What are the contraindications to scheduled Hydralazine (Hydralazine) and Carvedilol (Carvedilol) therapy?

From the Guidelines

Hydralazine and carvedilol should not be used in patients with certain conditions that increase the risk of adverse effects, including advanced aortic stenosis, soybean or egg allergies, defective lipid metabolism, and decompensated heart failure requiring inotropic therapy.

Contraindications for Hydralazine

• Contraindicated in patients with advanced aortic stenosis, as it can worsen the condition 1
• Contraindicated in patients with soybean, soy product, egg, and egg product allergy, and in patients with defective lipid metabolism (e.g., pathological hyperlipidemia, lipoid nephrosis, or acute pancreatitis) 1
• Should be used cautiously in patients with cerebrovascular disease, severe renal impairment, or hepatic dysfunction

Contraindications for Carvedilol

• Contraindicated in patients with decompensated heart failure requiring inotropic therapy, bronchial asthma or related bronchospastic conditions, second or third-degree AV block, severe bradycardia, cardiogenic shock, severe hepatic impairment, and hypersensitivity to carvedilol 1
• Should be avoided in patients with reactive airways disease or chronic obstructive pulmonary disease, as it can worsen bronchospasm 1
• Should be used cautiously in patients with low blood pressure, as both medications can cause hypotension

Additional Considerations

• Abrupt discontinuation of carvedilol can exacerbate angina and potentially lead to myocardial infarction, so it requires gradual tapering 1
• Hydralazine can worsen cardiac ischemia by causing reflex tachycardia, while carvedilol's beta-blocking properties can worsen bronchospasm and heart block, and its negative inotropic effects can worsen acute heart failure 1

From the FDA Drug Label

Carvedilol Tablet is contraindicated in the following conditions: Bronchial asthma or related bronchospastic conditions. Deaths from status asthmaticus have been reported following single doses of Carvedilol Tablet Second- or third-degree AV block Sick sinus syndrome Severe bradycardia (unless a permanent pacemaker is in place) Patients with cardiogenic shock or who have decompensated heart failure requiring the use of intravenous inotropic therapy. Such patients should first be weaned from intravenous therapy before initiating Carvedilol Tablet Patients with severe hepatic impairment Patients with a history of a serious hypersensitivity reaction (e.g., Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to any component of this medication or other medications containing Carvedilol Tablet.

Hypersensitivity to hydrALAZINE; coronary artery disease; mitral valvular rheumatic heart disease.

The contraindications to scheduled Hydralazine and Carvedilol therapy are:

• Hypersensitivity to either medication
• Coronary artery disease for Hydralazine
• Mitral valvular rheumatic heart disease for Hydralazine
• Bronchial asthma or related bronchospastic conditions for Carvedilol
• Second- or third-degree AV block for Carvedilol
• Sick sinus syndrome for Carvedilol
• Severe bradycardia (unless a permanent pacemaker is in place) for Carvedilol
• Cardiogenic shock or decompensated heart failure requiring intravenous inotropic therapy for Carvedilol
• Severe hepatic impairment for Carvedilol
• History of serious hypersensitivity reaction (e.g., Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to any component of Carvedilol 2 or Hydralazine 3

From the Research

Contraindications to Scheduled Hydralazine and Carvedilol Therapy

• The following are contraindications to scheduled Hydralazine and Carvedilol therapy:
  • For Hydralazine:
    • No direct contraindications are mentioned in the provided studies, but some of the adverse effects related to hydralazine that have been reported in the literature include reflex tachycardia, hemolytic anemia, vasculitis, glomerulonephritis, and a lupus-like syndrome 4
  • For Carvedilol:
    • Asthma remains a contraindication to beta-blockade, as patients with CHF and asthma tolerated carvedilol poorly 5
    • Caution is advised when using carvedilol in patients with chronic obstructive pulmonary disease (COPD), as it may cause adverse events such as hypotension, bradycardia, wheezing, dyspnoea, and oedema 5, 6

Special Considerations

• Patients with certain medical conditions, such as COPD or asthma, may require careful consideration and monitoring when using carvedilol 5, 6
• Hydralazine may be used in patients with primary hypertension, but its effect on clinical outcomes remains uncertain 4
• Carvedilol has been shown to have favorable effects on metabolic parameters, such as glycemic control, insulin sensitivity, and lipid metabolism, making it a potential option for patients with metabolic syndrome or diabetes 7