Article Text

Download PDFPDF
Hydralazine-induced liver injury: a review and discussion
  1. Meeta Bhardwaj,
  2. Nakul Jay Bhardwaj,
  3. Kendra Cueto,
  4. T Colin Killeen
  1. Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr T Colin Killeen; killeet{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.


Hydralazine is a commonly prescribed antihypertensive agent. Some of its labelled adverse reactions include lupus-like syndrome, tachycardia, headache and fever. Despite its well-known side effects, little is known about hydralazine’s hepatotoxic effects. We report the case of a 54-year-old female patient who was started on hydralazine for hypertension management but later presented with hydralazine-induced liver injury. Her initial presentation consisted of non-specific symptoms and a hepatocellular injury pattern. Liver biopsy revealed hepatic steatosis. Three weeks after discontinuation of hydralazine, the patient’s liver enzymes normalised, and her symptoms resolved. Few studies have examined the incidence and mechanism by which hydralazine induces a liver injury pattern. With this case, we review the literature, the pathogenesis involved and the eventual management of hydralazine-induced liver injury. We propose close monitoring of liver enzymes for patients on hydralazine throughout their treatment course.


Hydralazine is a phthalazine derivative often prescribed in severe hypertension and heart failure.1 It vasodilates arteries and arterioles, leading to a reduction in afterload of blood on the heart. Biochemically, it increases the level of cyclic guanosine monophosphate, leading to smooth muscle relaxation.1 This relaxation and reduction of afterload function to decrease blood pressure. Well-known adverse effects reported with hydralazine use include headache, dizziness, fluid retention and lupus-like syndrome.1 Increasingly, however, it has been associated with liver injury.2

Among the cases of hydralazine-related liver injury, non-specific symptoms were mostly noted, including fever, fatigue and nausea.2 In these cases, liver injury developed over the interval …

View Full Text


  • Contributors MB performed the literature review, analysed the case report, created tables/figures and was the major contributor in writing the manuscript. NJB assisted in analysis of the case report, writing of the manuscript and major editing of the manuscript. KC assisted in the analysis of the case report, creating tables/figures and writing of the manuscript. TCK assisted in the analysis of the case report, writing of the manuscript and major editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.