Initial Oral Hydralazine Dose

Standard Dosing Regimen

• The American College of Cardiology/American Heart Association recommends starting with 25-50 mg orally three to four times daily as the initial dose for heart failure with reduced ejection fraction (HFrEF) 1, 2, 3
• The fixed-dose combination formulation (hydralazine/isosorbide dinitrate) begins at 37.5 mg hydralazine/20 mg isosorbide dinitrate three times daily, which can be titrated to a maximum of 75 mg hydralazine/40 mg isosorbide dinitrate three times daily 1, 2, 3

Titration and Maximum Dosing

• The maximum daily dose is 300 mg in divided doses (typically 100 mg three times daily or 75 mg four times daily) 1, 2, 3
• The mean dose achieved in clinical trials was approximately 175 mg total daily dose (roughly 58 mg three times daily) 1, 2

Important Caveats

• Always combine hydralazine with isosorbide dinitrate in HFrEF for mortality benefit (7% relative risk reduction in mortality, NNT=43) 1, 2