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Old 01-26-2005, 08:26 PM   #1
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Aldomet 500mgs x3..just diagnosed today??

I am new here and I have some questions. I am 28 ,overweight and 12 weeks pregnant. My first Dr. app. BP was 151/95. Dr. said it was cause I was nervous. 2 weeks later it was 150/92, but today ( 4 weeks later) it was 158/102. So he says thats too high and I want to start you on some meds. I get the prescription filled and start looking around on the internet. It seems to me that this is kinda a high dose to start off with? Aldomet 5oo milligrams 3 times a day. Or is 158/102 really bad. I havent seen my primary Dr. for about 3 years and the last time I was in the ER for bronchitis they told me my BP was on the high side of normal, but it was cause I was sick.
I looked around this board and couldnt find anyone else that mentioned this drug. Any one else on it? I am worried about side effects. "They" say its safe to take during pregnancy, but I have a 8 year old also and I am worried I wont be able to do the mom things he needs. Thanks Mary

 
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Old 01-26-2005, 10:41 PM   #2
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Re: Aldomet 500mgs x3..just diagnosed today??

First, monitor your BP at home. Go to Walmart and invest about $50. It will be well worth it in the long run. This will tell you where your BP is the other times you are not at the doctor. You may or may not really have high BP. Also, many times, the treatment actually works. But, it doesn't change the doctor's office readings. Again, monitoring at home will tell you this.

Aldomet is a central acting agent like clonidine. And, I'm sure your dr selected this because you are pregnant. And, yes, 500 mg TID seems high. The recommended starting dose is 250 mg BID. Still, I think a simple diuretic would have been a better choice. Those central acting agents are usually reserved as a last resort. They are very potent.

Your BP doesn't seem high enough to be causing any acute symptoms (i.e. bronchitis). The real danger with your BP is the long term risk factors.

Pal

Last edited by Palamedes; 01-26-2005 at 10:58 PM.

 
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Old 01-27-2005, 05:35 AM   #3
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Re: Aldomet 500mgs x3..just diagnosed today??

Mary,

You probably have pregnancy induced hypertension which will abate once you deliver (although sometimes it takes several months after giving birth to get back to normal!).

Of all the hypertension drugs, Aldomet (methyldopa) is considered one of the safest during pregancy. Published reports of the use of this drug during all trimesters say that if Aldomet is used during pregnancy the possibility of fetal harm "appears very remote"

But if you intend to nurse, be aware that Methyldopa appears in breast milk. So discuss this with your doctor.


Palamedes is right about the starting dosage...but the usual daily dosages of methyldopa can be 500 mg up to 2 g in two to four doses.

See how you do...As Pal says, monitor your own BP at home. If it falls too low, you may not need the meds anymore or your doctor can always titrate the dosage down.

zuzu xx

 
Old 01-27-2005, 07:40 AM   #4
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Re: Aldomet 500mgs x3..just diagnosed today??

zuzu,

After reading up on things a little more, I have found extremely conflicting information reguarding HCTZ and pregnancy. I have found it documented as being anywhere from a category B (relatively safe) to a D (avoid). I believe the fda still considers it a B, though. Do you know what's up with this? Based on this conflicting information, these should probably be avoided as well (yes, I am now disagreeing with myself).

Aldomet seems to have consistent information reguarding safety (category B). And, yes, her dosage (while high) is within the allowable range (up to 3000 mg per day). Also, it appears to be about the best choice available for use during pregnancy. However, it may need a diuretic anyway to work properly. And, the drug has tolerance problems (i.e., you have to keep upping the dose to get it to work). Hopefully, it will last long enough to get through a pregnancy. Then, you can switch to more standard drugs.

But, still, I think we all agree monitoring is the most important.

Pal

 
Old 01-27-2005, 09:55 AM   #5
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Re: Aldomet 500mgs x3..just diagnosed today??

Whats a diuretic?

Thanks Mary

 
Old 01-27-2005, 11:33 AM   #6
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Re: Aldomet 500mgs x3..just diagnosed today??

Diuretic is sometimes called a "water pill". It makes you have to urinate. The idea is that water loss removes excess salt in your blood stream, thereby reducing your blood pressure. There are several different kinds.

 
Old 01-30-2005, 04:31 PM   #7
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Re: Aldomet 500mgs x3..just diagnosed today??

PAL-

I wanted to respond to your post earlier but got bogged down in RESEARCH on this- Almost a half day's worth...Couldn't stop! (Gimme a pill for CRS (Compulsive Research Syndrome).

Like you, I found an unbelievable amount of conflicting information regarding the risk category for thiazide use in pregnancy. As you said, B to D.


I found that the pregnancy risk factor for CERTAIN thiazides is Category B...(chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone) BUT bendroflumethiazide, benzthiazide, hydroflumethiazide, methyclothiazide, trichlormethiazide are designated category C.

" CATEGORY C - Safety for use during pregnancy has not been established....
Restrict use to women with volume-overload states (eg, renal or cardiac disease)"


But the way category B as described in the literature for thiazides is extremely confusing. On the one hand the studies state that "hydrochlorothiazide administered to mice and rats provided no evidence of fetal harm" but THEN they go on to tell us that since there have been no adequate or well-controlled studies in pregnant women, and since thiazides cross the placental barrier, theoretically they can compromise placental blood flow with a risk of causing either fetal OR neonatal jaundice and thrombocytopenia and hemolytic anemia. Newborns may also develop hypoglycemia at birth.

Sounds to me like it's a Category B only if you're a rodent!

Further digging found, as you did, several references to thiazides being Category D in pregnancy:
"Category D — Positive evidence of human fetal risk exists, but benefits in certain situations (for example, life-threatening situations or serious diseases for which safer drugs cannot be used or are ineffective) may make use of the drug acceptable despite its risks. (This means there is strong evidence of a risk of loss of pregnancy or birth defects that must be balanced against the value of treatment.)


And not to be forgotten, is the fact that thiazides may cause hypotension or electrolyte imbalance in the mom, therefore possibly (likely) affecting the fetus or newborn.

Aldomet seems to be the universal drug of choice in pregnancy.

A few British sources say:
2nd choice- Calcium Channel Blockers- specifically Nifedipine."Use during pregnancy must be evaluated on a case-by-case basis."

3rd choice-Betablockers - Propranolol, Atenolol. "Limited experience in first trimester. In late pregnancy can cause neonatal hypoglycemia and bradycardia. Avoid in first trimester if possible."

ACE Inhibitors - Captopril, Enalapril etc.- "Serious problems in the foetus may occur such as oligohydramnious and renal dysfuction after exposure in second and third trimenster. Contraindicated

Angiotensin receptor antagonists - Losartan et al- As for ACE inhibitors Contraindicated


Well. There you have it. Overall, It would seem wise to steer clear of thiazides if humanly possible.

Hopefully Mary will do very well on the Aldomet monotherapy.

zuzu xx


Some of my sources: American College of Physicians-American Society of Internal Medicine, Royal College of Physicians and Surgeons of Canada, Society of General Internal Medicine, and Society of Obstetric Medicine.

 
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