From the Guidelines
Hydralazine should be dosed at 25 mg three times daily and titrated upward to the maximum dose, as recommended for the treatment of resistant hypertension 1. The dosing of hydralazine is crucial for effective management of hypertension and heart failure.
- The initial dose of 25 mg three times daily can be adjusted based on the patient's response to the medication.
- In patients with congestive heart failure with reduced ejection fraction, hydralazine should be administered on a background of isosorbide mononitrate 30 mg daily, with a maximum dose of 90 mg daily 1.
- It is essential to monitor patients for potential side effects, such as headache, tachycardia, and fluid retention, which may require concurrent use of beta-blockers and diuretics.
- Long-term use of hydralazine also requires monitoring for drug-induced lupus-like syndrome, particularly in slow acetylators. The most recent and highest quality study 1 provides the best evidence for the dosing and administration of hydralazine, and its recommendations should be followed to ensure optimal patient outcomes.
- Other studies, such as 1, provide information on the dosing of other medications used in the treatment of heart failure, but they do not supersede the recommendations for hydralazine dosing provided in 1.
From the FDA Drug Label
The usual recommended oral starting dosage is 0.75 mg/kg of body weight daily in four divided doses. Dosage may be increased gradually over the next 3 to 4 weeks to a maximum of 7. 5 mg/kg or 200 mg daily.
The recommended dose and frequency of Hydralazine (Apresoline) for treatment is:
- Starting dosage: 0.75 mg/kg of body weight daily in four divided doses.
- Maximum dosage: 7.5 mg/kg or 200 mg daily. 2
From the Research
Recommended Dose and Frequency of Hydralazine
The recommended dose and frequency of Hydralazine (Apresoline) for treatment can vary depending on the specific condition being treated.
- For patients with severe refractory heart failure, a dose of 100 mg to 200 mg may be necessary to induce hemodynamic improvement, with the dosing interval requiring individualization 3.
- In patients with chronic congestive heart failure, a dose of 100 mg orally every eight hours has been shown to elicit a favorable circulatory response with long-term therapy 4.
- For the treatment of hypertension, hydralazine can be administered in combination with other medications, such as beta-blockers and diuretics, with doses ranging from 25 mg to 100 mg per day 5, 6, 7.
- A study comparing the efficacy of a propranolol-hydralazine combination tablet to each of its components found that daily doses of 80 mg propranolol/50 mg hydralazine or less, given twice daily, were effective in reducing blood pressure in patients with mild to moderate essential hypertension 7.
Factors Affecting Dose and Frequency
- Renal function can affect the duration of action of hydralazine, with patients having a creatinine clearance of less than 35 ml/min requiring longer dosing intervals 3.
- The incidence of side effects can be influenced by the dose and formulation of hydralazine, with slow-release preparations potentially reducing the risk of side effects 6.