Plasma hydrazine concentrations in man after isoniazid and hydralazine administration.

By using a specific sensitive stable-isotope dilution gas chromatography-mass spectrometry (GC-MS) assay, hydrazine was detected in the plasma of eight healthy male volunteer subjects taking isoniazid (300 mg daily) for 2 weeks. Accumulation of hydrazine occurred in slow-acetylator phenotypes. Hydrazine was also detected in the plasma of eight out of 14 hypertensive patients treated chronically with hydralazine (200 mg daily). However, the concentrations of hydrazine observed were much lower than in the isoniazid study and were close to the limit of detection. As hydrazine is hepatotoxic, mutagenic and carcinogenic in animals, its presence in human plasma has important toxicological implications.

Hydralazine-induced lupus: is there a toxic metabolic pathway?

The metabolism of hydralazine in a group of slow acetylator patients with the drug-induced lupus syndrome was compared with the metabolism in asymptomatic control subjects. There were no toxicologically significant difference in metabolite excretion between the groups which reached statistical significance, although there were interesting trends. However, the single lupus patient with the rapid acetylator phenotype excreted considerably greater quantities of phthalazinone than control patients and also increased amounts of hydrazine and hydralazine hydrazones. These results and the trends overall are consistent with the hypothesis that the metabolism of hydralazine may indeed be responsible for the drug induced lupus syndrome.

Hydralazine, antinuclear antibodies, and the lupus syndrome.

The incidence of patients with positive antinuclear antibody test results rose during three years of treatment with hydralazine. At the end of that period over half of the patients (both rapid and slow acetylators) had titres exceeding 1/20, but the rate of rise was faster in the slow acetylators than in the rapid. There was a significant relation between the cumulative dose of hydralazine and the proportion of patients found to have antinuclear factors. Fewer black patients had positive test results than white. Patients whose antinuclear antibody test results changed fron negative to positive during the study showed this change five to 26 months after beginning treatment. Some patients showed a substantial fall in antinuclear antibody titre even though hydralazine was continued. From these findings patients in whom test results for antinuclear antibody became positive during treatment with hydralazine need not have the drug stopped unless they have clinical features of the lupus syndrome.