Essential hypertension 

Peripheral Vasodilators- Isoxsuprine hcl, Papaverine hcl, Hydralazine hcl, Minodoxil, Epoprostenol sodium, Tresprostinil sodium, 

Headache-

Drugs causing adverse reactions- ( 388 )

1. Hydralazine

2. Bromides

3. Glyceryl trinitrate

4. Ergotamine ( withdrawal )

5. Indomethicin

Body as a whole- Headache, anorexia, nausea, vomiting, diarrhea, palpitations, tachycardia, angia pectoris.

Opthamalmic- lacrimation, conjuntivitis CNS- Perpheral neuritis, numbmess and tingling, dizziness, tremors,psychotic reactions characetrrized by depression, disoreintation and anxiety

Hypersenstivity- Rash, urticaria, pruritus, fever, chills, arthralgia, eosinophilia, hepatitis (rare)

GI- constipation, paralytic ileus

Hematologic- Blood dyscrasias, consisting of redction of hemoglobobin, and RBC, leukopenia, agranulocytosis, and purpura, lymphadenopathy, slenomegaly

Miscellaneous- Nasal congestion, flushing, edema, muscle cramps, hypotension, paradoxical pressor response, dyspnea, urination difficulty, lupus-like syndrome.hoarseness due to drug-induced lupus.

Hypersensitivity, coronary artery disease, mitral valvilar rheumatic heart disease. Special precautions: Hyperdynamic circulation caused by hydralazine. Coronary artery disease. Pulmonary hypertension, Tartrazine sensitivity.

Cardiovascular- the -hyperdynamic - circulation by hydralazine may accentuate specific cardiovascular inadequacies. It may reduce pressure response to pressor response to epinephrine. Use with caution in patients with cerebral vascular accidents.

Coronary artery disease- use with caution in patients with suspected coronary artery disease. Pulmonary hypertension- use hydralazine with caution in patients with pulmonary hypertension. Severe hypotension may result. Monitor carefully.

Lipids- hydralazine may cause some decrease in total cholesterol. Peripheral neuritis- evidence suggests an antipyridoxine effect. add pyridoxine too the regimen if symptoms develop.

Tatrazine sensitivity- some of these products contain tartrazine which may cause allergi-type reactions (including susceptible asthma ) in susceptible individuals.

Warnings-

Lupus erythematous- hydralazine may produce a clinical picture simulating systemic lupus erythematous (eg atthalgia, dermatoses, fever, splenomegaly )including glomerulonephritis. Symptoms usually regress when the drug is discontinued, but residual effects have been detected years later. Long term treatment with steroids may be necessary.

Renal function impairment- use with caution in patients with adsvanced renal damage.

Pregnancy- safety for use in pharmacy has not been established. Use only when the potential benefits outweigh potential hazards to the fetus.

Lactation- hydralysine is comptaible with breastfeeding according to the American Academay of Pediatrics.

Children- safety and efficacy for use in children have not been established.

Indications:

Essential hypertension

Dosage:

Individualise dosage.

Start with 10mg 4 times daily for the first 2 to 4 days, increase to 25mg 4 times daily for the balance of the first week.

Second and subsequent week - increase dosage to 50mg 4 times daily. Overdosage- Symptoms Treatment Hypotension, tachycardia, headache, and generalized

1. There is nospecific antidote. skin flushing. Complication can include myocardial

2. Evacuate gastric contents, prevent saspiration and ischemia and sybsequent myocardial infarction,cardiac protectv airway. arrhythmias and profound shock.

3. Instill activated slurry.

4. These manipulations may have to be omitted or carried out after cardiovascular status has been stabilized,since they might precipitate cardiac arrhythmias or increase the depth of shock.

5. Cardiovascular support is of primary importance

6. Treat shock with volume expanders without vasopressors. If necessary use a vasopressor that is least likely to prtecipitate or aggravate cardiac aeehthmias.

7. Tachycardia respond to betablockers.

8. Digitalization may be necessary.

9. Monitor renal function and support as required.

10. No experience has been reoprted with extracorporeal or peritonal dialysis.

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Headache-

Drugs causing adverse reactions- ( 388 )

1. Hydralazine

2. Bromides

3. Glyceryl trinitrate

4. Ergotamine ( withdrawal )

5. Indomethicin

1. Take with meals

2. Notify physician of any unexplained prolonged general tiredness or fever, muscle or joint aching or chest pain.

3.Allergies- tell your doctor if you have ever had any unusual or allergic reaction to hydralazine. Also tell your doctor if youare allergic to any other substances, such as foods, presrvatives or dyes.

4.Pregnancy - before taking this medicine make sure your doctor knows if you are pregnant or if you become pregnant

5.Breast feeding- mothers who are taking this medicine and who wish to breast feed should this with their doctor.

6 Children - this medicine is not expected to cause different side effects or problems in children than in adults.

7. Elderly- dizziness or lightheadedness may be more likely to occur in elderly

8. Other medicines - Let your doctor know what other medicines you are taking, so that he can advice you accordingly.

9.Diazoxide - efect on blood pressure may be increased

10. Other medical problems - Tell your doctor if you have any other medical problems especially - Heart or blood vessewl disease or Stroke -lowering blood pressure may make problems resulting from these conditions worse Kidney stone - effects may be increaased because of slower removal of hydrazine from the body

11. Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.

12. Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.

13. Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.

 Peripheral Vasodilators- Isoxsuprine hcl, Papaverine hcl, Hydralazine hcl, Minodoxil, Epoprostenol sodium, Tresprostinil sodium, 

Pharmacology:

Hydralazine exerts a peripheral vasodilating effect through a direct relaxation of vascular smooth muscle. The peripheral vasodilating effect of hydralazine results in decreased arterial blood pressure (diastolic more than systolic ); decreased peripheral vascular resistence and an increased heart rate, stroke volume and cardiac output.

Pharmacokinetics:

Hydralazine is rapidly absorbed after oral use. Protein binding is 87% and bioavailability is 30 to 50%. Peal plasma concentrations occur 1 to 2 hours after ingestion, duration of action is 6 to 12 hours.

Not significant

Pregnancy:

Safety for use during pregnacy has not been established.

Lactation:

Excercise caution while administering hydralazine

Children:

Safety and efficacy for use in children have not been established.