Hydralazine Dosing Regimens for Hypertension and Heart Failure

Dosing in Heart Failure

For heart failure with reduced ejection fraction (HFrEF), hydralazine is typically used in combination with isosorbide dinitrate, as recommended by the American College of Cardiology and the American Heart Association 1, 2
When using the fixed-dose combination, the initial dose is 37.5 mg hydralazine/20 mg isosorbide dinitrate three times daily, with a possible increase to 75 mg hydralazine/40 mg isosorbide dinitrate three times daily, according to the American Heart Association 2, 3
The combination of hydralazine and isosorbide dinitrate is particularly beneficial in African American patients with HFrEF who remain symptomatic despite standard therapy with ACE inhibitors, beta-blockers, and aldosterone antagonists, as stated by the American Heart Association 2

Blood pressure should be monitored after initiation and during dose titration, as recommended by the American College of Cardiology 1, 3
Common adverse effects of hydralazine include headache, dizziness, and gastrointestinal complaints, according to the American Heart Association 2
At higher doses, there is an increased risk of drug-induced lupus-like syndrome, as reported by the American Heart Association 2, 4