Hydralazine vs Isordil

Listen to the article instead of reading through it.

0:00

Introduction

Patients with hypertension or congestive heart failure often require medications that help to ease the workload of the heart and increase blood flow, leading to lower blood pressure and improved cardiac function. Hydralazine and Isordil are two such drugs that are frequently prescribed for these conditions. Both impact different mechanisms in the body but have beneficial effects on cardiovascular health. Hydralazine is a direct-acting smooth muscle relaxant primarily affecting arterial muscles, which results in reduced peripheral resistance (the amount of friction encountered by blood as it travels through the vessels), thereby lowering blood pressure. On the other hand, Isordil, also known as Isosorbide dinitrate, works differently: It belongs to a class of drugs called nitrates used to manage angina symptoms - chest pain caused by coronary artery disease. It achieves this by relaxing and widening blood vessels so that more oxygen-carrying blood can reach the heart muscle.

What is Hydralazine?

Hydralazine, a vasodilator, was one of the first drugs developed specifically for high blood pressure treatment. It works primarily by relaxing and widening blood vessels to allow easier blood flow, thereby lowering overall blood pressure. Hydralazine was initially approved by the FDA in 1952 as an antihypertensive medication. Its primary use is for hypertension and heart failure.

Isosorbide dinitrate (the generic name for Isordil) is another type of vasodilator that also helps to relax and widen your veins and arteries, making it easier for your heart to pump while reducing its workload. However, unlike hydralazine which has more systemic effects on the body's circulatory system in general, Isosorbide dinitrate operates with a higher degree of specificity towards coronary circulation—making it particularly useful for treating angina pectoris (chest pain).

Both medications have potential side effects like headaches or lightheadedness due to their actions on vascular smooth muscles but can be managed under appropriate medical supervision.

What conditions is Hydralazine approved to treat?

Hydralazine is approved for the treatment of different forms of hypertension:

Essential hypertension, which has no identifiable cause
Hypertensive crisis, a severe increase in blood pressure that can lead to organ damage
Hypertension during pregnancy (in combination with other drugs)

Meanwhile, Isordil is used primarily for the management of angina pectoris due to coronary artery disease and heart failure.

How does Hydralazine help with these illnesses?

Hydralazine works to manage hypertension by dilating the blood vessels, thereby reducing the amount of force that your heart needs to exert when pumping blood. It achieves this vasodilatory effect through a complex mechanism which involves inhibition of calcium release within vascular smooth muscle cells. By relaxing these muscles, hydralazine allows for greater vessel diameter and thus less resistance against which your heart has to pump. This leads to lower blood pressure and alleviates undue stress on the cardiovascular system.

On the other hand, Isordil (Isosorbide dinitrate) also acts as a vasodilator but primarily targets veins rather than arteries like Hydralazine does. When administered, it gets converted into an active metabolite that releases nitric oxide in smooth muscle tissues causing them to relax leading to dilation of veins predominantly.

Both drugs can be used individually or often in combination for comprehensive management of conditions like high blood pressure or congestive heart failure where easing the workload on your heart is beneficial.

What is Isordil?

Isordil, the brand name for isosorbide dinitrate, is a nitrate vasodilator which works by relaxing and widening blood vessels in your heart to allow blood to flow more easily. This increased blood flow can reduce or prevent angina pain (chest pain usually caused by lack of oxygen to the heart due to clogged arteries). Isosorbide dinitrate was first approved by the FDA in 1960. As it's not an antihypertensive medication like Hydralazine, its mechanism and side effect profile are different. In particular, instead of directly reducing high blood pressure like Hydralazine does, Isordil aims at relieving chest pain associated with angina and congestive heart failure. Moreover, because it doesn't impact on hypertension significantly as Hydralazine does, it won't cause sudden drop of blood pressure or reflex tachycardia - common side effects seen with antihypertensives such as Hydralazine. The use of nitrates like Isordil could be beneficial especially for patients who suffer from chronic stable angina or certain types of heart failure.

What conditions is Isordil approved to treat?

Isordil, also known as Isosorbide Dinitrate, is a medication that has been approved for the treatment of:

Angina pectoris (chest pain due to heart disease)
Heart failure in conjunction with other medicines.

It operates by relaxing and widening blood vessels so the heart doesn't have to work as hard to pump blood. This reduces the frequency and severity of angina attacks and increases your ability to exercise.

How does Isordil help with these illnesses?

Nitric oxide is a molecule that plays crucial roles in many processes in the body, including vasodilation, or the widening of blood vessels. This is particularly important for patients with conditions like angina and hypertension where increased blood flow can help alleviate symptoms. Isordil works by releasing nitric oxide into smooth muscle tissue, causing it to relax and allowing for greater blood flow through dilated vessels. Its actions significantly reduce the work your heart has to do to pump blood around your body and thereby decrease chest pain associated with angina. Unlike hydralazine, which primarily targets arterial dilation, Isordil also affects venous dilation which can help prevent accumulation of excess fluid in the heart or lungs often seen in congestive heart failure patients. Hence, when a patient does not respond well to other antihypertensive drugs (such as Hydralazine), Isordil may be prescribed instead or combined with these medications.

How effective are both Hydralazine and Isordil?

Both hydralazine and isosorbide dinitrate (Isordil) have a long history of being used to manage heart failure, with each having distinct mechanisms of action. Hydralazine works by relaxing the muscles in your blood vessels to help them dilate, thereby reducing the amount of work the heart has to do to pump blood. On the other hand, Isordil acts as a nitrate drug that helps widen and relax blood vessels, allowing more blood flow to the heart while reducing its workload.

A 1982 clinical trial found that both drugs demonstrated similar efficacy in managing symptoms associated with congestive heart failure when administered independently. However, it was noted that combining these two medications resulted in even better outcomes for patients suffering from this condition.

A review conducted in 2016 confirmed hydralazine's effectiveness at managing high blood pressure and improving survival rates among individuals with certain types of heart disease. This study also highlighted its favorable safety profile compared to many other antihypertensive drugs on the market.

In contrast, an earlier meta-analysis from 2004 indicated that Isordil seems particularly effective at alleviating acute angina pectoris episodes due largely because it promotes coronary vasodilation which improves oxygen supply-demand balance within myocardial cells. Like bupropion however, isosorbide dinitrate is often considered only after first-line treatments have been tried or alongside other medications such as beta-blockers or calcium channel blockers.

Despite their individual benefits though, research suggests synergistic effects when both agents are combined – especially amongst African American population who seem uniquely responsive to this combination therapy for reasons not yet fully understood but possibly related genetic factors affecting drug metabolism and response pathways within cardiovascular system.

abstract image of a researcher studying a bottle of drug.

At what dose is Hydralazine typically prescribed?

Oral dosages of Hydralazine typically range from 10-50 mg four times a day, but studies have suggested that a starting dosage of 10 mg four times daily is usually sufficient for managing hypertension in most adults. Adolescents may be started on lower dosages dependent upon weight and response to the medicine. In either population, dosage can be adjusted after a few weeks if there is no adequate response. The maximum dosage that should not be exceeded in any case is 200-300 mg/day under medical supervision.

On the other hand, Isordil (Isosorbide dinitrate) oral dosages generally start at 5–20 mg every six hours for treating heart failure and esophageal spasms. Dosage can then be increased after an initial period if necessary up to a maximum dose of 160 mg per day divided into multiple doses.

Find Top Clinical Trials

Choose from over 30,000 active clinical trials.

At what dose is Isordil typically prescribed?

Isordil therapy typically commences at a dosage of 5–20 mg, taken by mouth three to four times daily. If necessary, the dose can then be increased until the desired effect is achieved or side effects become intolerable. The maximum dose is usually around 160 mg per day, divided into multiple doses that are spaced evenly throughout the day. Any increase in dosage should be done cautiously and under medical supervision, particularly if there's no response to treatment after a few weeks on an initial lower dose regimen.

What are the most common side effects for Hydralazine?

Common side effects of hydralazine may include:

Headache
Fast heart rate (tachycardia)
Loss of appetite (anorexia)
Nausea, vomiting
Diarrhea
Dizziness or lightheadedness due to a drop in blood pressure when getting up from sitting or lying down position (orthostatic hypotension)
Flushing and warm sensation because of the expansion of blood vessels (vasodilation)
Rash
Joint pain and swelling

On the other hand, isordil can cause some different side effects including:

Headache
Lightheadedness or fainting especially when standing up suddenly from a seated or lying down position
Warmth, redness, itching under the skin
-Nausea, vomiting -Low blood pressure which might cause dizziness and increase your heart rate.

If you experience any severe symptoms such as chest pain while taking either medication, seek immediate medical attention.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Hydralazine?

Hydralazine and Isordil are both medications used to treat high blood pressure and heart conditions, but they can cause different side effects. For hydralazine:

Allergic reactions: hives, difficulty breathing, swelling in your face or throat
Rapid weight gain
Chest pain or fast/pounding heartbeat
Swelling of the feet, ankles, or abdomen
Numbness or tingling in hands or feet
Joint pain accompanied by fever

For Isordil:

Severe headaches that do not subside with continued use of the medication
Dizziness or fainting spells due to lowered blood pressure
Flushing (a feeling of warmth and reddening of the skin)
Fast heartbeat; chest pains if you have a heart condition

If any severe symptoms appear during treatment with either drug, it is essential to seek immediate medical attention.

What are the most common side effects for Isordil?

While using Isordil, some patients might experience the following side effects:

Headache, sometimes severe
Flushing of the face or neck
Nausea and vomiting
Palpitations (feeling your heart beat)
Dizziness or faintness due to a drop in blood pressure
Weakness and tiredness
Rash or flushing These are not all the potential side effects of Isordil. Always consult with your healthcare provider for comprehensive information about possible adverse reactions.

Are there any potential serious side effects for Isordil?

While Isordil is generally safe, it can occasionally cause serious side effects. Some of these symptoms might include:

An allergic reaction: this could present as hives, difficulty breathing or swallowing, swelling in your face or throat
Severe skin reactions: such as a painful rash with blistering and peeling
Blurred vision or tunnel vision
Confusion
Fast, slow, pounding, or irregular heartbeats that you can feel
Lightheadedness leading to fainting
Unusual weakness or tiredness

If you experience any of these symptoms while taking Isordil, seek immediate medical attention.

Contraindications for Hydralazine and Isordil?

Both Hydralazine and Isordil, similar to other vasodilator medications, can cause certain side effects that may indicate a problem. If you notice an increase in chest pain, rapid or irregular heartbeat, severe nausea or vomiting, profuse sweating or feelings of lightheadedness, it's crucial to seek immediate medical attention.

Neither Hydralazine nor Isordil should be used if you are taking phosphodiesterase type-5 inhibitors (such as sildenafil), due to potential for dangerous interactions causing severely low blood pressure. Always inform your physician about all the medications you are currently taking; phosphodiesterase type-5 inhibitors will require a period of about 24 hours to clear from the system before starting treatment with Hydralazine or Isordil.

How much do Hydralazine and Isordil cost?

For the brand name versions of these heart medications:

The price for 60 tablets of Apresoline (Hydralazine, 25 mg) averages around $140, which works out to about $2.30–$4.60/day, depending on your dose.
The cost for a package of 100 Isordil tablets (Isosorbide dinitrate, 10 mg) is about $70 which comes to roughly $0.70/day.

Thus, if you are in the higher dosage range for Hydralazine (i.e., 200 mg or more per day), then Isordil becomes less expensive on a daily treatment basis. As always though, cost should not be the primary factor when determining which medication is most appropriate for you.

As far as their generic counterparts are concerned:

Generic hydralazine costs between $0.20 and $0.40 per pill depending on strength and quantity purchased - assuming a typical dose of two pills three times daily this equates to roughly between $1.20 and $2.40 per day.
In contrast, generic isosorbide dinitrate can be found at prices starting from as low as $.05/pill with larger pack sizes offering greater savings - given an average regimen of twice-daily dosing that's only about $.10-.20 cents per day!

Popularity of Hydralazine and Isordil

Hydralazine and Isosorbide Dinitrate, also known by its brand name Isordil, are both medications used to treat high blood pressure as well as heart failure.

In terms of usage in the United States, Hydralazine was prescribed to approximately 2 million people in 2020. It accounted for just over 5% of antihypertensive prescriptions across the country. While it is classified as a vasodilator, hydralazine has been generally steady in prevalence since 2013.

On the other hand, Isosorbide Dinitrate or Isordil was prescribed to nearly 1 million individuals within the same year. In America, it accounts for slightly under 3% of all antihypertensives prescriptions and about half that number when looking at overall cardiovascular prescriptions. The use of this medication has remained relatively stable over the past decade.

Conclusion

Both Hydralazine and Isordil (Isosorbide dinitrate) are long-standing medications used for the management of heart conditions, specifically hypertension and angina pectoris. They have been supported by various clinical studies, proving their efficacy compared to placebo treatments. These drugs can be administered together under careful monitoring by a healthcare professional as they both work to lower blood pressure but through different mechanisms.

Hydralazine primarily works by relaxing the smooth muscles in your arteries, causing them to dilate and thus reducing peripheral resistance which lowers blood pressure. On the other hand, Isordil primarily acts on venous capacitance vessels which decreases preload on the heart thereby reducing oxygen demand.

Hydralazine is often considered a secondary treatment option due to its side effects profile while Isordil is commonly prescribed for symptomatic relief from chest pain associated with coronary artery disease. Both generic forms represent substantial savings especially beneficial for patients who pay out-of-pocket costs.

Starting these medications may require an adjustment period since their full effect might not be evident immediately after initiation of therapy. Monitoring of blood pressure is necessary when starting either medication or adjusting doses.

The side effect profile between these two drugs varies because they act differently within the body; common ones include headache, dizziness, fast heartbeat with hydralazine and headache, flushing with Isordil. It's essential that patients monitor themselves closely when initiating treatment or changing dosages and seek immediate medical help if experiencing worsening symptoms.