Hydralazine adverse reaction

For example, it has been suggested that the adverse reactions caused by a number of drugs such as isoniazid, procainamide, hydralazine could be due to metabolic activation by myeloperoxidase in neutrophils. Thus neutrophils will metabolize procainamide (Fig. 4.38) to a hydroxylamine metabolite. In the presence of chloride ion, myeloperoxidase will produce hypochlorous acid, a strong oxidizing agent, which may be responsible for metabolic activation and toxicity. One of the products is N-chloroprocainamide (see also sect. "Hydralazine," chap. 7). 

ACC/AHA guidelines (II), the combined use of hydralazine-isosorbide dinitrate may be considered as a therapeutic option in patients with reduced LV dysfunction already taking ACE inhibitors and (3 blockers and with persistent symptoms. Despite the lack of data about this vasodilator combination in patients who are intolerant of ACE inhibitors, the combined use of hydralazine and isosorbide dinitrate may be considered as an additive therapeutic option in such patients, However, compliance with this combination has generally been poor because of the large number of tablets required and the high incidence of adverse reactions. 

Reeves PR, Case DE, Jepson HT et al. (1978) Practolol metabolism in metabolism in human subjects. J Pharmacol Exp Ther 205(2) 489-498 Reinhardt DJ, Waldron JM (1954) Lupus erythematosus-like syndrome complicating hydralazine (Apresoline) therapy. JAMA 155 1491-1492 Riddiough MA (1977) Preventing, detecting and managing adverse reactions of antihypertensive agents in the ambulant patient with essential hypertension. Am J Hosp Pharm 45(5) 465-477... 

A Cochrane review failed to find any randomized placebo-controlled studies of hydralazine [103 ]. The reviewers noted that reported adverse reactions include reflex tachycardia, hemolytic anemia, vasculitis, glomerulonephritis, and lupus-like syndrome. Given the availability of antihypertensive... 

Other adverse effects are caused by immunological reactions, of which the drug-induced lupus syndrome is the most common. Hydralazine also can result in an illness that resembles serum sickness, hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis the mechanism of these autoimmune reactions is unknown. The drug-induced lupus syndrome usually occurs after at least 6 months of continuous treatment with hydralazine, and its incidence is related to dose, sex,... 

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