Control of hypertension in first trimester of pregnancy is critical. most of traditional drugs such as betablockers, ACEI. ARB, potassium channel opener and diuretics potentially have teratogenic effects. In addition clinician concern about hypertension crisis result in cardiovascular and brain damages. It claims that methyl-dopa is safe and useful without any potential of fetus malformation. Sometimes the therapeutic effects of this agent is not adequate. management of these patients is a dilemma.
Hi Seyed,,, following drugs can be safely given in pregnancy
..methyl dopa
Calcium channel blockers.. Nefidipine, isradepine, felodepine, diltiazem and probably amlodepine
Direct vasodilator like hydralazine
Labetalol
Following drugs should be used with caution
Betablocker
Alpha blocker like prozocin
Drugs preferably should be avoided in pregnancy is diuretics
Drugs absolutely contraindicated
ACE inhibitor and ARB...
Following article might help you...thanks
Dear Seyed,
This is a fragment from the ESC Guidelines on the Mx of CV-diseases during pregnancy by Regitz-Zagrosek et al. (2011):
"a-Methyldopa is the drug of choice for long-term treatment of hypertension during pregnancy. The a-/b-blocker labetalol has efficacy comparable with methyldopa. If there is severe hypertension it can be given i.v. Metoprolol is also recommended. Calcium channel blockers such as nifedipine (oral) or isradipine (i.v.) are drugs of second choice for hypertension treatment. These drugs can be administered in hypertensive emergencies or in hypertension caused by pre-eclampsia. Potential synergism with magnesium sulfate may induce maternal hypotension and fetal hypoxia. Urapidil can also be selected for hypertensive emergencies. Magnesium sulfate i.v. is the drug of choice for treatment of seizures and prevention of eclampsia".
In details drug Tx of hypertension in pregnancy you can read in the following article by C.M. Brown and V.D. Garovic: Article Drug Treatment of Hypertension in Pregnancy
Best regards!
Hi Gennadiy, I agree with your answar. Hypertensive emergency in pregnancy is an potential life threatening condition which needs prompt treatment. Following drugs can be safely given in pregnancy with Hypertensive emergency.
Iv Labetalol
Iv hydralazine
Nicardepine
Sodium nitroprusside can be used as last resort because of potential thiacyanite toxicity and worsening maternal cerebral oedema. Thanks
Hi Gennadiy,,Immediate release oral nefidipine probably will be also helpful in treatment of hypertensive emergency in pregnancy as an alternative to iv hydralazine and Labetalol. There are some suggestions that diazoxide and ketanserin may also be useful in hypertension with pregnancy. However some well designed trial is needed. What is your opinion about it? Thanks
Hi dear Gennadiy Taradin and Biswajit Majumder
Thank you very much for your precise and valuable recommendations. Limit the number of safe drugs remain as a chief problem in control of hypertensive pregnant women manifestations.
Best Regards.
I would recommend prescribing alpha-methyldopa . However, the administration of drug therapy should be strictly monitored.
Dear Biswajit,
Thank you for the question. I have no personal experience of arterial hypertension (AH) treatment during pregnancy with these drugs. So, I can refer to available information concerning diazoxide and ketanserin in hypertensive emergency treatment in pregnant. Despite previous reports about promissing results of these drugs (diazoxide - D.K. Dudley (1985); T. Thien (1980), etc. and ketanserin - A.C. Bolte (1998); D.W. Steyn and H.J.Odendaal (1997); D.L. van Schie (2002), etc.) I am trying to adhere to current recommendations to avoid both drugs in setting severe AH during pregnancy unless no alternative medication available in a particular case.
As J.Habib (2013) wrote:
"Pertinent Points: - A physician’s experience should guide drug choice when managing severe hypertension during pregnancy. - Evidence indicates that nimodipine, diazoxide, and ketanserin should be avoided in pregnant women. - Magnesium sulfate should be avoided in all cases of severe hypertension in pregnancy unless required for the prevention or treatment of seizures".
Probably, further studies need to assess the role of diazoxide and ketanserin in AH treatment during pregnancy.
Best regards,
G.T.
Hi Elena Karelkina
Thank you for the answer. Methyldopa is drug of choice(FDA classic group B) but in some cases the physician face to untoward effects such as allergy, hemolytic anemia (combs test follow up recommended) and abnormal liver function test.
Hi Sayed ,methyl dopa is the age old drug used for pregnancy with hypertension. You have rightly maintained the side effects of methyl dopa. Another important area is that it is often difficult to control blood pressure with methyl dopa alone in pregnancy. Often other drugs like Labetalol and calcium channel blockers is to be used additionally to control blood pressure. Calcium channel blockers like nefidipine, felodepine are very potent antihypertensive drugs with very few side effects except pedal oedema. There are also very safe for mother and foetus.. Thanks