Parenteral Manual

HydrALAZINE HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
APRESOLINE®
Classification: 
Antihypertensive
Original Date: 
August 2005
Revised Date: 
July 2013
Indications: 
  • For the treatment of various forms of hypertension when the oral route is not feasible
Reconstitution and Stability: 
  • Available as 20 mg/mL ampoules
  • Store at room temperature. Refrigeration may result in precipitation or crystallization 
  • Infusion solutions stable 24 hrs at room temperature
  • Undergoes colour changes in certain dextrose solutions and after contact with a metal filter (not recommended)
Compatibility: 

- Solutions Compatible:Saline solutions, lactated ringers solution

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: heparin, KCl (up to 40 mmol/L), verapamil

- Incompatible:  aminophylline, ampicillin, diazoxide, dextrose-containing solutions, furosemide, hydrocortisone, phenobarbital

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES
IV Direct

YES, BP monitoring.  Critical care areas only
Usual dilution: 1 mg/mL
Infusion time: 3-5 minutes
Infusion rate: do not exceed 5 mg/minute or 0.2 mg/kg/minute
IV Intermittent Infusion YES, BP monitoring
Usual dilution: 1 mg/mL
Infusion time: 15 minutes
IV Continuous Infusion YES, BP monitoring
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • 0.1-0.2 mg/kg/dose IM/IV Q 4-6 hours (max:20 mg/dose)
  • Up to 1.7-3.5 mg/kg/day divided in 4-6 doses

Adult:     

  • 10-20 mg/dose IM/IV Q 4-6 hours PRN (may increase to 40 mg/dose)

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl 10-50 mL/min: Administer Q 8 hours
  • CrCl <10 mL/min: Administer Q 8-18 hours (fast acetylators) and Q 12-24 hours (slow acetylators)
Potential hazards of parenteral administration: 
  • Hypotension (antidote norepinephrine or ephedrine - DO NOT use epinephrine; epinephrine may cause additive cardiac stimulation)
  • Early adverse effects (usually transient) are tachycardia, headache, palpitations, dizziness, nausea, vomiting, postural hypotension, anorexia, edema
  • Peripheral neuritis (paresthesias, numbness and tingling), pyridoxine may alleviate this reaction
  • Influenza-like syndrome, rheumatoid arthritis syndrome, lupus syndrome (after lengthy use)
Notes: 
  • Monitoring guidelines: monitor blood pressure immediately following the infusion, 15 min. post-infusion and one hour post infusion.  Patient should remain lying down for 30-60 minutes following the infusion.
  • Contraindicated in patients with angina pectoris, tachycardia, coronary artery disease
  • Use with caution in patients with recent coronary or cerebral ischemia
  • Hypotensive effects are enhanced by other antihypertensives

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