Alphapress - Precautions | Dosage | Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on Fri, 15 Mar 2019. To read more about an author, click here.

Alphapress is a drug containing an active substance called hydralazine. It belongs to a group of antihypertensive agents, i.e. medicines used to lower blood pressure. It is indicated in the treatment of essential hypertension, alone or in combination with other drugs.

This drug is registered in Australia. Keep in mind that in some other countries (e.g. Serbia), there is also a medicine that is called Alphapress but contains a completely different active substance and is used for other purposes. This article applies to Alphapress tablets that are registered in Australia and contain the active substance hydralazine.

Mechanism of Action

Alphapress works by relaxing smooth muscles of the blood vessels, leading to the spread of peripheral blood vessels (so called peripheral vasodilatation). By spreading peripheral blood vessels, Alphapress improves blood flow to the heart, which makes the heart work faster, but at the same time it leads to a reduction in arterial blood pressure (it has a greater effect on diastolic blood pressure). Studies show that Alphapress improves blood flow to the brain.

Contraindications and Precautions

Known contraindications for the use of Alphapress include:

  • Coronary artery disease. Alphapress can cause anginal attacks and myocardial ischemia, which is why it should not be used in patients who already have coronary artery disease.
  • Mitral valvular rheumatic heart disease.
  • Allergy to hydralazine.

Drug-induced lupus erythematosus (autoimmune disease) has been reported in patients taking Alphapress. If this autoimmune disease occurs while you are on Alphapress tablets, your doctor will probably discontinue Alphapress tablets. Upon discontinuation of the Alphapress, the symptoms of lupus are usually rapidly withdrawn. However, since lupus is a serious condition that must be treated immediately, you should tell your doctor if you notice pain in the muscles, pain in the joints or fever. For these reasons, Alphapress should not be used in patients already suffering from lupus.

Alphapress should be used very cautiously in patients who had a stroke. According to the Patient Leaflet, Alphapress should not be used in patients who have any of the following conditions:

  • Arrhythmias.
  • Aortic aneurysm.
  • Thyrotoxicosis.
  • Heart failure.

Alphapress can only be obtained with a prescription, and be sure to tell your doctor if you are suffering from any condition or have any symptoms.

Since it is metabolized by the liver and excreted via the kidneys, Alphapress should be used with caution in patients with kidney and / or liver damage.


Alphapress is available in the form of tablets (10, 25, 50 and 100 mg).

The usual starting dose in adult patients is 25 mg every 12 hours. If you have liver or kidney damage, your doctor may recommend lower doses.

Your doctor will tell you what dosage you should take. Your cardiologist or doctor is the only person who can determine your dose. Never change the dose on your own or because of the advice of a friend or article that you read on the Internet. Taking the wrong dose can lead to serious adverse effects or lack of efficacy of the drug, which again can have serious consequences for your health.

Alphapress should not be used in children.

Use of Alphapress During Pregnancy and Breastfeeding

The FDA places Alphapress in Category C, because animal studies have shown that Alphapress exhibits teratogenic effects in mice when administered at doses that are 20-30 times higher than the maximum recommended dose in humans. However, studies on rabbits at doses that were 10-15 times higher than the maximum recommended dose in humans did not show teratogenic effects.

However, due to the possible risk of malformation, Alphapress should not be used during pregnancy unless your doctor considers it necessary.

Alphapress is excreted into breast milk, and breastfeeding should be avoided while taking this medicine.


Alphapress should not be used concurrently with the following drugs:

  • Tizanidine (muscle relaxant). Concomitant administration with this medicine can lead to severe hypotension (low blood pressure).
  • Monoamine oxidase inhibitors, such as:
    • Tranilcipromine, isocarboxazide and phenelzine - drugs used in the treatment of depression.
    • Selegiline - medicine used to treat Parkinson's disease.
    • Linezolid - an antibiotic.
  • Other antihypertensive drugs, such as:
    • Beta blockers (propranolol, bisoprolol, atenolol, carvedilol and others).
    • ACE inhibitors (ramipril, enalapril, lisinopril, perindopril, etc.).
    • Calcium antagonists (diltiazem, nifedipine, nicardipine, verapamil, etc.).
    • Diuretics (hydrochlorothiazide, furosemide, bumetanide, etc.).
  • Adrenaline.
  • Tricyclic antidepressants, such as: imipramine, amitriptyline, desimipramine, and others.
  • Neuroleptics - drugs used in the treatment of psychiatric disorders (e.g. schizophrenia).

Adverse Effects

Alphapress can cause the following side effects:

  • Digestive disorders: nausea, anorexia, vomiting, loss of appetite, diarrhea, constipation, etc.
  • Low blood pressure.
  • Palpitations and rapid heart rate.
  • Muscle cramps.
  • Agranulocytosis.
  • Conjunctivitis.
  • Enlargement of the spleen.
  • Difficulty urinating.
  • Anxiety and depression.

Tell your doctor if you notice any side effects.


  1. TGA
  2. FDA
  3. Iyer P, Dirweesh A, Zijoo R. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody. Case Rep Rheumatol. 2017. 2017: 5245904.

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If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.