Bidil (Isosorbide Dinitrate and Hydralazine) Tablets – Heart Failure Treatment | EZ Chemist
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What is Bidil used for
Bidil is a prescription medicine combining isosorbide dinitrate and hydralazine hydrochloride, used to treat heart failure in self-identified Black patients as part of a comprehensive therapy. It improves survival and reduces hospitalization by dilating blood vessels and improving blood flow.
Generic Name: Isosorbide Dinitrate and Hydralazine Hydrochloride

Brand Name: Bidil

Form: Oral tablets

Strengths Available: Isosorbide Dinitrate 20 mg + Hydralazine 37.5 mg

Pack Size: Typically available in 90 or 180 tablets

Route of Administration: Oral

Prescription Required: Yes

Manufacturer: Arbor Pharmaceuticals, Inc.

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Isosorbide Dinitrate (20 mg) – A nitrate vasodilator

Hydralazine Hydrochloride (37.5 mg) – A direct-acting arterial vasodilator
Bidil Generic (Hydralazine + Isosorbide Dinitrate)

Heart Failure Combo Therapy

Vasodilator combination

Nitrate + Hydralazine Therapy

ISDN + Hydralazine
Bidil combines two vasodilators for synergistic effects:
Relaxes vascular smooth muscle, primarily in veins

Reduces preload by decreasing venous return to the heart

Hydralazine Hydrochloride:

Dilates arteries, reducing afterload

Enhances cardiac output by lowering resistance against which the heart pumps

Result: Improved hemodynamics, oxygen delivery, and reduced heart failure symptoms and mortality.
Treatment of heart failure in self-identified Black patients as adjunct to standard heart failure therapy (including ACE inhibitors and beta-blockers).
Proven to reduce mortality and hospitalization.
Patient Type Initial Dose Maintenance Dose
Adults 1 tablet (20/37.5 mg) three times daily Titrate up to 2 tablets three times daily if tolerated

Maximum dose: 120 mg isosorbide dinitrate / 225 mg hydralazine daily (2 tablets three times daily)

Take consistently with or without food
Onset of action: Within 20–45 minutes

Peak effect: 1–2 hours post-dose

Duration: Hydralazine (2–6 hours); ISDN (4–6 hours)

Half-life: Hydralazine ~3 hours; ISDN ~1–4 hours

Elimination: Primarily via liver metabolism and renal excretion
Headache

Dizziness or lightheadedness

Nausea

Palpitations

Nasal congestion
Drug-induced lupus-like syndrome (from Hydralazine)

Severe hypotension

Peripheral neuropathy

Hepatic dysfunction
Monitor for hypotension, especially when initiating or increasing dose

Lupus-like syndrome may occur after prolonged Hydralazine use – monitor ANA and symptoms
Coronary artery disease

Cerebrovascular disease
Renal or hepatic impairment
Not recommended as monotherapy; should be used as adjunct to standard therapy in heart failure.
Isosorbide Dinitrate – Organic Nitrate Vasodilator
Hydralazine – Direct Vasodilator

ATC Code: C01DA08 (Isosorbide) + C02DB02 (Hydralazine)
Legal Status: Schedule H (prescription only)
Interacting Drug/Class Effect
PDE-5 inhibitors (e.g., sildenafil) Severe hypotension risk
Beta-blockers or ACE inhibitors Additive blood pressure lowering
Tricyclic antidepressants Potentiated hypotensive response
MAO inhibitors Risk of hypertensive crisis
Alcohol Increased hypotensive effects
A-HeFT Trial (NEJM, 2004)
Studied Bidil in 1,050 self-identified Black patients with NYHA Class III heart failure.
43% reduction in mortality
33% reduction in hospitalizations
Significant improvement in quality of life scores
Conclusion: Bidil, when added to standard therapy, significantly improved survival in Black patients with heart failure.
FAQs – Bidil (Isosorbide Dinitrate + Hydralazine)
Q1: What is Bidil used for
Bidil is used to treat heart failure in Black patients by relaxing blood vessels, improving circulation, and reducing the workload on the heart.

Q2: Is Bidil a beta-blocker
No. Bidil is a combination of a nitrate and vasodilator, not a beta-blocker. It is used in addition to other heart failure treatments like ACE inhibitors and beta-blockers.

Q3: Can Bidil be used in non-Black patients?
While the A-HeFT study focused on Black patients, physicians may consider its use in others if clinically appropriate. Always consult your cardiologist.

Q4: How fast does Bidil work?
Patients may begin to see improvement in symptoms within a few days to weeks, with peak clinical benefit over time.

Q5: Can I stop Bidil suddenly?
No. Sudden discontinuation may worsen heart failure symptoms. Always consult your healthcare provider before stopping or adjusting dosage.
Store at 15°C to 30°C (59°F to 86°F)

Protect from moisture and light

Keep in original bottle with desiccant

Keep out of reach of children

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