What you don’t know about Clonidine or Hydralazine might hurt you. Clonidine and Hydralazine are two very effective blood pressure medications. Some patients have labeled them the two worst blood pressure medications due to their side effects.
They have also labeled the worst drugs here because both may cause you to feel sleepy, weak or fatigued. These symptoms might influence you to stop taking the medication as prescribed to feel better. This would be the wrong decision to make without the guidance of your health care provider. Stopping Clonidine or Hydralazine suddenly may be fatal.
If you are on these medications and they are working well for you, they are good for you. On the other hand, if the side effects are keeping you from being adherent, you might get hurt. To prevent a problem, you may need to work with your health care provider to get an alternative medication. Keep in mind, this information is not medical advice.
Why Are These Medications Prescribed?
Poor Adherence Versus Difficult to Control Blood Pressure
These two so-called worst drugs are prescribed for good intentions by your health care provider. They are used to control your blood pressure when other medications have failed to work. If you are on these medications, that is likely the case or it may be for other good reasons.
Nevertheless, sometimes these drugs are prescribed when providers are not aware of non-adherence to more tolerable medication. For example, you stop taking your medication without informing your doctor and your blood pressure is uncontrolled. Your doctor will likely add Clonidine or Hydralazine to your regimen as a last result to prevent problems.
However, it is important to assure you are not being prescribed any of these two medications due to non-adherence. Clonidine and Hydralazine have side effects that may affect your quality of life and if skipped could hurt you. Missing a dose of Clonidine or Hydralazine could cause serious spikes in your blood pressure that might lead to a stroke or heart attack. Other first-line medications might be better tolerated and without a serious spike in blood pressure.
Here is the information you need to help your health care provider select the best medication for you. I urge you to get with your health care provider and reveal any non-adherence to treatment. Many times, non-adherence is unintentional due to forgetfulness. If this is the case, a pillbox placed in a visible place may help you remember to take your medication. Also, set an alarm on your smartphone as a reminder to take your medication on time.
Other times, non-adherence is due to real challenges such as side effects or economics. There could be many legitimate reasons for non-adherence. However, it is important to address any reason for non-adherence and get on the RIGHT medication.
What Are The Two Worst Medications?
Clonidine and Hydralazine are usually used in patients who have difficulty to treat blood pressure. However, I have seen patients on one or both of these medications as first-line drugs. They are not first-line drugs according to the 2017 hypertension guidelines.
Emergency Blood Pressure Medication
Clonidine and Hydralazine are also given in the emergency room or in the hospital to quickly lower critically high blood pressure. Blood pressure greater than 160/100 mm Hg is considered critical. That is, either the systolic or diastolic or both are considered critical. However, during the administration of these two medications, the patient’s heart rate and blood pressure are monitored frequently.
Actions of These Two Drugs
According to the Physician Desk Reference (PDR), Clonidine decreases blood pressure by decreasing the sympathetic tone in your body. This lowers your blood pressure. However, Clonidine stops working around 12 hours after taking the medication. Therefore, it is commonly prescribed every 12 hours.
If you fail to take the MEDICATION EVERY 12 HOURS as prescribed, your blood pressure will spike. A spike in blood pressure occurs when your blood pressure increases suddenly. Then, you might go into withdrawal from the medication.
A tapering PROCESS is used over several days when Clonidine or Hydralazine is no longer needed. Slowly reducing the dose allows your body to adjust to the changes preventing the spike in your blood pressure.
Clonidine is contraindicated if you have a slow heartbeat (less than 60), coronary heart disease, or kidney failure. Clonidine and a beta-blocker taken together may cause withdrawal or blood pressure spikes when you are intentionally nonadherent.
This may not be true if you forget to take your medication and take it within an allotted period of time. Check with your pharmacist or health care provider for additional information.
Hydralazine causes your blood vessels to relax, which lowers your blood pressure. Your health care provider may start with a low dose of 25 mg twice a day until your body gets used to the medication. However, the lowest dose is 10 mg.
Your provider may prescribe up to 300 mg a day of Hydralazine, in divided doses every 6-8 hours. For example, it is common to have a dose of 100 mg every 8 hours based on the response of your blood pressure.
Like Clonidine, Hydralazine spike your blood pressure if you fail to take your medication as prescribed. This happens because it stops working after about 6-8 hours, depending on the dose. In addition, Hydralazine is used in the emergency room and inpatient to quickly lower blood pressure during a hypertensive urgency or emergency.
Serious Side Effects
There are several blood pressure medications that have serious side effects to monitor. But Clonidine or Hydralazine could be causing your blood pressure to spike at dangerous levels if you are not strictly adherent to your medication.
So, if you are not taking your blood pressure medication as prescribed by your doctor 100% of the time, these two medications may cause hypertension urgency or emergency. Go to my blog post on hypertension urgency and emergency to find out more about these two conditions.
Essentially, both conditions put you at high risk for a stroke, heart attack or kidney failure if not treated appropriately. Hypertension urgency or emergency are little known side effects of these two medications.
According to the PDR, Hydralazine puts you at risk for drug-induced systemic lupus including kidney disease. Your risk is higher with higher doses (200-300 mg a day). Consult your health care provider for any concerns you may have.
Potential Alternative Medication
There are many different combinations of medication that your health care provider may prescribe for you as an alternative to Clonidine or Hydralazine. Be sure that you HAVE FAILED the treatment of the other effective medication PRESCRIBED.
For example, if you were non-adherent, and your medication was changed, you may not have failed that medication. The medication was not effective likely due to non-adherence.
In this case, ask your doctor to re-prescribe that medication. Then, take it as prescribed while monitoring and logging your blood pressure at home. The upcoming post will give more instructions about this process.
Be sure to consider the fact that you may have stopped the medication on your own because of medication intolerance. If you experienced side effects from the medication or the medication made you feel sick, you probably had medication intolerance.
Consult Your Provider or Pharmacist
Clonidine and Hydralazine have been labeled here as the worst blood pressure medication because both may cause hypertensive urgency or emergency if not taken as prescribed. In addition, Hydralazine may put you at risk for lupus. These are the “last result” medications.
Both of these medications, if used as prescribed, maybe the last result of getting your blood pressure to goal. This is reasonable if many other effective medications have failed. In this case, either or both might be the most appropriate drug for you.
Consult with your pharmacist and health care provider or email me the hypertensionresistanttotreat@gmail.com to get a free patient education sheet to learn how to safely take these two medications.
Get the most accurate blood pressure monitor at this link:
Monitor your blood pressure at least once a week, keep a log, and share your diary with your health care provider. Report any moderate readings soon and report any severe measurements immediately to avoid these mistakes. Go to 30 days to a Better Blood Pressure for a step by step approach to obtaining normal blood pressure.
Resources
http://www.pdr.net/drug summary
2017 Hypertension Guidelines
www.gacguidelines.ca
