Hydralazine may induce
amenorrhea in Premenopausal Patient, according to a recently published
Case study. The case reported by Dr Kwadwo Yeboah atUniversity of North
Carolina at Chapel Hill and colleagues has appeared in Clinical
Therapeutics.
Several antihypertensive
medications have been associated with various forms of sexual
dysfunction. Administration of spironolactone in standard dosage to nine
women with mild renal disease has also reportedly resulted in
amenorrhea in six and marked menstrual irregularity in a seventh.
Discontinuation of therapy resulted in normal menstrual periods within
two months in every patient.
The case describes the
development of amenorrhea following initiation of hydralazine in a
31-year-old premenopausal female patient with stage 3 chronic kidney
disease (CKD) and hypertension.
The patient presented to the
nephrology clinic for CKD management, after having discontinued her
antihypertensive medications due to side effects. She also expressed her
desire to become pregnant. When her physical examination revealed
bradycardia, hydralazine 10mg twice daily was initiated. One month
later, the patient reported an at-home blood pressure reading of 138/96,
therefore her dose of hydralazine was increased to 20mg twice daily.
At the patient’s next
follow-up visit, she complained of amenorrhea following the initiation
of hydralazine 11 weeks prior. Hydralazine was then tapered over 3 to 5
days and permanently discontinued. The study authors reported that the
patient’s hypertension was then managed through a reduction in her
sodium bicarbonate dosage as well as through lifestyle modifications
(exercise, hydration, and a balanced diet). The patient was closely
monitored and menstruation resumed 13 days after her follow-up visit.
“The Naranjo adverse drug
reaction probability scale was used to assess the probability that
hydralazine was associated with the patient’s amenorrhea,” the study
authors explained. A score of 6 was calculated, therefore indicating “a
probable relationship between the development of amenorrhea and
hydralazine therapy.”
This case highlights a
possible relationship between the administration of hydralazine and the
development of amenorrhea. Although reversible, it is important for
healthcare providers to be aware of this association and counsel
patients accordingly.
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