Centrally-acting drugs like methyldopa and moxonidine as well as direct vasodilators such as hydralazine and minoxidil are other options for treating hypertension when first-line treatments have failed or are not suitable. However, these alternatives are often poorly tolerated, causing side effects like headaches, palpitations, and edema. Hydralazine can also cause drug-induced lupus and minoxidil can result in hirsutism in women. Moxonidine, hydralazine, and minoxidil have recommended dosing ranges for treatment.

1. Other antihypertensive agents Centrally-acting drugs (methyldopa, moxonidine) Direct vasodilator (hydralazine, minoxidil) Poorly tolerated - headache, palpitation, edema - drug-induced lupus syndrome (hydralazine) - hirsutism in women (minoxidil) Used when other treatments have failed Used in special conditions (pregnancy) Moxonidine 200 mg once daily – 300 mg twice daily Hydralazine 25-5- mg twice daily Minoxidil 2.5-50 mg in 1-2 doses Adapted from: Oparil S and Weber MA. Hypertension.Elsevier/Sanders 2nd ed. 2005; L ip G and Bakris G. Handbook Hypertension Management. CMG 2006 For Internal Use Only