Direct vasodilator
Hydralazine hydrochloride
Brand names: Apresoline
Adult dose
Dose: PO 25–50mg BD–QDS (max 200mg/day). IV (hypertensive emergency, esp. pregnancy): 5–10mg slow IV every 20–30 min, or 200–300 micrograms/min infusion
Route: PO/IV/IM
Frequency: BD-QDS
Clinical pearls
- IV hydralazine is a workhorse for hypertensive emergency in pregnancy/eclampsia (alongside labetalol)
- Combine with nitrate + diuretic in HFrEF (especially Black patients)
- Pre-treat with β-blocker to limit reflex tachycardia
Contraindications
- SLE
- Severe tachycardia
- High-output heart failure
- Cor pulmonale
- Dissecting aortic aneurysm
- Idiopathic SLE
Side effects
- Reflex tachycardia
- Headache
- Drug-induced lupus
- Fluid retention
- Polyneuropathy (with isoniazid)
Interactions
- Other antihypertensives (additive)
- NSAIDs (reduce effect)
- MAOIs
Monitoring
- BP
- HR
- ANA if long-term
- FBC
Reference: BNF; NICE NG133; ESC guidelines; https://bnf.nice.org.uk/drugs/hydralazine-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines