Peripheral neuritis, evidenced by paresthesias, numbness and tingling has been observed. Published evidence suggests an antipyridoxine effect and addition of pyridoxine to the regimen if symptoms develop.
Blood dyscrasias, consisting of reduction in hemoglobin and red cell count, leukopenia, agranulocytosis and purpura have been reported rarely. If such abnormalities develop, discontinue therapy.
Late adverse effects: An arthritis-like syndrome has been observed in few a cases, usually after hydralazine was administered for long periods and in relatively high doses. The milder phase of the syndrome is characterized by migratory arthralgia in the joints of the hands and less commonly in the wrist, elbows, shoulders and knees. It may or may not be accompanied by fever. Continued use of hydralazine in these cases has been reported to lead to a clinical picture simulating acute systemic lupus erythematosus.
When early arthritis-like symptoms appear during therapy with hydralazine, spontaneous remission of symptoms usually follows withdrawal of the drug. The late reactions, which develop when treatment is continued despite the appearance of early symptoms, are more severe and longer lasting than the early phase. Most of these reactions have been completely reversible. Some patients may require protracted therapy, including ACTH and cortisone.
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