Hydralazine and Hydrochlorothiazide (Systemic)

Brand name(s): Apresazide

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For hydralazine and hydrochlorothiazide, the following should be considered:

Allergies-Tell your doctor if you have ever had any unusual or allergic reaction to hydralazine, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, or methazolamide or to hydrochlorothiazide or any of the other thiazide diuretics (water pills). Also tell your health care professional if you are allergic to any other substance, such as foods, preservatives, or dyes.

Pregnancy-When hydrochlorothiazide is used during pregnancy, it may cause side effects including jaundice, blood problems, and low potassium in the newborn infant.

Studies with hydralazine have not been done in humans. However, blood problems have been reported in infants of mothers who took hydralazine during pregnancy. In addition, studies in mice have shown that hydralazine causes birth defects (cleft palate, defects in head and face bones); these birth defects may also occur in rabbits, but do not occur in rats.

Breast-feeding-Hydrochlorothiazide passes into breast milk. However, neither hydralazine nor hydrochlorothiazide has been reported to cause problems in nursing babies.

Children-Although there is no specific information comparing use of this medicine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults. However, extra caution may be necessary in infants with jaundice, because thiazide diuretics can make this condition worse.

Older adults-Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of hydralazine and hydrochlorothiazide combination in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults. However, dizziness or lightheadedness or symptoms of too much potassium loss may be more likely to occur in the elderly, who are usually more sensitive to the effects of this medicine. Also, this medicine may reduce tolerance to cold temperatures in elderly patients.

Other medicines-Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking hydralazine and hydrochlorothiazide, it is especially important that your health care professional know if you are taking any of the following:

• Cholestyramine or
• Colestipol-Use with hydrochlorothiazide may prevent it from working properly; take this combination medicine at least 1 hour before or 4 hours after cholestyramine or colestipol

• Diazoxide (e.g., Proglycem)-Effect on blood pressure may be increased

• Digitalis glycosides (heart medicine)-Hydrochlorothiazide may cause low potassium in the blood, which can lead to symptoms of digitalis toxicity

• Lithium (e.g., Lithane)-Risk of lithium overdose, even at usual doses, may be increased

Other medical problems-The presence of other medical problems may affect the use of hydralazine and hydrochlorothiazide. Make sure you tell your doctor if you have any other medical problems, especially:

• Diabetes mellitus (sugar diabetes)-Hydrochlorothiazide may change the amount of diabetes medicine needed

• Gout (history of)-Hydrochlorothiazide may increase the amount of uric acid in the blood, which can lead to gout

• Heart or blood vessel disease or
• Stroke (recent)-Lowering blood pressure may make problems resulting from these conditions worse

• Kidney disease-Hydrochlorothiazide may worsen this condition. Also, the blood pressure lowering effects may be increased because of slower removal of hydralazine from the body

• Liver disease-If hydrochlorothiazide causes loss of too much water from the body, liver disease can become much worse

• Lupus erythematosus (history of)-Hydrochlorothiazide may worsen the condition

Last Revised: 08/13/1998