isosorbide dinitrate / hydralazine
BiDil is a combination medication that contains isosorbide dinitrate (a nitrate) and hydralazine (an arteriolar vasodilator). It's used to treat heart failure in Black adults. But BiDil (isosorbide dinitrate / hydralazine) isn't a first-choice medication, but typically prescribed along with other heart failure medications. BiDil (isosorbide dinitrate / hydralazine) is taken by mouth three times per day. Common side effects of this medication include low blood pressure, dizziness, and weakness. BiDil is available as a brand-name medication and as lower-cost generics.
What is BiDil (isosorbide dinitrate / hydralazine)?
What is BiDil (isosorbide dinitrate / hydralazine) used for?
Treatment of heart failure in Black adults, when taken along with heart failure medications
How BiDil (isosorbide dinitrate / hydralazine) works
BiDil is a combination medication that contains two medications, isosorbide dinitrate (a nitrate) and hydralazine (an arteriolar vasodilator). Both medications work differently to keep levels of a chemical called nitric oxide high. Nitric oxide helps to relax your blood vessels. This allows more blood to get to your heart and other organs. Your heart won't work as hard, so you'll feel better and have less heart failure problems.
Drug Facts
More on BiDil (isosorbide dinitrate / hydralazine) essentials
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What are the side effects of BiDil (isosorbide dinitrate / hydralazine)?
Common Side Effects
- Headache (50%)
- Dizziness (32%)
- Weakness or lack of energy (14%)
- Nausea (10%)
- Low blood pressure (8%)
Other Side Effects
- Sinus inflammation
- Feeling like pins and needles in hands or feet
- Vomiting
- Lazy eye
Serious Side Effects
- Severely low blood pressure: lightheadedness, dizziness, feeling faint, tiredness, confusion
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Chest pain (angina)—pain, pressure, or tightness in the chest, neck, back, or arms
- Fast or irregular heartbeat
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Lupus-like syndrome—joint pain, swelling, or stiffness, butterfly-shaped rash on the face, rashes that get worse in the sun, fever, unusual weakness or fatigue
- Pain, tingling, or numbness in the hands or feet
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of BiDil (isosorbide dinitrate / hydralazine)
Pros
Option for Black adults whose heart failure symptoms aren't well-controlled on existing medications
More convenient to take two medications within a single pill
Taken by mouth
Cons
Headache and dizziness are common side effects
Taken three times a day
Not meant to be taken alone for heart failure
Pharmacist tips for BiDil (isosorbide dinitrate / hydralazine)
You can take BiDil (isosorbide dinitrate / hydralazine) with or without food. But nausea is a common side effect, so taking it with food might help.
Swallow BiDil (isosorbide dinitrate / hydralazine) whole. Don't break, crush, or chew the tablet. Let your prescriber know if you can't swallow the tablets.
Headache and dizziness are common side effects, especially when first starting the medication and with dose changes. These might get better once your body adjusts to your new blood pressure. But if they don't and are too bothersome, speak to your prescriber. You might need to have your dose of BiDil (isosorbide dinitrate / hydralazine) or other medications adjusted.
Make sure to stay hydrated, especially if you are sweating, have diarrhea, or are vomiting, while taking BiDil (isosorbide dinitrate / hydralazine). This will help prevent a severe drop in your blood pressure, making you feel lightheaded. If you feel lightheaded or like you're about to faint, seek medical help right away.
Tell your prescriber about all the medications you're taking before you start BiDil (isosorbide dinitrate / hydralazine). And don't start any new medications without talking to a healthcare professional (HCP) first. Your care team should review your medication list to make sure your medications are safe to take together. They'll also check to see if you're taking something that might worsen heart failure.
Don't use Adempas (riociguat) or erectile dysfunction medications like sildenafil (Viagra) or tadalafil (Cialis), while taking BiDil (isosorbide dinitrate / hydralazine). Combining these medications can make your blood pressure become dangerously low, which raises your risk for falls and can be life-threatening.
Make sure to have a healthy diet, including a low-salt diet, while taking BiDil (isosorbide dinitrate / hydralazine). This will help lower the amount of fluid in your body, which helps make your heart not work as hard.
Frequently asked questions about BiDil (isosorbide dinitrate / hydralazine)
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What are the risks and warnings for BiDil (isosorbide dinitrate / hydralazine)?
BiDil (isosorbide dinitrate / hydralazine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood pressure
Risk factors: Age 65 or older | Not enough fluids in the body | Taking PDE-5 inhibitors like Viagra (sildenafil) | Taking other medicines that lower your blood pressure
BiDil (isosorbide dinitrate / hydralazine) can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. This side effect is more common when you first start BiDil (isosorbide dinitrate / hydralazine) or when the dose is raised. Your risk is higher if you're dehydrated or have medical conditions that cause you to become dehydrated, such as diarrhea or vomiting. If your blood pressure drops too much and you feel dizzy, make sure to sit down slowly while holding onto something and let your healthcare professional (HCP) know. If you fall and hit your head, get medical help right away. If you feel dizzy, lightheaded, faint, tired, or confused while taking BiDil (isosorbide dinitrate / hydralazine), contact your HCP right away.
Lupus-like symptoms
Although rare, hydralazine in BiDil can cause lupus. If this does happen, it usually goes away when stopping the medication. Contact you prescriber right away notice muscle or joint pain, swelling, fatigue, or fever.
Risk of worsening heart problems
Hydralazine in BiDil can raise your heart rate and lower blood pressure. In people who have hypertrophic cardiomyopathy (HCM), this can worsen blood flow to the heart and raise the risk for chest pain. If you have HCM, your healthcare team can talk with you about the risks and benefits of taking BiDil (isosorbide dinitrate / hydralazine).
Numbness or tingling
Hydralazine in BiDil can cause neuropathy, which can feel like numbness, tingling, or a "pins-and-needles" sensation. If you get these symptoms, let your prescriber know. They'll likely recommend taking a vitamin B6 (pyridoxine) supplement to help.
BiDil (isosorbide dinitrate / hydralazine) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 20mg/37.5mg | 90 tablets | $402.74 | $4.47 |
Typical dosing for BiDil (isosorbide dinitrate / hydralazine)
Each tablet of BiDil contains 20 mg of isosorbide dinitrate and 37.5 mg of hydralazine.
Adults: The typical starting dose is 1 tablet by mouth three times per day. If needed, your cardiologist can slowly raise the dose to up to 2 tablets by mouth three times per day, as long as you're not having side effects.
How much does BiDil (isosorbide dinitrate / hydralazine) cost?
BiDil (isosorbide dinitrate / hydralazine) contraindications
Allergy to nitrates
Taking PDE-5 inhibitors or Adempas (riociguat) at the same time
What are alternatives to BiDil (isosorbide dinitrate / hydralazine)?
Treatment of heart failure in Black adults, when taken along with heart failure medications
Chest pain caused by angina
What is the latest news about BiDil (isosorbide dinitrate / hydralazine)?
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References
Best studies we foundA2A Integrated Pharmaceuticals. (2024). Isosorbide dinitrate and hydralazine hydrochloride tablet, film coated [package insert]. DailyMed.
Cole, R. T., et al. (2011). Hydralazine and isosorbide dinitrate in heart failure: Historical perspective, mechanisms, and future directions. Circulation.
Heidenreich, P. A., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation.
i3 Pharmaceuticals, LLC. (2024). Isosorbide dinitrate and hydralazine hydrochloride tablet, film coated [package insert]. DailyMed.
Lupus Foundation of America. (n.d.). What is drug-induced lupus?
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