Hydralazine Digoxin

A reduction in the labeling yield of RBC has been reported for heparin, tin-over-load, aluminum, prazocin, methyldopa, hydralazine, digoxin, quinidine, jff-adrenergic blockers, (e.g., propanolol), calcium channel blockers (e.g., verapamil), nitrates (e.g., nitroglycerin), doxorubicin, iodinated contrast agents, and Teflon tubing (catheter) (Hladik et al. 1987). 

More recently, the value of adding the combination of isosorbide dinitrate 40 mg and hydralazine 75 mg three times daily to therapy including ACE inhibitors, P-blockers, digoxin, and diuretics was evaluated in a prospective, randomized trial26 The study enrolled only African-American patients and demonstrated a significant reduction in mortality, as well as first hospitalization for HF. Quality-of-life scores were also improved over placebo. Combination therapy with hydralazine and isosorbide dinitrate is an appropriate substitute for angiotensin II antagonism... 

Develop a medication regimen to slow the progression of HF with the use of neurohormonal blockers such as vasodilators (ACE inhibitors, ARBs, or hydralazine/ isosorbide dinitrate), P-blockers, and aldosterone antagonists. Utilize digoxin if the patient remains symptomatic despite optimization of the above therapies. 

Cardiovascular Acetyldigosin, ajmaline, amiodarone, aprindine, bepridil, bezaflbrate, captopril, dinepazide, clopidogrel, coumarins, diazoxide, digoxin, dipyridamole, disopyramide, doxazosin, enalapril, flurbiprofen, fur-oxemide, hydralazine, lisinopril methyldopa, metolazone, nifedipine, phenindione, procainamide, propanolol, propafenone, quinidine, ramapril, spironolactone, thiazide diuretics, ticlopidine, vesnarinone... 

At Cynthia s pharmacy, patients with heart disease are usually on several medications for their heart disease a diuretic, a beta blocker, and an angiotensin-converting enzyme (ACE) inhibitor. Patients with more severe disease may also be on an aldosterone inhibitor such as spironolactone, digoxin, hydralazine nitrate, and/or an angiotensin-receptor blocker (ARB). Some patients are... 

Examples of specific drugs used in the treatment of chronic heart failure include digitalis glycosides (e.g., digoxin, positive inotropic agent), diuretics (hydrochlortiazide and furosemide), and vasodilators (nitrates such as nitroglycerin, ACE inhibitors, such as captopril, and hydralazine). 

The vasodilator hydralazine increases the renal clearance of digoxin, perhaps by increasing renal blood flow and therefore renal tubular secretion (261). This causes a small fall in plasma digoxin concentration the clinical significance of which is unclear. 

Compared with placebo, the combination of hydralazine and isosorbide dinitrate (ISDN) reduced mortality in patients receiving diuretics and digoxin (but not ACE inhibitors or /3-blockers). However, another trial comparing the combination with an ACE inhibitor found that mortality was lower in the ACE inhibitor group. Adverse effects (primarily headache and gastrointestinal complaints) with combined hydralazine-ISDN were common, limiting their use in many patients. Patient compliance also was an important issue because hydralazine-ISDN therapy was given four times daily in these trials. Whether less frequent administration provides equivalent benefit is unknown. 

Drugs or pharmacological interventions (heparin (Berger and Zaret 1984), antimicrobials or antibiotics, anticonvulsants, tranquilizers, anti-inflammatory agents (Chervu et al. 1981 Hladik et al. 1982), nifedipine (Sampson 1993), prazosin, digoxin (Lee 1983), propanolol, hydralazine, methyldopa, verapamil, chlorothiazide, furosemide, ranitidine, iron therapy, etoposide-h doxontbicin (Sampson 1993, 1995), others)... 

Noninterfering albuterol, allopurinol, alprenolol, aspirin, atenolol, captopril, carbimazole, clonidine, coloxyl, danthron, diazepam, digoxin, doxepin, glibenclamide, hydralazine, in-domethacin, labetalol, metformin, methyldopa, metoprolol, mianserin, minoxidil, nifedipine, nitrazepam, oxazepam, oxprenolol, pindolol, prazosin, propranolol, senokot, theophylline, trifluoperazine... 

An experimental study in 8 patients with congestive heart failure found that when they were given either sodium nitroprusside hy infusion (7 to 425 micrograms/minute) or hydralazine hy intravenous injection (5 mg every 10 to 20 minutes to a total dose of 10 to 60 mg) the total renal digoxin clearance was increased by about 50% by both drugs and the serum digoxin levels were decreased by 20% by the nitroprusside and 11% by the hydralazine. ... 

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