralazine can cause anginal attacks and ECG changes of myocardial ischemia. The drug has been implicated in the production of myocardial infarction. It must, therefore, be used with caution in patients with suspected coronary artery disease.

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.

Hydralazine may cause some people to have headaches or to feel dizzy. Make sure you know how you react to hydralazine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Hydralazine injection may discolor upon contact with metal; discolored solutions should be discarded.

Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

5 Potential Side Effects

Make sure you meet with your doctor in using Apresoline to avoid unwanted potential side effects. Along with the beneficial effects, this medicine may cause some unwanted effects which are frequent and mainly due to vasodilatation.

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:

  • Facial flushing, conjunctival infection, throbbing headache, dizziness, palpitation, nasal stiffness, fluid retention, and edema are the most common side effects.
  • Angina and MI may be precipitated in patients with coronary artery disease.
  • Postural hypotension is not prominent because of little action on veins.
  • Paresthesias, tremor, muscle cramps, rarely peripheral neuritis.
  • Lupus erythematosus or rheumatoid arthritis like symptoms develop on prolonged use of doses above 100 mg/day. This is more common in women and in slow acetylators.

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