The drug atlas
Obstetrics & Gynaecology/Pregnancy antihypertensive
Methyldopa
also: centrally-acting antihypertensive · pregnancy HTN
Overview
Centrally-acting antihypertensive used in pregnancy. Labetalol and nifedipine are the other pregnancy-safe options (ACEi/ARB are contraindicated).
Mechanism
Converted centrally to α-methylnoradrenaline, a potent α₂-adrenoceptor agonist → reduces central sympathetic outflow → ↓peripheral resistance and BP.
Indications
- Hypertension in pregnancy (alternative to labetalol/nifedipine)
Adverse effects
Depression / sedationclassic
STOP within 2 days of birth — avoid postnatal depression risk.
Positive direct antiglobulin (Coombs) test ± haemolytic anaemiaserious
Drug-induced hepatitiscommon
Postural hypotension, dry mouthcommon
Cautions & contraindications
Active depressionall
Hepatic disease / phaeochromocytomaall
Interactions
- Additive hypotension with other antihypertensives
Monitoring & kinetics
BP; FBC/LFTs; mood,Switch postnatally (e.g. to enalapril) to avoid depression
Oral. Long-established pregnancy safety record.
Choosing it
true
Source: NICE NG133 — Hypertension in pregnancy · BNF — Methyldopa