South Australian Perinatal Practice Guidelines

Hydralazine infusion
regimen
Department of Health, Government of South Australia. All rights reserved.

ISBN number: UNKNOWN
Endorsed by: SA Maternal & Neonatal Clinical Network
Contact: South Australian Perinatal Practice Guidelines workgroup at:
cywhs.perinatalprotocol@health.sa.gov.au
Page 1 of 4



Note:
This statewide guideline has been prepared to promote and facilitate standardisation and
consistency of practice, using a multidisciplinary approach.
Information in this statewide guideline is current at the time of publication.
SA Health does not accept responsibility for the quality or accuracy of material on websites
linked from this site and does not sponsor, approve or endorse materials.
The clinical material offered in this statewide standard/policy provides a minimum standard,
but does not replace or remove clinical judgement or the professional care and duty
necessary for each specific patient case. Where care deviates from that indicated in the
statewide guideline contemporaneous documentation with explanation must be provided.
This statewide guideline does not address all the elements of clinical practice and assumes
that the individual clinicians are responsible for:

> Discussing care with consumers in an environment that is culturally appropriate and
which enables respectful confidential discussion. This includes the use of interpreter
services where necessary,
> Advising consumers of their choice and ensuring informed consent is obtained,
> Providing care within scope of practice, meeting all legislative requirements and
maintaining standards of professional conduct, and
> Documenting all care in accordance with mandatory and local requirements

South Australian Perinatal Practice Guidelines
Hydralazine infusion
regimen
Department of Health, Government of South Australia. All rights reserved.

ISBN number: UNKNOWN
Endorsed by: SA Maternal & Neonatal Clinical Network
Contact: South Australian Perinatal Practice Guidelines workgroup at:
cywhs.perinatalprotocol@health.sa.gov.au
Page 2 of 4


Introduction
> Hydralazine is a direct peripheral arteriolar vasodilator with a slow onset of action (10-
20 minutes) and peaks approximately 20 minutes after administration (SOMANZ
2008)
> Initially treatment is commenced as intermittent boluses. Subsequently, bolus
administration may be followed by an infusion
> Hydralazine is known to cross the placenta following IV administration and has been
associated with fetal distress and fetal cardiac arrhythmia in the last trimester
> Continuous electronic fetal monitoring is required

Presentation
> Hydralazine (Apresoline

)
> In powdered form in 1 mL ampoules containing 20 mg
> Dilute with sodium chloride 0.9 %

Indication
> Intravenous hydralazine is used for the acute control of blood pressure in
preeclampsia and eclampsia

Contraindications
> Known hypersensitivity to hydralazine or dihydralazine
> Idiopathic systemic lupus erythematosus (SLE)
> Severe tachycardia and heart failure with a high cardiac output (e.g. thyrotoxicosis)
> Myocardial insufficiency due to mechanical obstruction (e.g. aortic or mitral stenosis
or constrictive pericarditis)
> Isolated right ventricular heart failure due to pulmonary hypertension (cor pulmonale)
> Dissecting aortic aneurysm
Precautions
> Avoid use before the third trimester due to possible teratogenic effects

South Australian Perinatal Practice Guidelines
Hydralazine infusion
regimen
Department of Health, Government of South Australia. All rights reserved.

ISBN number: UNKNOWN
Endorsed by: SA Maternal & Neonatal Clinical Network
Contact: South Australian Perinatal Practice Guidelines workgroup at:
cywhs.perinatalprotocol@health.sa.gov.au
Page 3 of 4


Intermittent bolus administration
> When administering hydralazine, intravenous treatment with crystalloid solution is
required (for further information, refer to the PPG fluid management and monitoring
in severe pre-eclampsia)
> May be administered by a midwife under the supervision of a medical officer
> Dilute hydralazine 1 mL (20 mg) up to 20 mL with sodium chloride 0.9
%. Label: hydralazine 1 mg per mL
> The initial dose is 5-10 mg as ordered given by slow intravenous
injection over 2 minutes
> Blood pressure is taken at 5 minute intervals for at least 20 minutes
following each bolus
> After 15 minutes, depending upon response, a second dose of 5 mg
may be given. Note that the maximal effect occurs 15-20 minutes
after each bolus
> Consider infusion if the total bolus dosage is 20 mg or more

Hydralazine infusion
> Mix 2 ampoules (40 mg) of hydralazine up to a volume of 40 mL with sodium chloride
0.9 % (to obtain 1 mg per mL in a 50 mL syringe)
> Administer via syringe pump
> May be piggybacked into the main line
> Commence infusion at the rate of 2 to 10 mg per hour depending on blood pressure
> Monitor blood pressure and pulse every 15 - 30 minutes as required
> Blood pressure should not be lowered below 140 / 85 mm Hg

Side effects
> Facial flushing and headache
> Tachycardia (if pulse rate exceeds 120 beats per minute and the blood pressure is
still high, alternative antihypertensives should be considered)
> Nausea, vomiting, dizziness, anxiety and tremor


South Australian Perinatal Practice Guidelines
Hydralazine infusion
regimen
Department of Health, Government of South Australia. All rights reserved.

ISBN number: UNKNOWN
Endorsed by: SA Maternal & Neonatal Clinical Network
Contact: South Australian Perinatal Practice Guidelines workgroup at:
cywhs.perinatalprotocol@health.sa.gov.au
Page 4 of 4


Version control and change history
PDS reference: OCE use only

Version Date from Date to Amendment
1.0 08 Dec 04 21 Oct 08 Original version
2.0 21 Oct 08 22 Nov 11 Review
3.0 22 Nov 11 current



References
1. Lowe SA, Brown MA, Dekker G, Gatt S, McLintock C, McMahon L, Mangos G, Moore
MP, Muller P, Paech M, Walters B. Guidelines for the management of hypertensive
disorders of pregnancy. SOMANZ; 2008.
2. World Health Organisation (WHO). Managing complications in pregnancy and
childbirth. A guide for midwives and doctors, Geneva; 2000. WHO/RHR/00.7
3. Australian Prescription Products Guide (APPG). [Online version] 32
nd
edition
incorporating the Non Prescription Products Guide; 2003.
4. MIMSOnline. Apresoline. CMPmedica; Sydney. Australia; 2011.
5. Magee LA, Cham C, Waterman EJ , Ohlsson A, von Dadelszen P. Hydralazine for
treatment of severe hypertension in pregnancy: meta-analysis. BMJ 2003; 327:955-
60.
Abbreviations
APPG Australian Prescription Products Guide
IV Intravenous
mg Milligram(s)
mL Millilitre(s)
mm Hg Millimetres of mercury
Registered trademark
SLE Systemic lupus erythematosus
SOMANZ Society of Obstetric Medicine of Australia and New Zealand
WHO World Health Organisation