HydralazineHydralazine hydrochloride

About Hydralazine

Hydralazine lowers blood pressure by directly relaxing the muscle in blood vessel walls. It is approved for high blood pressure, alone or with other medicines such as a thiazide diuretic or a beta blocker, and is also used in heart failure. A combination with isosorbide dinitrate, sold as BiDil and as a generic, is approved as an add-on to standard heart failure treatment in self-identified Black patients to improve survival.

Headache, a fast or pounding heartbeat, flushing, loss of appetite, nausea and diarrhea are common. Because it stimulates the heart it can bring on angina. It must not be used in coronary artery disease or in mitral valve disease caused by rheumatic fever. There is no boxed warning.

Its best-known serious effect is a lupus-like illness, with joint or muscle pain and fever, more likely at higher doses; blood counts and an antinuclear antibody test are recommended before and during long-term treatment. Numbness or tingling in the hands and feet can occur, and the label advises adding pyridoxine (vitamin B6) if it does.

Taking Hydralazine

How to take it

Usually two to four times a day at about the same times, with meals or a snack; food increases how much is absorbed. The combination tablet is usually taken three times a day. Do not stop it without talking to your prescriber.

If you miss a dose

Take it when you remember, unless the next dose is nearly due; then skip the missed dose. Do not take a double dose to make up for it.

Storage

At room temperature in the container it came in, tightly closed and out of reach of children.

Interactions to know about

Other blood pressure medicines add to its effect, MAO inhibitors need caution, and alcohol can worsen side effects. The combination tablet contains a nitrate and must not be taken with avanafil, sildenafil, tadalafil, vardenafil or riociguat, because blood pressure can drop severely. Report chest pain, a racing heartbeat, or joint pain with fever.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Hydralazine differs from pharmacy to pharmacy

Hydralazine tablets have many makers and cost pharmacies little, but at two to four doses a day a month’s supply is a large quantity, so a pharmacy that prices generics per tablet quotes far more than one charging a flat price per prescription. The isosorbide dinitrate combination is priced separately: BiDil is a brand and the generics have few makers, so both cost much more than plain hydralazine.

Ways to pay less for Hydralazine without insurance

• Ask whether the pharmacy charges a flat price per prescription or prices hydralazine per tablet.
• Ask the prescriber whether your dose can be written as one tablet per dose, and for a ninety-day supply once it is stable.
• If BiDil is prescribed, ask for a generic quote, and ask the prescriber whether separate hydralazine and isosorbide dinitrate tablets would do; no single hydralazine tablet matches the combination’s dose.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Hydralazine

1. 1.Should I take each dose with food?
2. 2.Which symptoms of a lupus-like reaction should I report?
3. 3.When are my blood count and antibody tests due?
4. 4.What should I do about headache or a racing heart at the start?
5. 5.Do I need vitamin B6 if my hands or feet tingle?

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