Apreszine 25/Apreszine 50 Special Precautions

Apreszine 25: May cause a drug-induced lupus-like syndrome including glomerulonephritis, especially in patients receiving higher doses.
Postural hypotension may occur.
Use with caution in patients with cerebral vascular accidents and suspected coronary artery disease (CAD); myocardial stimulation produced by hydralazine can cause angina attacks and electrocardiogram (ECG) changes of myocardial ischemia; has been implicated in the production of myocardial infarction.
Use with caution in patients with mitral valvular disease; may increased pulmonary artery pressure in these patients.
Use with caution in patients with advanced renal impairment; dosage adjustment.
Hydralazine has been associated with peripheral neuritis (eg, paresthesia, numbness, tingling), possibly due to an antipyridoxine effect. Pyridoxine therapy should be initiated with onset of such symptoms.
Blood dyscrasias (eg, reduction in haemoglobin and red blood cell count, leucopenia, agranulocytosis, purpura) may occur, discontinue therapy if these hematologic effects occur.
Apreszine 50: Hydralazine dose or interval between doses should be adjusted according to clinical response in patients with hepatic dysfunction or renal impairment (creatinine clearance <30 mL/min or serum creatinine >2.5 mg/100 mL) in order to avoid accumulation of the drug.
Hydralazine should be used with caution in patients with coronary artery disease (since it may increase angina) or cerebrovascular disease.
Patients on Hydralazine who undergo surgery, may show a fall in blood pressure. Adrenaline should not be used to correct the hypotension since it enhances the cardiac-accelerating effects of hydralazine.
When initiating therapy in heart failure, particular caution should be exercised, and the patient monitored for early detection of postural hypotension or tachycardia. Where discontinuation of therapy in heart failure is necessary, Hydralazine should be withdrawn gradually (except in serious situations such as SLE-like syndrome or blood dyscrasias) in order to avoid precipitation and/or exacerbation of heart failure.
Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Effects on ability to drive and use machines: Hydralazine may cause headache and difficulty in concentration, especially at the start of treatment, which can impair the patient's reactions. If symptoms are severe, the patient should not drive or operate machinery.