BiDil Disease Interactions
There are 13 disease interactions with BiDil (hydralazine / isosorbide dinitrate).
- Bone marrow suppression
- Coronary artery disease
- Lupus erythematosus
- Valvular heart disease
- AMI
- Anemia
- Hemodialysis
- Hypotension
- Intracranial pressure
- Cerebral vasculopathy
- Renal dysfunction
- Hypertrophic cardiomyopathy
- Glaucoma
Hydralazine (applies to BiDil) bone marrow suppression
Major Potential Hazard, Low plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts
Hydralazine may rarely cause blood dyscrasias at recommended dosages. Reduction in hemoglobin, red cell count, agranulocytosis, leukopenia, and purpura have been reported. Therapy with hydralazine should be administered cautiously in patients with these preexisting conditions and if such abnormalities develop during the course of therapy, treatment should be discontinued. Monitoring blood counts should be considered for those patients at higher risk.
References
- Koch-Weser J (1976) "Hydralazine." N Engl J Med, 295, p. 320-3
- Orenstein AA, Yakulis V, Eipe J, Costea N (1977) "Immune hemolysis due to hydralazine." Ann Intern Med, 86, p. 450-1
- Widerlov E, Karlman I, Storsater J (1980) "Hydralazine-induced neonatal thrombocytopenia." N Engl J Med, 303, p. 1235
- Freestone S, Ramsay LE (1982) "Transient monoclonal gammopathy in hydralazine-induced lupus erythematosus." Br Med J, 285, p. 1536-7
- Macleod WN (1983) "Anaemia in the hydrallazine-induced lupus syndrome." Scott Med J, 28, p. 181-2
- Harrison BD, Laidlaw ST, Reilly JT (1995) "Fatal aplastic anaemia associated with lisinopril." Lancet, 346, p. 247-8
- (2001) "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals
Hydralazine (applies to BiDil) coronary artery disease
Major Potential Hazard, High plausibility. Applicable conditions: Ischemic Heart Disease
The use of hydralazine is contraindicated in patients with coronary artery disease. Reflex tachycardia may commonly occur. Palpitations and chest pain have also been reported. Myocardial infarction has been associated with the use of hydralazine.
References
- Koch-Weser J (1976) "Hydralazine." N Engl J Med, 295, p. 320-3
- Laslett LJ, DeMaria AN, Amsterdam EA, Mason DT (1978) "Hydralazine-induced tachycardia and sodium retention in heart failure: hemodynamic and symptomatic correlation by prazosin therapy." Arch Intern Med, 138, p. 819-20
- Packer M, Meller J, Medina N, et al. (1981) "Provocation of myocardial ischemic events during initiation of vasodilator therapy for severe chronic heart failure." Am J Cardiol, 48, p. 939-46
Hydralazine (applies to BiDil) lupus erythematosus
Major Potential Hazard, High plausibility.
The use of hydralazine has been associated with the development of lupus erythematosus and lupus-like syndromes, as well as exacerbation of the disease. Hydralazine therapy should be withdrawn in patients experiencing worsening of preexisting lupus. Monitoring complete blood counts, and antinuclear antibody titers before and during prolonged therapy is recommended.
References
- Hahn BH, Sharp GC, Irvin WS, et al. (1972) "Immune responses to hydralazine and nuclear antigens in hydralazine-induced lupus erythematosus." Ann Intern Med, 76, p. 365-74
- Carey RM, Coleman M, Feder A (1973) "Pericardial tamponade: a major presenting manifestation of hydralazine-induced lupus syndrome." Am J Med, 54, p. 84-7
- Perry HM (1973) "Late toxicity to hydralazine resembling systemic lupus erythematosus or rheumatoid arthritis." Am J Med, 54, p. 58-72
- Blumenkrantz N, Christiansen AH, Ullman S, Asboe-Hansen G (1974) "Hydralazine-induced lupoid syndrome." Acta Med Scand, 195, p. 443-9
- Weinstein J (1978) "Hypocomplementemia in hydralazine-associated systemic lupus erythematosus." Am J Med, 65, p. 553-6
- Freestone S, Ramsay LE (1982) "Transient monoclonal gammopathy in hydralazine-induced lupus erythematosus." Br Med J, 285, p. 1536-7
- Macleod WN (1983) "Anaemia in the hydrallazine-induced lupus syndrome." Scott Med J, 28, p. 181-2
- Ihle BU, Whitworth JA, Dowling JP, Kincaid-Smith P (1984) "Hydralazine and lupus nephritis." Clin Nephrol, 22, p. 230-8
- Cameron HA, Ramsay LE (1984) "The lupus syndrome induced by hydralazine: a common complication with low dose treatment." Br Med J, 289, p. 410-12
- Naparstek Y, Kopolovic J, Tur-Kaspa R, Rubinger D (1984) "Focal glumerulonephritis in the course of hydralazine-induced lupus syndrome." Arthritis Rheum, 27, p. 822-5
- Shapiro KS, Pinn VW, Harrington JT, Levey AS (1984) "Immune complex glomerulonephritis in hydralazine-induced SLE." Am J Kidney Dis, 3, p. 270-4
- Cush JJ, Goldings EA (1985) "Southwestern internal medicine conference: drug-induced lupus: clinical spectrum and pathogenesis." Am J Med Sci, 290, p. 36-45
- Innes A, Rennie JA, Cato GR (1986) "Drug-induced lupus caused by very-low-dose hydralazine." Br J Rheumatol, 25, p. 225-31
- Darwaza A, Lamey P-J, Connell JM (1988) "Hydrallazine-induced Sjogren's syndrome." Int J Oral Maxillofac Surg, 17, p. 92-3
- Sturman SG, Kumararatne D, Beevers DG (1988) "Fatal hydralazine-induced systemic lupus erythematosus." Lancet, 12/03/88, p. 1304
- Fleming MG, Bergfeld WF, Tomecki KJ, et al. (1989) "Bullous systemic lupus erythematosus." Int J Dermatol, 28, p. 321-6
- Ramsey-Goldman R, Franz T, Solano FX, Medsger TA (1990) "Hydralazine induced lupus and sweet's syndrome: report and review of the literature." J Rheumatol, 17, p. 682-4
- Lunde PK, Frislid K, Hansteen V (1977) "Disease and acetylation polymorphism." Clin Pharmacokinet, 2, p. 182-97
- Timbrell JA, Facchini V, Harland SJ, Mansilla-Tinoco R (1984) "Hydralazine-induced lupus: is there a toxic metabolic pathway?" Eur J Clin Pharmacol, 27, p. 555-9
- (2001) "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals
- Pirmohamed M (1996) "Hydralazine-induced lupus: yet another autoantibody! triplex-DNA stabilization by hydralazine and the presence of anti-(triplex DNA) antibodies in patients treated with hydralazine - comment." Hum Exp Toxicol, 15, p. 361-2
Hydralazine (applies to BiDil) valvular heart disease
Major Potential Hazard, High plausibility.
The use of hydralazine is contraindicated in patients with mitral valvular rheumatic heart disease.
References
- (2001) "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals
Nitrates/nitrites (applies to BiDil) AMI
Major Potential Hazard, High plausibility. Applicable conditions: Myocardial Infarction, Congestive Heart Failure
The benefits of organic nitrates and nitrites in patients with acute myocardial infarction (AMI) or congestive heart failure have not been established and its use is not recommended in these settings. If used, it should be accompanied by careful clinical and hemodynamic monitoring to avoid the hazards of systemic hypotension and tachycardia, which in AMI can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate- onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.
References
- Scardi S, Zingone B, Pandullo C (1990) "Myocardial infarction following sublingual administration of isosorbide dinitrate." Int J Cardiol, 26, p. 378-9
- Berisso MZ, Cavallini A, Iannetti M (1984) "Sudden death during continuous Holter monitoring out of hospital after nitroglycerin consumption." Am J Cardiol, 54, p. 677-9
- Buckley R, Roberts R (1993) "Symptomatic bradycardia following the administration of sublingual nitroglycerin." Am J Emerg Med, 11, p. 253-5
- Ong EA, Canlas C, Smith W (1985) "Nitroglycerin-induced asystole ." Arch Intern Med, 145, p. 954
- von Arnim T, Autenrieth G, Bolte HD (1984) "Acute myocardial infarction during continuous electrocardiographic ST segment recording. Possible role of bradycardia and hypotension induced by glyceryl trinitrate." Br Heart J, 51, p. 575-7
- Lancaster L, Fenster PE (1983) "Complete heart block after sublingual nitroglycerin." Chest, 84, p. 111-2
- Brandes W, Santiago T, Limacher M (1990) "Nitroglycerin-induced hypotension, bradycardia, and asystole: report of a case and review of the literature." Clin Cardiol, 13, p. 741-4
- (2002) "Product Information. Isordil (isosorbide dinitrate)." Wyeth-Ayerst Laboratories
- (2002) "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories
- (2002) "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals
- (2002) "Product Information. Nitrostat (nitroglycerin)." Parke-Davis
Nitrates/nitrites (applies to BiDil) anemia
Major Potential Hazard, High plausibility.
Some manufacturers and medical references consider the use of nitrates and nitrites to be contraindicated in patients with severe anemia. Nitrates and nitrites can cause methemoglobinemia, primarily in high-dose intravenous therapy or acute poisoning and in patients with NADH reductase deficiency. However, elevations of methemoglobin may also occur with commonly used dosages. While probably not of routine clinical significance, the increases may be important in certain patient populations such as those with coronary insufficiency or anemia.
References
- Fibuch EE, Cecil WT, Reed WA (1979) "Methemoglobinemia associated with organic nitrate therapy." Anesth Analg, 58, p. 521-3
- Arsura E, Lichstein E, Guadagnino V, Nicchi V, Sanders M, Hollander G, Greengart A (1984) "Methemoglobin levels produced by organic nitrates in patients with coronary artery disease." J Clin Pharmacol, 24, p. 160-4
- Curry SC, Arnold-Capell P (1991) "Toxic effects of drugs used in the ICU. Nitroprusside, nitroglycerin, and angiotensin-converting enzyme inhibitors." Crit Care Clin, 7, p. 555-81
- Kaplan K, Davison R (1986) "Nitroglycerin and methemoglobinemia." Am J Cardiol, 57, p. 1004
- Saxon SA, Silverman ME (1985) "Effects of continuous infusion of intravenous nitroglycerin on methemoglobin levels." Am J Cardiol, 56, p. 461-4
- Gibson GR, Hunter JB, Raabe DS, Jr Manjoney DL, Ittleman FP (1982) "Methemoglobinemia produced by high-dose intravenous nitroglycerin." Ann Intern Med, 96, p. 615-6
- Robicsek F (1985) "Acute methemoglobinemia during cardiopulmonary bypass caused by intravenous nitroglycerin infusion." J Thorac Cardiovasc Surg, 90, p. 931-4
- (2002) "Product Information. Nitrostat (nitroglycerin)." Parke-Davis
- Forsyth RJ, Moulden A (1991) "Methaemoglobinaemia after ingestion of amyl nitrite." Arch Dis Child, 66, p. 152
- Pierce JM, Nielsen MS (1989) "Acute acquired methaemoglobinaemia after amyl nitrite poisoning." BMJ, 298, p. 1566
- Sutton M, Jeffrey B (1992) "Acquired methemoglobinemia from amyl nitrate inhalation." J Emerg Nurs, 18, p. 8-9
- Sobey RJ, Campbell CM (1992) "A 37-year-old with amyl nitrite-induced methemoglobinemia." J Emerg Nurs, 18, p. 11-3
- Edwards RJ, Ujma J (1995) "Extreme methaemoglobinaemia secondary to recreational use of amyl nitrite." J Accid Emerg Med, 12, p. 138-42
- Machabert R, Testud F, Descotes J (1994) "Methaemoglobinaemia due to amyl nitrite inhalation: a case report." Hum Exp Toxicol, 13, p. 313-4
Nitrates/nitrites (applies to BiDil) hemodialysis
Major Potential Hazard, High plausibility.
The combined effect of organic nitrates or nitrites with hemodialysis, which often lowers blood pressure, can cause life-threatening hypotension. Therapy with these agents should be administered cautiously in patients requiring hemodialysis. The medication should be withheld before undergoing dialysis, and hemodynamic stability should be established prior to resumption of medication following dialysis. Nitroglycerin and isosorbide dinitrate are moderately dialyzed.
References
- Imamura T, Tamura K, Taguchi T, Minoda M, Seita M (1988) "Reduction of nitroglycerin and isosorbide dinitrate by hemodialysis in refractory angina pectoris after acute myocardial infarction." Am J Cardiol, 61, p. 954-5
- Dunetz PS (1992) "Dialysis patients and nitrates." Nursing, 22, p. 4
Nitrates/nitrites (applies to BiDil) hypotension
Major Potential Hazard, High plausibility. Applicable conditions: Dehydration, Cerebrovascular Insufficiency, Shock, Constrictive Pericarditis, Aortic Stenosis
Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.
References
- Purvin VA, Dunn DW (1981) "Nitrate-induced transient ischemic attacks." South Med J, 74, p. 1130-1
- Buckley R, Roberts R (1993) "Symptomatic bradycardia following the administration of sublingual nitroglycerin." Am J Emerg Med, 11, p. 253-5
- von Arnim T, Autenrieth G, Bolte HD (1984) "Acute myocardial infarction during continuous electrocardiographic ST segment recording. Possible role of bradycardia and hypotension induced by glyceryl trinitrate." Br Heart J, 51, p. 575-7
- Lancaster L, Fenster PE (1983) "Complete heart block after sublingual nitroglycerin." Chest, 84, p. 111-2
- Ong EA, Bass S (1980) "Nitroglycerin-induced bradycardia and hypotension in acute myocardial infarction." Chest, 77, p. 244
- Cunningham J (1979) "Hypotension following administration of sublingual nitroglycerin ." Heart Lung, 8, p. 364
- Nemerovski M, Shah PK (1981) "Syndrome of severe bradycardia and hypotension following sublingual nitroglycerin administration." Cardiology, 67, p. 180-9
- Brandes W, Santiago T, Limacher M (1990) "Nitroglycerin-induced hypotension, bradycardia, and asystole: report of a case and review of the literature." Clin Cardiol, 13, p. 741-4
- (2002) "Product Information. Isordil (isosorbide dinitrate)." Wyeth-Ayerst Laboratories
- (2002) "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories
- (2002) "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals
- (2002) "Product Information. Nitrostat (nitroglycerin)." Parke-Davis
Nitrates/nitrites (applies to BiDil) intracranial pressure
Major Potential Hazard, High plausibility. Applicable conditions: Head Injury, Brain/Intracranial Tumor, Intracranial Hemorrhage, Intracranial Hypertension
Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.
References
- Ahmad S (1991) "Nitroglycerin and intracranial hypertension ." Am Heart J, 121, p. 1850-1
- Gagnon RL, Marsh ML, Smith RW, Shapiro HM (1979) "Intracranial hypertension caused by nitroglycerin." Anesthesiology, 51, p. 86-7
- Boggild M (1992) "Intracerebral haemorrhage after dermal nitrate application." BMJ, 305, p. 1000
- Hannerz J, Greitz D (1992) "Cerebrospinal fluid pressure and venous pressure in "dynamite headache" and cluster headache attacks." Headache, 32, p. 436-8
- (2002) "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals
- (2002) "Product Information. Nitrostat (nitroglycerin)." Parke-Davis
Hydralazine (applies to BiDil) cerebral vasculopathy
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Cerebral Vascular Disorder
The vasodilatory effects of hydralazine may aggravate cerebral vasculopathy. Therapy with hydralazine should be administered cautiously in patients with cerebral vasculopathy.
References
- Koch-Weser J (1976) "Hydralazine." N Engl J Med, 295, p. 320-3
- (2001) "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals
Hydralazine (applies to BiDil) renal dysfunction
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glomerulonephritis
The use of hydralazine has been associated with the development of glomerulonephritis. Hydralazine should be used with caution in patients with advanced renal damage and these patients may require a lower dose. Renal function should be monitored and supported as required.
References
- (2001) "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals
Nitrates/nitrites (applies to BiDil) hypertrophic cardiomyopathy
Moderate Potential Hazard, High plausibility.
Organic nitrates and nitrites may aggravate the angina associated with hypertrophic cardiomyopathy and should be administered cautiously in patients with this condition.
References
- (2002) "Product Information. Isordil (isosorbide dinitrate)." Wyeth-Ayerst Laboratories
- (2002) "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories
- (2002) "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals
- (2002) "Product Information. Nitrostat (nitroglycerin)." Parke-Davis
Nitrates/nitrites (applies to BiDil) glaucoma
Minor Potential Hazard, Low plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension
Some medical references state that organic nitrates and nitrites may increase intraocular pressure and should be used with caution in patients with glaucoma. However, the effect on intraocular pressure is variable and brief, and there is no evidence that these drugs precipitate narrow-angle glaucoma. Amyl nitrate typically may cause a slight rise of 3+ mm for several seconds followed by a fall in intraocular pressure for 10 to 20 minutes, the latter secondary to a fall in blood pressure. Nitroglycerin rarely produces ocular side effects, and oral nitroglycerin appears to have few to no significant ocular side effects.
References
- Fraunfelder FT, Fraunfelder FW; Randall JA (2001) "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann
BiDil drug interactions
There are 436 drug interactions with BiDil (hydralazine / isosorbide dinitrate).
BiDil alcohol/food interactions
There is 1 alcohol/food interaction with BiDil (hydralazine / isosorbide dinitrate).
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Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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