Diuretics

T Plasma and extracellular fluid volume

The side effect profile of direct-acting vasodilators. The most common and most serious effects of hydralazine and minoxidil are related to their direct or reflex-mediated hemodynamic actions, including flushing, headache, palpitations, anginal attacks, and electrocardiographic changes of myocardial ischemia [6,9]. These effects may be prevented by concurrent administration of a P-adrenergic antagonist. Sodium retention with expansion of extracellular fluid volume is a significant problem. Large doses of potent diuretics may be required to prevent fluid retention and the development of pseudotolerance [13]. (From Koch-Weser [13]; with permission.)

Repeated administration of hydralazine can lead to a reversible syndrome that resembles disseminated lupus erythematosus. The incidence is dose dependent; it rarely occurs in patients receiving less than 200 mg/day. Hypertrichosis is a common troublesome but reversible side effect of minoxidil; it develops during the first 3 to 6 weeks of therapy in approximately 80% of patients.

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