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Under pressure... hydralazine shortage

There is a worldwide shortage of injectable hydralazine. This is a major problem because this medication is crucial for rapid, controlled reduction of elevated blood pressure in pregnancy.

There is a worldwide shortage of injectable hydralazine. This is a major problem because this medication is crucial for rapid, controlled reduction of elevated blood pressure in pregnancy. Pre-eclampsia and eclampsia are by far the most frequent complications we see at Jude Anne, comprising 20-30% or so of our caseload. They are much, much more frequent here than at home, and much more severe. We admit women regularly with systolic BPs over 200, or convulsing (this is eclampsia). The principles of treatment, then, are magnesium sulphate to prevent seizures, something (often hydralazine) to stabilize the blood pressure, and delivery as soon as feasible. Delivery is the definitive cure, although the patient remains at risk for several weeks post-partum (and we see seizures post-partum fairly regularly, too). Hydralazine is not the only medication you can use to stabilize a patient's blood pressure, but is usually one of the first-line choices, and certainly the one our staff are most used to. We go through 1000 ampoules a week. If we ran out of injectable hydralazine, it would be catastrophic. There is only one manufacturer of injectable hydralazine in the world, apparently. My understanding is that one recently-made batch didn't satisfy their quality control, and so didn't enter the market. So supplies are scarce, and the going rate from at least one source has increased from 3 euros per ampoule to 17 euros per ampoule. Logistics has promised me that we will not run out. Meanwhile, last week our Haitian Chief Gynecologist and I wrote a new protocol for anti-hypertensives in order to conserve hydralazine. It involves immediate-release nifedipine capsules as an alternative (we have them in stock). (Labetolol is reserved for resistant hypertension because of quantity in stock and lack of local comfort with it.) Word has it that the worldwide shortage will resolve in January or February, when the next batch will be ready.