Methyldopa pregnancy

Central a2-Agonists Methyl dopa Clonidine (Catapres) Guanabenz Guanfacine (Tenex) Guanadrel No recommendations at this time Transient sedation initially First-line in pregnancy (methyldopa)... 

Chronic hypertension is defined as elevated BP that was noted before pregnancy began. Methyldopa is considered the drug of choice because of experience with its use. /3-Blockers, labetalol, and CCBs are also reasonable alternatives. ACE inhibitors and ARBs are known teratogens and are absolutely contraindicated. The direct renin inhibitor aliskiren also should not be used in pregnancy. 

The cure for preeclampsia is delivery of the fetus if the pregnancy is at term. Drug therapy for hypertension in preeclampsia includes methyldopa, labetalol, and calcium channel blockers. Magnesium sulfate is used to prevent eclampsia and to treat eclamptic seizures. 

Antihypertensives for hypertension in pregnancy are Pi-selective adrenoceptor-blockers, methyldopa (p. 96), and dihydralazine (i.v. infusion) for eclampsia (massive rise in blood pressure with CNS symptoms). 

Methyldopa was widely used in the past but is now used primarily for hypertension during pregnancy. It lowers blood pressure chiefly by reducing peripheral vascular resistance, with a variable reduction in heart rate and cardiac output. 

M. Shimohira, J. Kohyama, Y. Kawano, H. Suzuki, M. Ogiso and Y. Iwakawa, Effect of alpha-methyldopa administration during pregnancy on the development of a child s sleep, Brain Dev., 8 (1986) 416-423. 

Picaud A, Walter P, de Preville G, Nicolas P. Hepatite toxique morteUe au cours de la grossesse. [Fatal toxic hepatitis in pregnancy. A discussion of the role of methyldopa.] J Gynecol Obstet Biol Reprod (Paris) 1990 19(2) 192-6. 

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... 

Methyldopa (Aldomet) is a centrally acting antihypertensive agent. It is a prodrug that exerts its antihypertensive action via an active metabolite. Although used frequently as an antihypertensive agent in the past, methyldopa s significant adverse effects limit its current use in the United States to treatment of hypertension in pregnancy, where it has a record for safety. 

Methyldopa is an effective antihypertensive agent that has been replaced by other drugs in many parts of the world. It is a preferred drng for treatment of hypertension dnring pregnancy based on its effectiveness and safety for both mother and fetns. 

Antihypertensive drugs such as methyldopa, the alfa-betablocker labetalol, and nifedipine are widely used and regarded safe to use in pregnancy and during lactation [26], and other types of calci-umblockers such as diltiazem have also been used in pregnant women with proteinuria [27]. 

Slim R, Ben Salem C, Hmouda H, Bouraoui K. Hepatotoxicity of alpha-methyldopa in pregnancy. J Clin Pharm Ther 2010 35(3) 361-3. 

A 26-year-old woman taking a combined oral contraceptive took methyldopa for hypertension as she was planning a pregnancy in the near future. She developed a hemolytic anemia. The methyldopa was withdrawn and the anemia resolved within 6 weeks. 

Liver Two independent case reports have described acute hepatitis in pregnancy related to methyldopa [98, 99 ]. Each presented with jaundice and dark urine one in the first trimester and one in the second trimester. In both cases the hepatitis resolved quickly, although in one case prednisolone was given. 

Fetotoxicity A positive antiglobulin test in a neonate investigated for jaundice was related to her mother s use of methyldopa during pregnancy [100 ]. The authors correctly pointed out that the presence of a positive direct antiglobulin test in the absence of blood group incompatibility should prompt a search for a drug-related cause. 

Valdes E, Candia P. Hepatitis aguda por alfa metildopa durante el embarazo. [Acute hepatitis due to alpha-methyldopa in pregnancy.] Prog Obstet Ginecol 2009 52(8) 473-5. 

Ozdemir OM, Ergin H, Lice T. A newborn with positive antiglobulin test whose mother took methyldopa in pregnancy. Turk J Pediatr 2008 50(6) 592-4. 

Grigoriadis C, Tympa A, liapis A, Hassiakos D, Bakas P. Alpha-methyldopa-induced autoimmune hemolytic anemia in the third trimester of pregnancy. Case Rep Obstet Gynecol 2013 2013 150278. 

Methyldopa is used as an antihypertensive drug. It is useful since it is safe for treatment of hypertension in asthmatics, in cases of heart failure and in pregnancy. This is because it does not act directly on adrenergic receptors. The biosynthesis of noradrenaline is shown in figure 10.17 with an indication where methyldopa acts... 

---