Methyldopa (Aldomet)
Its use at present has largely been replaced by antihypertensive drug classes with less side effects, but it is still used in developing countries due to its low cost - Greg T Mah
HWN Suggests
Methyldopa for primary hypertension
Methyldopa lowers blood pressure in patients with primary (essential) hypertension, when given at doses 500‐2250 mg daily compared to placebo. Clinicians who wish to recommend methyldopa for their patients should understand, however, that while methyldopa may reduce blood pressure, to the best of our knowledge, there are no known clinical studies which have associated use of methyldopa with a reduction in all cause mortality, myocardial infarction, or stroke. In addition, despite poor reporting of treatment‐emergent adverse effects, clinicians must weigh the risks of potential serious side effects with use of methyldopa that include hemolytic anemia, hepatotoxicity as well as lupus‐like syndrome…
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Managing Chronic Hypertension in Pregnant Women: ACOG Releases Updated Practice Bulletin
Labetalol and nifedipine are the preferred medications and hydrochlorothiazide and methyldopa are considered secondary options. Methyldopa has a long history of use in pregnancy, but has limited effectiveness and significant adverse effects. Use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor antagonists should be avoided in pregnancy.
Articles of Interest
Comparative evaluation of efficacy and safety of methyldopa and labetalol in pregnancy-induced hypertension: A meta-analysis
This analysis showed that labetalol is more advantageous than methyldopa in terms of better and quicker control of blood pressure. Labetalol has comparatively fewer maternal side-effects with the good prenatal outcomes. Thus, Labetalol having less maternal side effects is a smarter choice for treating PIH for better outcomes.
Methyldopa and pregnancy or breastfeeding: Is it safe?
Because of the low levels of methyldopa in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
Methyldopa Hepatotoxicity: A Paradoxical High-Risk Pregnancy
The dangers of hepatotoxic medications like methyldopa cannot be overemphasized. A high index of suspicion is critical in diagnosis for early management especially in pregnancy.
The Benefits of Methyldopa During Pregnancy
It is important to note that methyldopa is not a first-line treatment for hypertension during pregnancy. Lifestyle modifications, such as a healthy diet and regular exercise, are often recommended as the first step in managing hypertension in pregnant women. However, if lifestyle changes are not effective, medication may be necessary to control blood pressure and prevent complications.
Which antihypertensive treatment is better for mild to moderate hypertension in pregnancy?
In this analysis that used all available evidence to inform drug vs. drug comparisons, similar effectiveness was seen for prevention of severe hypertension, for labetalol, nifedipine, and methyldopa compared with placebo/no therapy. Also, labetalol was superior to: methyldopa for severe hypertension, methyldopa or calcium channel blockers (including nifedipine) for proteinuria/preeclampsia, and placebo/no therapy for perinatal mortality.
Resources
Methyldopa (Aldomet)
The usual daily dosage of methyldopa is 500 mg to 2 g in two to four doses.
StatPearls
Methyldopa is a centrally acting sympatholytic agent used in the treatment of hypertension. Since its introduction in 1960, the drug quickly became a leading antihypertensive, but its use has decreased markedly, replaced by better-tolerated alternatives.
