Hydralazine + Isosorbide-dinitrate
Find more information about this combination medication at the webpages for hydralazine and isosorbide dinitrate
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Drug Status
Government Approvals
UK(FDA), US(FDA)
WHO Essential Medicine
NO
Known Teratogen
Possible
Pharmaceutical Class
Arteriolar Vasodilator and Nitrate Vasodilator
Controlled Drug Substance
NO
Summary
Hydralazine and isosorbide dinitrate are used to treat heart failure, which is a condition where the heart can't pump blood effectively, and certain types of chest pain, known as angina, which is caused by reduced blood flow to the heart. This combination is especially beneficial for patients who cannot tolerate other heart failure medications.
Hydralazine works by relaxing the muscles in the walls of blood vessels, which lowers blood pressure. Isosorbide dinitrate releases nitric oxide, which helps blood vessels relax and widen, improving blood flow. Together, they reduce the heart's workload and improve its efficiency, making them effective in managing heart-related conditions.
The usual adult dose for hydralazine is 10 to 50 mg taken three to four times a day. For isosorbide dinitrate, the usual dose is 10 to 40 mg taken two to three times a day. These medicines are taken orally, and the exact dosage may vary based on individual needs and the specific condition being treated.
Common side effects of hydralazine include headaches, dizziness, and a fast heartbeat. Isosorbide dinitrate can cause headaches, flushing, and low blood pressure. Both medicines can cause dizziness and lightheadedness, especially when standing up quickly. It's important to monitor for these side effects and consult a healthcare provider if they occur.
Hydralazine may cause a lupus-like syndrome, which mimics lupus symptoms, in some patients. Isosorbide dinitrate should not be used with erectile dysfunction medications due to the risk of severe low blood pressure. Both medicines require caution in patients with certain heart conditions. Patients should discuss their medical history with their healthcare provider before starting these medications.
Indications and Purpose
How does combination of Hydralazine and Isosorbide Dinitrate work?
Hydralazine works by directly relaxing the smooth muscles in the walls of arteries, leading to vasodilation and reduced blood pressure. Isosorbide Dinitrate acts on both arteries and veins, releasing nitric oxide which relaxes vascular smooth muscle and reduces the heart's workload. Both medicines share the common mechanism of vasodilation, which improves blood flow and oxygen delivery to the heart, alleviating symptoms of heart failure and angina. Together, they provide a complementary effect in managing cardiovascular conditions.
How effective is combination of Hydralazine and Isosorbide Dinitrate?
The effectiveness of Hydralazine and Isosorbide Dinitrate is supported by clinical trials such as the A-HeFT study, which demonstrated a significant reduction in mortality and hospitalization for heart failure in black patients. Hydralazine has been shown to improve cardiac output and reduce vascular resistance, while Isosorbide Dinitrate enhances blood flow and reduces cardiac workload. Both medicines have been proven to improve symptoms and quality of life in patients with heart failure, particularly when used in combination. Their complementary actions provide a robust therapeutic effect in managing cardiovascular conditions.
Directions for Use
What is the usual dose of combination of Hydralazine and Isosorbide Dinitrate?
For Hydralazine, the usual adult dose for hypertension starts at 25 mg twice daily, which can be increased to a maximum of 200 mg daily. For heart failure, doses are generally higher, starting at 25 mg three or four times daily, with maintenance doses averaging 50-75 mg four times daily. Isosorbide Dinitrate is typically dosed at 10 mg taken three or four times daily for angina or heart failure. When combined in a single tablet, the initial dose is one tablet three times a day, which can be increased to two tablets three times daily if tolerated. Both medicines are adjusted based on patient response and tolerance.
How does one take combination of Hydralazine and Isosorbide Dinitrate?
Hydralazine and Isosorbide Dinitrate can be taken with or without food, but taking them with food may help reduce stomach upset. Patients should be consistent in how they take their medication to maintain stable blood levels. There are no specific food restrictions, but patients should avoid alcohol as it can enhance the blood pressure-lowering effects and increase the risk of side effects like dizziness. It's important to follow the prescribed dosing schedule and consult a healthcare provider for any dietary concerns.
For how long is combination of Hydralazine and Isosorbide Dinitrate taken?
The duration of use for Hydralazine and Isosorbide Dinitrate depends on the condition being treated and the patient's response to therapy. For chronic conditions like heart failure and hypertension, these medications are often used long-term to manage symptoms and improve quality of life. Both medicines require ongoing assessment to adjust dosages and ensure effectiveness, with the goal of maintaining optimal heart function and blood pressure control. Regular monitoring by a healthcare provider is essential to determine the appropriate duration of therapy.
How long does it take for combination of Hydralazine and Isosorbide Dinitrate to work?
Hydralazine and Isosorbide Dinitrate work by dilating blood vessels, which helps to lower blood pressure and improve blood flow. The onset of action for Hydralazine is typically within 1 hour, as it is rapidly absorbed and distributed in the body. Isosorbide Dinitrate also begins to work within 1 hour, as it is quickly absorbed and converted to active metabolites. Both medicines share the common attribute of being fast-acting vasodilators, which means they start working relatively quickly to relieve symptoms of heart failure and angina.
Warnings and Precautions
Are there harms and risks from taking combination of Hydralazine and Isosorbide Dinitrate?
Common side effects of Hydralazine include headache, dizziness, and palpitations, while Isosorbide Dinitrate may cause headaches and hypotension. Both medicines can lead to symptoms like flushing and nausea. Significant adverse effects include the risk of systemic lupus erythematosus-like syndrome with Hydralazine and severe hypotension with Isosorbide Dinitrate. Both medicines share the potential for causing dizziness and lightheadedness, especially when standing up quickly, due to their vasodilatory effects. Patients should be monitored for these side effects and advised to report any severe or persistent symptoms to their healthcare provider.
Can I take combination of Hydralazine and Isosorbide Dinitrate with other prescription drugs?
Hydralazine can interact with beta-blockers, increasing their bioavailability, and may require dose adjustments. Isosorbide Dinitrate should not be used with phosphodiesterase inhibitors like sildenafil, as this can lead to severe hypotension. Both medicines can have additive effects with other antihypertensives, leading to increased risk of low blood pressure. Patients should inform their healthcare provider of all medications they are taking to avoid potential interactions and ensure safe and effective treatment.
Can I take combination of Hydralazine and Isosorbide Dinitrate if I am pregnant?
There is limited data on the use of Hydralazine and Isosorbide Dinitrate during pregnancy. Hydralazine has been used in pregnancy, particularly in the second and third trimesters, without showing adverse outcomes. Isosorbide Dinitrate's safety in pregnancy is not well-established, and it should be used only if the potential benefits justify the risks. Pregnant women with heart failure are at increased risk for complications, and treatment decisions should be made in consultation with a healthcare provider to ensure the safety of both mother and baby.
Can I take combination of Hydralazine and Isosorbide Dinitrate while breastfeeding?
There is limited data on the presence of Hydralazine and Isosorbide Dinitrate in human milk. Hydralazine is known to pass into breast milk, but no adverse effects on infants have been reported. The excretion of Isosorbide Dinitrate in breast milk is not well-documented. The benefits of breastfeeding should be weighed against the mother's need for these medications and any potential risks to the infant. Healthcare providers should be consulted to make informed decisions regarding the use of these medicines during lactation.
Who should avoid taking combination of Hydralazine and Isosorbide Dinitrate?
Hydralazine is contraindicated in patients with systemic lupus erythematosus and severe tachycardia, while Isosorbide Dinitrate should not be used in patients with severe hypotension or those taking phosphodiesterase inhibitors. Both medicines can cause significant hypotension, especially in volume-depleted patients. Patients should be warned about the risk of dizziness and advised to rise slowly from sitting or lying positions. It's important to inform healthcare providers of any existing health conditions or medications to avoid contraindications and ensure safe use of these medicines.
