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BiDil (hydralazine / isosorbide dinitrate) Disease Interactions

There are 12 disease interactions with BiDil (hydralazine / isosorbide dinitrate):

Major

Hydralazine (Includes BiDil) ↔ Bone Marrow Suppression

Severe Potential Hazard, Low plausibility

Applies to: 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

  1. Widerlov E, Karlman I, Storsater J "Hydralazine-induced neonatal thrombocytopenia." N Engl J Med 303 (1980): 1235
  2. "Product Information. Apresoline (hydralazine)." Ciba Pharmaceuticals, Summit, NJ.
  3. Freestone S, Ramsay LE "Transient monoclonal gammopathy in hydralazine-induced lupus erythematosus." Br Med J 285 (1982): 1536-7
  4. Koch-Weser J "Hydralazine." N Engl J Med 295 (1976): 320-3
  5. Orenstein AA, Yakulis V, Eipe J, Costea N "Immune hemolysis due to hydralazine." Ann Intern Med 86 (1977): 450-1
  6. Harrison BD, Laidlaw ST, Reilly JT "Fatal aplastic anaemia associated with lisinopril." Lancet 346 (1995): 247-8
  7. Macleod WN "Anaemia in the hydrallazine-induced lupus syndrome." Scott Med J 28 (1983): 181-2
View all 7 references
Major

Hydralazine (Includes BiDil) ↔ Coronary Artery Disease

Severe Potential Hazard, High plausibility

Applies to: 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

  1. Laslett LJ, DeMaria AN, Amsterdam EA, Mason DT "Hydralazine-induced tachycardia and sodium retention in heart failure: hemodynamic and symptomatic correlation by prazosin therapy." Arch Intern Med 138 (1978): 819-20
  2. Packer M, Meller J, Medina N, et al "Provocation of myocardial ischemic events during initiation of vasodilator therapy for severe chronic heart failure." Am J Cardiol 48 (1981): 939-46
  3. Koch-Weser J "Hydralazine." N Engl J Med 295 (1976): 320-3
Major

Hydralazine (Includes BiDil) ↔ Lupus Erythematosus

Severe Potential Hazard, High plausibility

Applies to: Lupus Erythematosus

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

  1. Shapiro KS, Pinn VW, Harrington JT, Levey AS "Immune complex glomerulonephritis in hydralazine-induced SLE." Am J Kidney Dis 3 (1984): 270-4
  2. Pirmohamed M "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 (1996): 361-2
  3. Darwaza A, Lamey P-J, Connell JM "Hydrallazine-induced Sjogren's syndrome." Int J Oral Maxillofac Surg 17 (1988): 92-3
  4. Carey RM, Coleman M, Feder A "Pericardial tamponade: a major presenting manifestation of hydralazine-induced lupus syndrome." Am J Med 54 (1973): 84-7
  5. Freestone S, Ramsay LE "Transient monoclonal gammopathy in hydralazine-induced lupus erythematosus." Br Med J 285 (1982): 1536-7
  6. Naparstek Y, Kopolovic J, Tur-Kaspa R, Rubinger D "Focal glumerulonephritis in the course of hydralazine-induced lupus syndrome." Arthritis Rheum 27 (1984): 822-5
  7. Sturman SG, Kumararatne D, Beevers DG "Fatal hydralazine-induced systemic lupus erythematosus." Lancet 12/03/88 (1988): 1304
  8. Cush JJ, Goldings EA "Southwestern internal medicine conference: drug-induced lupus: clinical spectrum and pathogenesis." Am J Med Sci 290 (1985): 36-45
  9. Weinstein J "Hypocomplementemia in hydralazine-associated systemic lupus erythematosus." Am J Med 65 (1978): 553-6
  10. "Product Information. Apresoline (hydralazine)." Ciba Pharmaceuticals, Summit, NJ.
  11. Innes A, Rennie JA, Cato GR "Drug-induced lupus caused by very-low-dose hydralazine." Br J Rheumatol 25 (1986): 225-31
  12. Timbrell JA, Facchini V, Harland SJ, Mansilla-Tinoco R "Hydralazine-induced lupus: is there a toxic metabolic pathway?" Eur J Clin Pharmacol 27 (1984): 555-9
  13. Cameron HA, Ramsay LE "The lupus syndrome induced by hydralazine: a common complication with low dose treatment." Br Med J 289 (1984): 410-12
  14. Lunde PK, Frislid K, Hansteen V "Disease and acetylation polymorphism." Clin Pharmacokinet 2 (1977): 182-97
  15. Macleod WN "Anaemia in the hydrallazine-induced lupus syndrome." Scott Med J 28 (1983): 181-2
  16. Hahn BH, Sharp GC, Irvin WS, et al "Immune responses to hydralazine and nuclear antigens in hydralazine-induced lupus erythematosus." Ann Intern Med 76 (1972): 365-74
  17. Perry HM "Late toxicity to hydralazine resembling systemic lupus erythematosus or rheumatoid arthritis." Am J Med 54 (1973): 58-72
  18. Ihle BU, Whitworth JA, Dowling JP, Kincaid-Smith P "Hydralazine and lupus nephritis." Clin Nephrol 22 (1984): 230-8
  19. Fleming MG, Bergfeld WF, Tomecki KJ, et al "Bullous systemic lupus erythematosus." Int J Dermatol 28 (1989): 321-6
  20. Blumenkrantz N, Christiansen AH, Ullman S, Asboe-Hansen G "Hydralazine-induced lupoid syndrome." Acta Med Scand 195 (1974): 443-9
  21. Ramsey-Goldman R, Franz T, Solano FX, Medsger TA "Hydralazine induced lupus and sweet's syndrome: report and review of the literature." J Rheumatol 17 (1990): 682-4
View all 21 references
Major

Hydralazine (Includes BiDil) ↔ Valvular Heart Disease

Severe Potential Hazard, High plausibility

Applies to: Valvular Heart Disease

The use of hydralazine is contraindicated in patients with mitral valvular rheumatic heart disease.

References

  1. "Product Information. Apresoline (hydralazine)." Ciba Pharmaceuticals, Summit, NJ.
Major

Nitrates/Nitrites (Includes BiDil) ↔ Ami

Severe Potential Hazard, High plausibility

Applies to: 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

  1. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
  2. Scardi S, Zingone B, Pandullo C "Myocardial infarction following sublingual administration of isosorbide dinitrate." Int J Cardiol 26 (1990): 378-9
  3. Berisso MZ, Cavallini A, Iannetti M "Sudden death during continuous Holter monitoring out of hospital after nitroglycerin consumption." Am J Cardiol 54 (1984): 677-9
  4. Buckley R, Roberts R "Symptomatic bradycardia following the administration of sublingual nitroglycerin." Am J Emerg Med 11 (1993): 253-5
  5. "Product Information. Isordil (isosorbide dinitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. Lancaster L, Fenster PE "Complete heart block after sublingual nitroglycerin." Chest 84 (1983): 111-2
  7. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  8. "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. Brandes W, Santiago T, Limacher M "Nitroglycerin-induced hypotension, bradycardia, and asystole: report of a case and review of the literature." Clin Cardiol 13 (1990): 741-4
  10. Ong EA, Canlas C, Smith W "Nitroglycerin-induced asystole ." Arch Intern Med 145 (1985): 954
  11. von Arnim T, Autenrieth G, Bolte HD "Acute myocardial infarction during continuous electrocardiographic ST segment recording. Possible role of bradycardia and hypotension induced by glyceryl trinitrate." Br Heart J 51 (1984): 575-7
View all 11 references
Major

Nitrates/Nitrites (Includes BiDil) ↔ Anemia

Severe Potential Hazard, High plausibility

Applies to: Anemia

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

  1. Arsura E, Lichstein E, Guadagnino V, Nicchi V, Sanders M, Hollander G, Greengart A "Methemoglobin levels produced by organic nitrates in patients with coronary artery disease." J Clin Pharmacol 24 (1984): 160-4
  2. Saxon SA, Silverman ME "Effects of continuous infusion of intravenous nitroglycerin on methemoglobin levels." Am J Cardiol 56 (1985): 461-4
  3. Machabert R, Testud F, Descotes J "Methaemoglobinaemia due to amyl nitrite inhalation: a case report." Hum Exp Toxicol 13 (1994): 313-4
  4. Sutton M, Jeffrey B "Acquired methemoglobinemia from amyl nitrate inhalation." J Emerg Nurs 18 (1992): 8-9
  5. Pierce JM, Nielsen MS "Acute acquired methaemoglobinaemia after amyl nitrite poisoning." BMJ 298 (1989): 1566
  6. Gibson GR, Hunter JB, Raabe DS, Jr Manjoney DL, Ittleman FP "Methemoglobinemia produced by high-dose intravenous nitroglycerin." Ann Intern Med 96 (1982): 615-6
  7. Edwards RJ, Ujma J "Extreme methaemoglobinaemia secondary to recreational use of amyl nitrite." J Accid Emerg Med 12 (1995): 138-42
  8. Curry SC, Arnold-Capell P "Toxic effects of drugs used in the ICU. Nitroprusside, nitroglycerin, and angiotensin-converting enzyme inhibitors." Crit Care Clin 7 (1991): 555-81
  9. Kaplan K, Davison R "Nitroglycerin and methemoglobinemia." Am J Cardiol 57 (1986): 1004
  10. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
  11. Sobey RJ, Campbell CM "A 37-year-old with amyl nitrite-induced methemoglobinemia." J Emerg Nurs 18 (1992): 11-3
  12. Fibuch EE, Cecil WT, Reed WA "Methemoglobinemia associated with organic nitrate therapy." Anesth Analg 58 (1979): 521-3
  13. Robicsek F "Acute methemoglobinemia during cardiopulmonary bypass caused by intravenous nitroglycerin infusion." J Thorac Cardiovasc Surg 90 (1985): 931-4
  14. Forsyth RJ, Moulden A "Methaemoglobinaemia after ingestion of amyl nitrite." Arch Dis Child 66 (1991): 152
View all 14 references
Major

Nitrates/Nitrites (Includes BiDil) ↔ Hemodialysis

Severe Potential Hazard, High plausibility

Applies to: hemodialysis

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

  1. Imamura T, Tamura K, Taguchi T, Minoda M, Seita M "Reduction of nitroglycerin and isosorbide dinitrate by hemodialysis in refractory angina pectoris after acute myocardial infarction." Am J Cardiol 61 (1988): 954-5
  2. Dunetz PS "Dialysis patients and nitrates." Nursing 22 (1992): 4
Major

Nitrates/Nitrites (Includes BiDil) ↔ Hypotension

Severe Potential Hazard, High plausibility

Applies to: Hypotension, 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

  1. "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  3. Ong EA, Bass S "Nitroglycerin-induced bradycardia and hypotension in acute myocardial infarction." Chest 77 (1980): 244
  4. Purvin VA, Dunn DW "Nitrate-induced transient ischemic attacks." South Med J 74 (1981): 1130-1
  5. Brandes W, Santiago T, Limacher M "Nitroglycerin-induced hypotension, bradycardia, and asystole: report of a case and review of the literature." Clin Cardiol 13 (1990): 741-4
  6. Nemerovski M, Shah PK "Syndrome of severe bradycardia and hypotension following sublingual nitroglycerin administration." Cardiology 67 (1981): 180-9
  7. von Arnim T, Autenrieth G, Bolte HD "Acute myocardial infarction during continuous electrocardiographic ST segment recording. Possible role of bradycardia and hypotension induced by glyceryl trinitrate." Br Heart J 51 (1984): 575-7
  8. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
  9. Cunningham J "Hypotension following administration of sublingual nitroglycerin ." Heart Lung 8 (1979): 364
  10. Lancaster L, Fenster PE "Complete heart block after sublingual nitroglycerin." Chest 84 (1983): 111-2
  11. "Product Information. Isordil (isosorbide dinitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  12. Buckley R, Roberts R "Symptomatic bradycardia following the administration of sublingual nitroglycerin." Am J Emerg Med 11 (1993): 253-5
View all 12 references
Major

Nitrates/Nitrites (Includes BiDil) ↔ Intracranial Pressure

Severe Potential Hazard, High plausibility

Applies to: 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

  1. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  2. Hannerz J, Greitz D "Cerebrospinal fluid pressure and venous pressure in "dynamite headache" and cluster headache attacks." Headache 32 (1992): 436-8
  3. Ahmad S "Nitroglycerin and intracranial hypertension ." Am Heart J 121 (1991): 1850-1
  4. Boggild M "Intracerebral haemorrhage after dermal nitrate application." BMJ 305 (1992): 1000
  5. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
  6. Gagnon RL, Marsh ML, Smith RW, Shapiro HM "Intracranial hypertension caused by nitroglycerin." Anesthesiology 51 (1979): 86-7
View all 6 references
Moderate

Hydralazine (Includes BiDil) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Glomerulonephritis, Renal Dysfunction

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 required a lower dose. Renal function should be monitored and supported as required.

Moderate

Nitrates/Nitrites (Includes BiDil) ↔ Hypertrophic Cardiomyopathy

Moderate Potential Hazard, High plausibility

Applies to: Hypertrophic Cardiomyopathy

Organic nitrates and nitrites may aggravate the angina associated with hypertrophic cardiomyopathy and should be administered cautiously in patients with this condition.

References

  1. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  2. "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
  4. "Product Information. Isordil (isosorbide dinitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 4 references
Moderate

Nitrates/Nitrites (Includes BiDil) ↔ Glaucoma

Minor Potential Hazard, Low plausibility

Applies to: 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

  1. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):

BiDil (hydralazine / isosorbide dinitrate) drug Interactions

There are 527 drug interactions with BiDil (hydralazine / isosorbide dinitrate)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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