Critical Care Trauma Centre

HYDRALAZINE (Apresoline)

Name: HYDRALAZINE (ApresolineR)
Classification: vasodilator - antihypertensive agent
  • reduces systemic vascular resistance by direct relaxation of vascular smooth muscle
  • reduces pulmonary vascular resistance
  • dilates renal arterioles
Dose:
  • Afterload reduction:
    • 1 mg-5 mg/hr
  • Antihypertensive
    • 5 mg-25 mg/hr (titrated to effect)
  • Intermittent doses
    • 5-40 mg IV direct
Administration:
  • IV Direct:
    • maximum rate of injection 5 mg/min 
  • IV Infusion:
    • 50 mg/500 mL NS, RL
  • hypovolemia should be corrected concurrently with therapy
  • should be weaned off
Adverse Effects:
  • tachycardias
  • arrhythmias
  • hypovolemia
  • hypotension
  • increased myocardial oxygen consumption
  • peripheral neuritis as evidenced by numbness, tremor, agitation, anxiety
  • rheumatoid syndrome---systemic lupus erythematosus like syndrome
  • risk of hemorrhage in patients with cerebral or abdominal aneurysms due to speed of blood flow
  • may worsen a pulmonary shunt
Monitoring Therapy:
  • continuous heart rate and ECG rhythm
  • blood pressure
  • urine output
  • lactate
  • joint appearance and mobility
Adult Critical Care Protocol:
  • May be administered by IV infusion by a nurse in Adult Critical Care.
  • May be administered IV direct by an approved nurse in the CCTC at a rate < 5mg/min.
  • May be titrated by a nurse in Adult Critical Care.
  • Central line is preferred.
  • Patient requires placement of an arterial line to monitor BP.
  • Continuous infusions must be administered by infusion device and the pump library must be enabled.
  • Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 17, 2018