From the Research
Hydralazine should be avoided in patients with acute liver failure due to the risk of worsening liver dysfunction and potential for severe adverse effects, as evidenced by a recent case report of hydralazine-induced fulminant liver failure requiring liver transplant 1.
Key Considerations
- Hydralazine is metabolized by the liver and can accumulate in patients with impaired liver function, leading to increased risk of adverse effects such as hypotension, tachycardia, headache, and fluid retention.
- The drug has been associated with rare cases of drug-induced liver injury, which could potentially worsen existing liver dysfunction 2, 3.
- Alternative antihypertensives that are less dependent on hepatic metabolism, such as certain calcium channel blockers or nitrates, might be safer options in acute liver failure.
Management of Acute Liver Failure
- Optimal management begins with identifying that liver failure is indeed present and its etiology, since outcomes and the need for transplantation vary widely across the different etiologies 4.
- Management involves optimizing fluid balance and cardiovascular support, including the use of continuous renal replacement therapy, vasopressors, and pulmonary ventilation.
- Early evaluation for liver transplantation is advised particularly for acetaminophen toxicity, which evolves so rapidly that delay is likely to lead to death.
Monitoring and Precautions
- Close monitoring of blood pressure, heart rate, and liver function tests is crucial if hydralazine must be used in patients with acute liver failure.
- Patients should be closely monitored for signs of worsening liver dysfunction, such as increased liver enzymes, coagulopathy, and encephalopathy.
- Alternative treatments, such as liver support devices and/or agents that improve hepatocyte regeneration, may be considered in the future 4.