This combination tablet contains Isosorbide Dinitrate, a long-acting nitrate vasodilator, and Hydralazine, a direct-acting arterial vasodilator. Together, they provide a synergistic effect in reducing both preload and afterload, improving cardiac output, and lowering myocardial oxygen demand. Isosorbide Dinitrate primarily dilates venous vessels, decreasing venous return and preload on the heart, while Hydralazine relaxes arterial smooth muscles, reducing systemic vascular resistance and afterload. This combination is especially beneficial in patients with chronic heart failure, particularly in those with reduced ejection fraction, and is often recommended in patients who cannot tolerate ACE inhibitors or ARBs, or as an add-on therapy for refractory heart failure. The fixed-dose ratio of 20 mg Isosorbide Dinitrate and 37.5 mg Hydralazine has been clinically shown to improve symptoms, exercise tolerance, and survival in heart failure patients.
Common side effects include headache, flushing, dizziness, lightheadedness, and nasal congestion due to vasodilation. Some patients may experience hypotension, palpitations, tachycardia, or gastrointestinal disturbances such as nausea. Hydralazine may cause fluid retention and, rarely, a lupus-like syndrome with long-term high-dose therapy. Serious but uncommon adverse reactions include severe hypotension, syncope, or allergic reactions. Gradual dose titration is recommended to minimize side effects.
Indicated for the management of chronic congestive heart failure (CHF), particularly in patients with reduced left ventricular ejection fraction, symptomatic heart failure unresponsive to standard therapy, or in those intolerant to ACE inhibitors or ARBs. It is also used as adjunct therapy to standard heart failure regimens for additional vasodilation and symptom control.
This combination should only be taken under medical supervision, typically as part of a heart failure management plan. Caution is advised in patients with severe hypotension, hypertrophic cardiomyopathy, or cerebrovascular disease. It is not recommended during pregnancy and breastfeeding unless the benefits clearly outweigh the risks. Abrupt discontinuation should be avoided to prevent rebound angina or worsening heart failure symptoms. Alcohol should be minimized as it can enhance hypotensive effects. Regular monitoring of blood pressure, heart rate, and renal function is recommended during therapy. Dose adjustments may be necessary in elderly patients or those with impaired hepatic or renal function.
Store the tablets in a cool, dry place below 30°C. Protect from moisture and direct sunlight. Keep the medication in its original blister or container and out of the reach of children. Do not use after the expiry date printed on the pack.