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Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Methyldopa, labetalol, beta-blockers, calcium channel blockers, and most other agents are safe with breastfeeding, with the possible exception of ACE inhibitors, because even low concentrations in breast milk could affect neonatal renal function.
Hypertension and pre-eclampsia
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Methyldopa has been used for many years without any reports of serious adverse effects on the fetus or on children up to the age of 7 years. Methyldopa does have side effects, including depression, sedation and postural hypotension. Patients become tolerant to the sedative effect and this is less of a problem beyond 1 week after starting or increasing therapy. Depression or other side effects such as liver function test abnormalities, which persist or are severe, and haemolytic anaemia necessitate a change to an alternative drug.
Treatment of pre-eclampsia
Published in Pankaj Desai, Pre-eclampsia, 2020
Alpha methyldopa is usually started in a dose of 250 mg every 8 hours. However, if this does not suffice to control blood pressure, the dosage can be increased to 250 mg every 6 hours. This can be further increased up to 500 mg every 6 hours. Thus, alpha methyldopa can be given up to 2 g in 24 hours in 4 divided doses.
Selecting emergency therapy for patients with pre-eclampsia
Published in Expert Opinion on Pharmacotherapy, 2020
Severe postpartum hypertension can be treated as already described, but other antihypertensives (amlodipine, atenolol, amlodipine, atenolol, captopril, enalapril, nifedipine retard, quinapril) can be used [8,9]. Diuretics, methyldopa, or angiotensin receptor blockers should be avoided in breastfeeding women [8,9]. Guidelines provide contradictory recommendations on the use of nonsteroidal anti–inflammatory drugs (NSAIDs) for postpartum analgesia in women with PE. They should be avoided when BP is difficult to control or there is evidence of acute kidney injury. Postpartum thromboprophylaxis should be considered in women with PE, particularly in the presence of other risk factors.
Preeclampsia: state of art and future perspectives. A special focus on possible preventions
Published in Journal of Obstetrics and Gynaecology, 2022
Özge Kahramanoglu, Antonio Schiattarella, Oya Demirci, Giovanni Sisti, Franco Pietro Ammaturo, Carlo Trotta, Federico Ferrari, Agnese Maria Chiara Rapisarda
Patients with SBP ≥160 mmHg and/or DBP ≥110 mmHg should receive antihypertensive therapy. The aim is primarily to prevent maternal complications such as stroke. Antihypertensive therapy may be started at lower blood pressure values in people with end organ damage. Target values are 140–150 mmHg for systolic pressure and 90 mmHg for diastolic pressure. Drugs used in emergency blood pressure control are labetalol, hydralazine and nifedipine. Although, any of them can be used, they have no advantage over each other (Cox et al. 2019). Methyldopa, which has been used for many years, has been proven to be highly safe for the foetus, but it is effective only in treating mild hypertension and the onset of its effect is relatively late (within 3–6 hours) (El-Qarmalawi et al. 1995). Labetalol, a combined α blocker and β blocker, may preserve uteroplacental blood flow to a greater extent than β blockers, and its onset of action is faster than methyldopa (within two hours) (Molvi et al. 2012; Peacock et al. 2012). Hydralazine is the most commonly used drug in gestational hypertension since it significantly reduces cerebral haemorrhage. Starting with an initial dose of 5–10 mg (IV or IM), it can be repeated every 20 minutes, and the maximum dose is 30 mg. In case of no effect, treatment should be switched to another drug. Of note, it has more maternal side effects such as reflex tachycardia and fluid retention than labetalol and nifedipine (Magee et al. 2003). Nifedipine (immediate release) is used by repeating every 30 minutes after starting 10–20 mg orally, and it should not be used sublingually. ACOG Committee recommends its use as a first-line treatment in acute, severe hypertension in pregnancy or postpartum (ACOG 2019b). Its onset and duration of action are very short, with tachycardia and headache as common side effects. Commonly used antihypertensive drugs are summarised in Table 2.
Methyldopa versus labetalol or no medication for treatment of mild and moderate chronic hypertension during pregnancy: a randomized clinical trial
Published in Hypertension in Pregnancy, 2020
Mohamed Rezk, Mohamed Emarh, Alaa Masood, Ragab Dawood, Elsayed El-Shamy, Awni Gamal, Hassan Badr
Another prospective randomized trial by Molvi et al. (8) conducted on 150 women with mild to moderate pregnancy-induced hypertension who were randomized to receive labetalol plus standard care, methyldopa plus standard care, or the control group of standard care alone. Occurrence of severe hypertension and proteinuria was significantly lowered in both treatment groups when compared to the control group. Severe hypertension occurred in 16.3% of the women treated with methyldopa, compared to only 4% in the labetalol group.