Methyldopa long-term effects

An important aspect of a-methyldopa s hemodynamic effects is that renal blood flow and glomerular filtration rate are not reduced. As occurs with most sympathetic depressant drugs and vasodilators, long-term therapy with a-methyldopa leads to fluid retention, edema formation, and plasma volume expansion. While data conflict somewhat, it is generally thought that a-methyldopa suppresses plasma renin activity. 

The most common undesirable effect of methyldopa is sedation, particularly at the onset of treatment. With long-term therapy, patients may complain of persistent mental lassitude and impaired mental concentration. Nightmares, mental depression, vertigo, and extrapyramidal signs may occur but are relatively infrequent. Lactation, associated with increased prolactin secretion, can occur both in men and in women treated with methyldopa. This toxicity is probably mediated by inhibition of dopaminergic mechanisms in the hypothalamus. 

Many agents can be used to treat chronic hypertension in pregnancy (Table 13-7). Methyldopa is considered the drug of choice. Data indicate that uteroplacental blood flow and fetal hemodynamics are stable with methyldopa. Moreover, it is viewed as very safe based on long-term follow-up data (7.5 years) that have not demonstrated adverse effects on childhood development. /S-Blockers, labetalol, and... 

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