{"id":52906,"date":"2022-08-01T11:17:44","date_gmt":"2022-08-01T15:17:44","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=52906"},"modified":"2022-08-01T11:17:44","modified_gmt":"2022-08-01T15:17:44","slug":"methyldopa-alternatives","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/methyldopa-alternatives\/","title":{"rendered":"Methyldopa alternatives: What can I take instead of methyldopa?"},"content":{"rendered":"

Compare methyldopa alternatives<\/a>\u00a0| <\/span>Labetalol<\/span><\/a> | <\/span>Nifedipine<\/span><\/a> | Hydralazine<\/a> | <\/span>Clonidine <\/span><\/a>| Furosemide<\/a> | Natural alternatives<\/a> | How to switch meds<\/a><\/span><\/p>\n

A diagnosis of <\/span>hypertension<\/span><\/a>\u2014generally defined as systolic blood pressure greater than or equal to 140 <\/span>mmHg<\/span> or diastolic blood pressure greater than or equal to 90 <\/span>mmHg<\/span>\u2014<\/span>can be scary to hear. What may add to the fear and confusion of such a diagnosis are the number of medications available for the treatment of <\/span>high blood pressure<\/span>. There are several drug classes to manage <\/span>hypertension<\/span> with each containing many individual medications, and some people will require multiple medications from different drug classes.\u00a0<\/span><\/p>\n

A diagnosis of <\/span>high blood pressure<\/span> is also rarely isolated; many who suffer from <\/span>hypertension<\/span> carry other diagnoses, such as; diabetes, high cholesterol, and other <\/span>cardiovascular<\/span> conditions like <\/span>heart failure<\/span>, which in turn may require additional medications. Many <\/span>antihypertensive<\/span><\/a> medications have niche indications based on safety in certain patient populations and the benefits in the management of some of these other comorbid conditions. Selection of an <\/span>antihypertensive<\/span> is in no way a \u201cone size fits all\u201d approach. Careful consideration from <\/span>healthcare professionals<\/span> with an individualized approach to medication selection should always occur.\u00a0<\/span><\/p>\n

Methyldopa<\/span><\/a> is an oral <\/span>antihypertensive<\/span> medication in the drug class known as <\/span>alpha-2 adrenergic <\/span>agonists<\/span><\/a>; stimulation of these <\/span>receptors<\/span> results in a decrease in smooth muscle resistance in <\/span>blood vessels<\/span> and ultimately a decrease in blood pressure. Like most <\/span>antihypertensives<\/span>, <\/span>methyldopa<\/span> has a very specific patient population in which it is optimally employed, and this is in pregnant and <\/span>postpartum<\/span> women (including those <\/span>breastfeeding<\/span>). As with most medications in pregnancy, <\/span>antihypertensives<\/span> have not been evaluated in robust, randomized controlled <\/span>clinical trials<\/span> so much of the data is limited. One should weigh the risks of uncontrolled <\/span>hypertension<\/span> against the risks of <\/span>antihypertensives<\/span> and medications should be selected in conjunction with a <\/span>healthcare professional<\/span>. The risks of uncontrolled <\/span>hypertension<\/span> in pregnancy are real. Chronic maternal <\/span>hypertension<\/span> may increase the risk of poor fetal outcomes, including the risk of birth defects, low birth weight, preterm delivery, stillbirth, and neonatal death. Untreated <\/span>hypertension<\/span> can also increase risks of adverse maternal outcomes, such as <\/span>gestational diabetes<\/span><\/a>, stroke, and delivery complications. Exposure to <\/span>methyldopa<\/span> has proven to be safe to the developing fetus and\/or has minimal effect on a <\/span>breastfeeding<\/span> infant despite crossing over into <\/span>breastmilk<\/span>.\u00a0<\/span><\/p>\n

Methyldopa<\/span> may be used in patients who have chronic <\/span>hypertension<\/span> during pregnancy (generally diagnosed prior to 20 weeks\u2019 gestation), pregnancy-induced or gestational <\/span>hypertension<\/span> (diagnosed after 20 weeks gestation), and less commonly in those <\/span>pregnant women<\/span> that develop <\/span>severe hypertension<\/span> or other <\/span>hypertensive disorders<\/span> including <\/span>preeclampsia<\/span><\/a>, eclampsia, or <\/span>HELPP<\/span><\/a> syndrome (Hemolysis Elevated Liver Enzymes and Low Platelets). An injectable formulation of <\/span>methyldopa<\/span> is no longer available in the United States, and <\/span>severe hypertension<\/span> and the other scenarios that may require urgent blood pressure lowering with the use of intravenous formulations of medications.\u00a0<\/span><\/p>\n

What can I take in place of <\/span>methyldopa<\/span>?<\/span><\/h2>\n

There are a few options available for the <\/span>treatment of hypertension<\/span> in pregnancy and while <\/span>breastfeeding<\/span>. These alternative prescription medications include a similar medication to <\/span>methyldopa<\/span> known as <\/span>clonidine<\/span>, or other classes of blood pressure lowering medications such as the <\/span>beta blocker<\/span><\/a> labetalol<\/span>, <\/span>calcium channel blocker<\/span><\/a> nifedipine<\/span>, or the <\/span>vasodilator<\/span><\/a> hydralazine.\u00a0<\/span><\/p>\n

In <\/span>pregnant women<\/span> with other comorbid conditions, like <\/span>heart failure<\/span><\/a>, <\/span>loop <\/span>diuretics<\/span><\/a> such as furosemide may be added to a patient\u2019s <\/span>hypertension<\/span> regimen. <\/span>Thiazide <\/span>diuretics<\/span><\/a>, like hydrochlorothiazide, may be risky to a developing fetus in the very beginning weeks of development; however, some experts will suggest continuing thiazides throughout pregnancy if initiated prior to pregnancy. Doses of hydrochlorothiazide less than or equal to 50 mg appear compatible with <\/span>breastfeeding<\/span>, whereas higher doses theoretically could decrease <\/span>breastmilk<\/span> volume. For patients on a thiazide <\/span>diuretic<\/span> prior to conception, if continued the dose may be decreased and the patient may require an additional agent added to their regimen to maintain adequate <\/span>blood pressure control<\/span>.\u00a0<\/span><\/p>\n

In patients with chronic <\/span>hypertension<\/span> after pregnancy, <\/span>methyldopa<\/span> or alternatives would likely be changed to first-line therapies based on <\/span>national guidelines<\/span><\/a>, but for those that are pregnant or trying to get pregnant the management of <\/span>hypertension<\/span> should be limited to use of specific <\/span>antihypertensives<\/span> with established fetal and infant safety profiles. Many first-line <\/span>antihypertensive drugs<\/span> outlined in <\/span>hypertension<\/span> management guidelines are contraindicated in pregnancy, including angiotensin converting enzyme <\/span>inhibitors<\/span> (ACEIs), angiotensin <\/span>receptor<\/span> blockers (ARBs), direct renin <\/span>inhibitors<\/span>, and aldosterone antagonists.\u00a0<\/span><\/p>\n

In pregnancy or while <\/span>breastfeeding<\/span>, alternative options to <\/span>methyldopa<\/span> may be more suitable for some women due to other comorbid conditions requiring medications given multiple <\/span>drug interactions<\/span> and\/or its <\/span>side effect<\/span> profiles. <\/span>Side effects<\/span> of <\/span>methyldopa<\/span> include <\/span>orthostatic <\/span>hypotension<\/span><\/a>, <\/span>drowsiness<\/span> and <\/span>tiredness<\/span>, skin rash, <\/span>constipation<\/span><\/a>, bone marrow depression, <\/span>hemolytic anemia<\/span><\/a>, abnormal liver function tests, edema, <\/span>photosensitivity<\/span><\/a>, and nasal congestion. Many experts also avoid <\/span>methyldopa<\/span> beyond pregnancy for management of <\/span>hypertension<\/span> since its use as been associated with depression, which may confuse a diagnosis of <\/span>postpartum<\/span> depression. This list of <\/span>adverse effects<\/span> and improved tolerance profiles of other <\/span>antihypertensive drugs<\/span> may yield better adherence by patients.\u00a0<\/span><\/p>\n

RELATED: <\/b>What a pharmacist wants you to know about <\/b>breastfeeding<\/b> and medications<\/b><\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
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Compare methyldopa alternatives<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n

Drug name<\/b><\/td>\nUses<\/b><\/td>\nDosage<\/b><\/td>\nSavings options<\/b><\/td>\n<\/tr>\n
Methyldopa<\/a><\/td>\nChronic hypertension, gestational hypertension<\/td>\n250 mg by mouth two to three times daily, increase every 2 days as needed up to a maximum total daily dose of 3000 mg<\/td>\nMethyldopa coupons<\/a><\/td>\n<\/tr>\n
Labetalol<\/a><\/td>\nChronic hypertension, gestational hypertension, severe hypertension, preeclampsia<\/td>\n100 mg by mouth twice daily, increase by 100 mg twice daily every 2 to 3 days as needed up to a maximum total daily dose of 2400 mg<\/td>\nLabetalol coupons<\/a><\/td>\n<\/tr>\n
Nifedipine<\/a><\/td>\nChronic hypertension, gestational hypertension, severe hypertension, preeclampsia<\/td>\nImmediate release:<\/b> 10 mg by mouth one-time; may repeat 10 mg to 20 mg in 20 minutes if target blood pressure not achieved x 2 additional doses<\/p>\n

Extended release:<\/b> 30 mg to 90 mg by mouth once daily, increase by 30 mg at 7 to 14 day intervals up to a maximum total daily dose of 120 mg<\/td>\n

Nifedipine coupons<\/a><\/td>\n<\/tr>\n
Hydralazine<\/a><\/td>\nChronic hypertension, gestational hypertension, severe hypertension, preeclampsia<\/td>\n10 mg by mouth four times daily, increase by 10mg to 25 mg per dose every 2 to 5 days up to a maximum total daily dose of 200 mg<\/td>\nHydralazine coupons<\/a><\/td>\n<\/tr>\n
Clonidine<\/a><\/td>\nChronic hypertension, gestational hypertension<\/td>\nImmediate release:<\/b> 0.1mg by mouth twice daily, may increase dose by 0.1 mg per day at weekly intervals up to a maximum daily dose of 0.6 mg<\/p>\n

Transdermal patch:<\/b> 0.1 mg\/24-hour patch applied once every 7 days, may increase by 0.1 mg at 1 to 2 week intervals up to a maximum of 0.3 mg\/24-hour patch<\/td>\n

Clonidine coupons<\/a><\/td>\n<\/tr>\n
Furosemide<\/a><\/td>\nChronic hypertension accompanied by severe edema<\/td>\n20 mg once or twice daily<\/td>\nFurosemide coupons<\/a><\/td>\n<\/tr>\n
Hydrochlorothiazide<\/a><\/td>\nChronic hypertension<\/td>\nLimit dose up to a maximum total daily dose of 50 mg<\/td>\nHydrochlorothiazide coupons<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Other alternatives to <\/span>methyldopa<\/span><\/h2>\n

Outside of pregnancy and\/or <\/span>breastfeeding<\/span>, national guidelines should be followed for the management of <\/span>hypertension<\/span>. Medications for control of <\/span>high blood pressure<\/span> include:<\/span><\/p>\n