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히드랄라진

Hydralazine

Hydralazine HCl

혈관 확장제POIV개고양이말

다른 이름: Alphapress · Bionobal · Cesoline · Hydrapres · Hyperex · Hyperphen · Ipolina · Nepresol · Novo-Hylazin · Nu-Hydral · Rolazine · Slow-Apresoline · Supres · apressinum · hydralazini · hydrallazine · Hydralazine hydrochloride · Hidralazina

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

1 mg/kg (starting dose, titrate up to 3 mg/kg if needed)PO· q12h
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
Adjunctive therapy in treatment of heart failure (not receiving ACE inhibitors)1 mg/kg (starting dose, titrate up to 3 mg/kg if needed)POq12h—🌎 NA
Acute, fulminant heart failure due to severe mitral regurgitation (not receiving ACE inhibitors)2 mg/kgPOOnce—🌎 NA
Adjunctive therapy in treatment of heart failure (receiving ACE inhibitors)0.5 mg/kg (starting dose, increase in 0.5 mg/kg increments to max 3 mg/kg)POq12h—🌎 NA
Short-term treatment of CHF secondary to valve diseaseInitial dose of 1 mg/kg PO (additional 0.5-1 mg/kg can be administered to max cumulative 3 mg/kg)POq12hShort-term🌎 NA
Treatment of systemic hypertension (Fifth step drug)0.5 mg/kgPOtwice daily—🌎 NA
Congestive heart failure / Systemic hypertension0.5-3 mg/kgPOq8-12hLong-term🌍 EU
  • Adjunctive therapy in treatment of heart failure (not receiving ACE inhibitors): Effective dose is 0.5-3 mg/kg PO q12h. Titrate upwards carefully. If BP monitored, can titrate more rapidly in 1-2 hour intervals.
  • Acute, fulminant heart failure due to severe mitral regurgitation (not receiving ACE inhibitors): Given along with IV furosemide. May cause hypotension, but benefits outweigh risks.
  • Adjunctive therapy in treatment of heart failure (receiving ACE inhibitors): Give with extreme caution as severe hypotension may occur. Blood pressure monitoring required.
  • Short-term treatment of CHF secondary to valve disease: Goal MAP is 60-80 mmHg. Once desired BP achieved, administer PO q12h.
  • Treatment of systemic hypertension (Fifth step drug): Added if systolic BP > 160 mmHg after enalapril/benazepril, amlodipine (low then high dose), and spironolactone.
  • Congestive heart failure / Systemic hypertension: Start at low dose (0.5-1 mg/kg q12h), monitor blood pressure regularly and increase to 2 mg/kg or even 3 mg/kg q12h if necessary.

고양이

적응증용량경로빈도기간지역
Adjunctive therapy in treatment of heart failurestart titration at 2.5 mg (total dose) and if necessary, increase up to 10 mgPOq12h—🌎 NA
Treatment of systemic hypertension (Fourth step drug)0.5 mg/kgPOtwice daily—🌎 NA
Systemic hypertension2.5-10 mg/catPOq12hLong-term🌍 EU
  • Adjunctive therapy in treatment of heart failure: Follow similar titration protocols as dogs.
  • Treatment of systemic hypertension (Fourth step drug): Added if systolic BP > 160 mmHg after amlodipine, ACE inhibitor, and spironolactone.
  • Systemic hypertension: Start at low dose and titrate upwards cautiously. Monitor blood pressure regularly.

말

적응증용량경로빈도기간지역
Adjunctive therapy in treatment of heart failure (afterload reducer)0.5 mg/kgIVOnce—🌎 NA
Adjunctive therapy in treatment of heart failure (long-term therapy)0.5-1.5 mg/kgPOq12hLong-term🌎 NA
  • Adjunctive therapy in treatment of heart failure (afterload reducer): ARCI UCGFS Class 3 Drug.

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

히드랄라진(Hydralazine)은 강력한 ​직접 작용 세동맥 확장제​로, 주로 전신 고혈압 관리 및 소동물의 울혈성 심부전(CHF) 보조 치료 시 ​후부하 감소제​로 사용됩니다.

  • ​임상적 유용성​: 승모판 폐쇄 부전증, 큰 심실 중격 결손 또는 중증 대동맥판 역류증 환자에서 심장이 혈액을 펌프질할 때 받는 저항(후부하)을 줄이는 것이 중요하므로 특히 유익합니다.
  • ​난치성 심부전​: 승모판 폐쇄 부전증이 있는 개에서 ACE 억제제(예: 에날라프릴)만으로 임상적 개선이 불충분할 때 자주 사용됩니다.
  • ​병용 요법​: 나트륨 및 수분 저류를 유발하는 경향을 상쇄하기 위해 이뇨제와 자주 병용되며, 반사성 빈맥을 완화하기 위해 베타 차단제와 병용하기도 합니다.
  • ​한계점​: 유의미한 판막 역류 없이 원발성 심근 질환(예: 확장성 심근병증)만이 문제인 경우 심부전 치료에 큰 도움이 되지 않습니다.

작용 기전

Hydralazine acts as a semicarbazide-sensitive amine oxidase (SSAO) inhibitor, directly relaxing vascular smooth muscle.

  • Mechanism: Alters cellular calcium metabolism in smooth muscle → interferes with calcium movements → prevents the initiation and maintenance of the contractile state.
  • Vascular Selectivity: Exerts a much greater effect on arterioles than on veins. This selective arterial dilation significantly decreases systemic vascular resistance (SVR) and blood pressure.
  • Cardiac Effects: In CHF patients, the reduction in afterload → significantly increases forward cardiac output.
  • Compensatory Responses: In non-CHF hypertensive patients, the sudden drop in blood pressure can trigger baroreceptor-mediated reflex tachycardia and activation of the ​renin-angiotensin-aldosterone system (RAAS)​ → leading to sodium and water retention.

안전성·주의사항

금기사항

  • Known hypersensitivity to hydralazine
  • Coronary artery disease
  • Hypovolemia
  • Preexisting hypotension
  • Hypovolaemia
  • Renal impairment
  • Cerebral bleeding

부작용

  • Weakness and lethargy
  • Syncope (fainting)
  • Reflex tachycardia
  • Sodium and water retention
  • GI distress (vomiting, diarrhea)
  • Increased creatinine levels
  • SLE-like syndrome (documented in humans, theoretical in animals)
  • Lacrimation and conjunctivitis
  • Peripheral neuritis
  • Blood dyscrasias
  • Urinary retention
  • Constipation
  • Severe hypotension
  • Anorexia (especially in cats)
  • Vomiting (especially in cats)

주의

Dose Titration: Doses must be titrated upwards carefully to avoid severe, life-threatening hypotension.

  • Renal Disease: Use with caution. Reduced renal blood flow can activate the RAAS and exacerbate renal injury; pretreatment with an ACE inhibitor and spironolactone is often advised.
  • Intracerebral Bleeding: Use with caution due to potential effects on cerebral blood flow.
  • Autoimmune Disease: Use cautiously in patients with preexisting autoimmune diseases, as an SLE-like syndrome has been documented in humans.
  • Pregnancy: FDA Category C (humans); Papich Class B (veterinary). Safe for use if used cautiously, but crosses the placenta. Excreted in milk but generally considered compatible with nursing.

약물 상호작용

ACE-INHIBITORS

May cause additive hypotensive effect; usually used for therapeutic advantage

BETA-BLOCKERS

May cause additive hypotensive effect; usually used for therapeutic advantage

DIAZOXIDE

Potentially could cause profound hypotension

DIURETICSModerate

May cause additive hypotensive effect; usually used for therapeutic advantage

FUROSEMIDE

Hydralazine may increase furosemide's renal effects

MAO INHIBITORS

May cause additive hypotensive effect

SYMPATHOMIMETICS (e.g., epinephrine)

Hydralazine may cause decreased pressor effect and may cause additive tachycardia

ACE inhibitors (e.g., enalapril, benazepril)Major

Enhanced hypotensive effects

AnaestheticsModerate

Enhanced hypotensive effects

Beta-blockers (e.g., propranolol)Moderate

Enhanced hypotensive effects

Calcium-channel blockers (e.g., diltiazem, verapamil)Moderate

Enhanced hypotensive effects

CorticosteroidsMinor

Enhanced hypotensive effects

NSAIDsModerate

Enhanced hypotensive effects

Sympathomimetics (e.g., phenylpropanolamine)Moderate

May cause tachycardia

Adrenaline (Epinephrine)Moderate

Reduced pressor response to adrenaline

모니터링

  • Baseline thoracic radiographs
  • Mucous membrane color and capillary refill time
  • Serum electrolytes and creatinine
  • Arterial blood pressure (Target MAP 60-80 mmHg for short-term CHF treatment)
  • Venous PO2
  • Occasional CBC (due to possibility of blood dyscrasias)
  • Systemic blood pressure (frequent monitoring during initiation)
  • Heart rate and rhythm
  • Renal function (BUN, Creatinine)
  • Hydration status and body weight (to monitor for fluid retention)

약동학

반감기

고양이Unknown개2-4 hours

흡수

Rapidly absorbed after oral administration. Onset of action within 1 hour, peak effects at 3-5 hours. High first-pass effect. Food decreases oral bioavailability in dogs by about 63% (though some reports suggest food may enhance tablet bioavailability).

분포

Widely distributed in body tissues. Approximately 85% bound to plasma proteins in humans. Crosses the placenta and very small amounts are excreted into milk.

대사

Extensively metabolized in the liver. N-acetylation is a primary enzymatic pathway, which is mostly absent in dogs, leading to increased risks for toxicity.

배설

Approximately 15% is excreted unchanged in the urine. Duration of action in dogs after oral administration is reportedly 11-13 hours.

과다투여

Clinical Signs: Overdoses are characterized by severe hypotension, reflex tachycardia or other arrhythmias, skin flushing, and myocardial ischemia.

Treatment:

  • Decontamination: Evacuate gastric contents and administer activated charcoal using standard precautions if ingestion was recent and cardiovascular status is stable.
  • Cardiovascular Support: Treat shock using volume expanders. Avoid pressor agents if possible.
  • Pressor Agents: If required to maintain blood pressure, use a minimally arrhythmogenic agent (e.g., phenylephrine or methoxamine).
  • Additional Support: Digitalis agents may be required. Diligently monitor blood pressure and renal function.

제품

제형

  • Oral tablets
  • Injection
  • 25 mg oral tablet
  • 50 mg oral tablet

인용의약품

  • Hydralazine HCl Oral Tablets: 10 mg, 25 mg, 50 mg & 100 mg (Apresoline, generic)
  • Hydralazine Injection: 20 mg/mL in 1 mL vials (generic)
  • Apresoline 25 mg tablets
  • Apresoline 50 mg tablets

규제 현황

European Union✗ 미승인처방전의약품EMA

POM (Prescription Only Medicine). Used under the cascade.

United Kingdom✗ 미승인처방전의약품VMD

POM (Prescription Only Medicine). Used under the prescribing cascade.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Store tablets in tight, light-resistant containers at room temperature. Store injectable product at room temperature; avoid refrigeration or freezing. When mixed with infusion solutions, a color change may occur over 8-12 hours, which does not necessarily indicate a loss in potency.

보호자 정보

히드랄라진은 혈압을 낮추고 반려동물의 심장 부담을 줄여주는 약물로, 특히 심장 판막 질환이 있는 반려동물에게 유용합니다.

  • ​지시 사항 엄수​: 약물의 효과를 극대화하고 위험한 혈압 저하를 방지하려면 수의사의 처방에 따라 정확하게 투여하는 것이 매우 중요합니다.
  • ​주의 깊게 관찰할 사항​: 반려동물이 평소보다 무기력해지거나, 쇠약해지거나, 우울해하거나, 기절하는 경우 즉시 수의사에게 연락하십시오. 이는 혈압이 너무 낮아졌음(저혈압)을 나타내는 신호일 수 있습니다.
  • ​부작용​: 가벼운 구토나 설사가 나타날 수 있습니다. 이러한 증상이 지속되면 수의사에게 알리십시오.
  • ​식이​: 음식이 약물의 체내 흡수량에 영향을 미칠 수 있으므로, 이 약을 음식과 함께 먹여야 하는지 여부를 수의사에게 확인하십시오.

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