A member of my Facebook Group is having trouble finding her prescribed high blood pressure medication called methyldopa. She wanted to know what medication might be a substitute in pregnacy and if she is trying to conceive.
The best person to answer this question is her doctor or her pharmacist (PharmD). Many times physicians, pharmDs, and insurance providers work together to come up with the best medication substitution.
The member said, “Hello Everyone! Does anyone know of any high blood pressure medication that is approved for during pregnancy or trying to conceive? I’ve been taking Methyldopa for a while now but it’s discontinued at my regular pharmacy, and all other pharmacies in my area are saying the same thing.”
Methyldopa
Methyldopa is also known as Aldoment, and it is used to control blood pressure. The common methyldopa dose is 250-1000 mg every 12 hours or every 8 hours. Your dose should not be more than 3000mg a day in divided doses.
This medication should not be used in women with liver disease (cirrhosis and hepatitis B or C), and liver function should be monitored closely. Methyldopa could cause swelling in your legs or feet, slow heart rhythm, or depression.
The most serious methyldopa side effects are congestive heart failure and pancreatitis. The common side effect of methyldopa is headache, dizziness, or low libido.
High Blood Pressure Medication, Conception, & Pregnancy
Methyldopa has been used for years in pregnant women; however, labetalol and metoprolol are most commonly used in pregnant women and in women who are trying to conceive. Nifedipine and amlodipine are also currently used. Back in 2008, low dose hydrochlorothiazide (HCTZ) was recommended as well.
Although nowadays, hydrochlorothiazide (HCTZ) and other diuretics are avoided due to the potential of decreased blood flow to the placenta. Hydralazine is also safe during pregnancy but perhaps used as a last result because it can cause blood pressure spikes if a dose is missed or delayed.
High Blood Pressure & Pregnancy
About one pregnant woman out of every 4 of them develops high blood pressure during pregnancy. A pregnant woman has gestation high blood pressure (hypertension) if she develops high blood pressure at about 6 months (20 weeks) or more of pregnancy. Before 6 months of pregnancy, high blood pressure is called chronic high blood pressure (hypertension).
Do you Have Questions or Comments?
High blood pressure in pregnancy is defined at a higher blood pressure level than in non-pregnant adults. A systolic (top number) blood pressure of 140 mm Hg or higher or a diastolic (bottom number) blood pressure of 90 mm Hg or higher would be considered high blood pressure in pregnant women.
Moderate blood pressures in pregnant women are tolerated to allow adequate blood to the placenta (the sack that holds the baby and supplies nutrition to the baby). A moderately high blood pressure is systolic of 145-150 mm Hg or a diastolic of 95-100 mm Hg. Both the systolic or diastolic might be high or just the systolic or just the diastolic might be high, which would still be high blood pressure.
Severe high blood pressure should always be controlled in pregnancy to prevent stroke, kidney damage or failure, liver failure, bleeding disorders, and eclampsia. Severe blood pressure is a systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg Or more.
High Blood Pressure & Pre-Eclampsia
Gestational hypertension could turn into pre-eclampsia if two blood pressures are 140/90 mmHg or more at least 6 hours apart. In addition, protein in your urine and organ damage must be present. Protein in the urine is seen using a protein dipstick test greater than 1+ using a dip-stick). Symptoms of kidney, brain, or liver damage would be detected by a blood test (chemistries and a liver panel).
If you have had pre-eclampsia or your mother or grandmother has had it, then you are more likely to have it during pregnancy. You are also more likely to have pre-eclampsia if you are less than 18 years old or 35 years old or older during pregnancy.
If this is your first pregnancy, your BMI is 25-29, or you are pregnant with twins or triples, then you also likely to have pre-eclampsia. So you need to monitor your blood pressure closely especially after 19 weeks of pregnancy.
High Blood Pressure & Eclampsia
Pre-eclampsia could turn into eclampsia if two blood pressures are 140/90 mmHg or more at least 6 hours apart. Eclampsia is likely if you develop pr-eclampsia at 5 months of pregnancy or less. Eclampsia causes seizures due to the large amounts of swelling to the brain. In addition, protein in your urine and organ damage must be present. Protein in the urine is seen using a protein dipstick test greater than 1+ using a dip-stick).
Symptoms of kidney, brain, or liver damage would be detected by a blood test (chemistries and a liver panel). You will generally develop swelling in your face, hands, ankle, or feet, and weight gain. Symptoms like headaches and shortness of breath and a decrease in urination may be seen with eclampsia.
Eclampsia is a severe disease during pregnancy that could be dangerous for you and your baby if not treated. Magnesium sulfate is given through the vein in the hospital to decrease the risk of seizures. Bedrest lying on your left side might be ordered by your doctor to improve the blood circulation to the baby.
Your doctor may want to deliver your baby before your due date to get rid of the eclampsia. Once the baby is delivered, eclampsia is usually resolved. Delivering the baby as soon as possible is considered to prevent serious damage to you and the baby. However, delivery is not usually considered before 34 weeks unless you are having seizures or there is organ damage.
https://www.youtube.com/watch?v=OSenNxcmq4s
Home Blood Pressure Monitoring During Pregnancy
Pregnancy causes altered hemodynamics that may cause electronic blood pressure measurements to be inaccurate. Currently, there are limited data about validated home blood pressure monitors. Usually, watch blood pressure monitors are not recommended because of the inaccuracy of the monitors. However, the Microlite Watch BP Home monitor has been validated in pregnant women and women who have preeclampsia. This is an arm cuff monitor. The Omron MIT Elitehas also been validated in pregnant women.
Conclusion
High blood pressure should not be ignored, and it should be controlled to prevent complications during pregnancy. Using medication that is safe during pregnancy will prevent potential harm to you and your baby. So, be sure to consider safe medication when you are trying to conceive or when you are pregnant.
Resources:
de Greeff A, Reggiori F, Anthony J, Shennan A. The Microlife 3AC1: An accurate blood pressure measurement device in pregnancy and pre-eclampsia [abstract]. J Hypertens 2006;24(suppl 4):S279 Abstract P14.475
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