Ok. So I am about 3 weeks pregnant and taking 50mg of Atenolol once a day. Two family doctors heavily discourage use of Atenolol during pregnancy. I have tried switching in the past, but I dont respond well to other high blood pressure meds. I called my OB's office and spoke to her nurse, and she said that Atenolol is commonly used during pregnancy, however my OB says she can't control my BP meds, that my regular MD has to do that. My OB is considered one of the best in the OKC area, but who do I believe. I am not having much luck finding anything on the interent about any known cases of birth defects due to atenolol use, but that does not mean anything. Anybody here know anything? I posted this on the pregnancy board but did not have much luck.
I feel for you. I can't believe that this OB of yours is pushing away your need to know more about this drug. THEY should inquire through THEIR sources and get an answer for you - plain and simple. It's incomprehensible that they refuse to help you. I would find another OB if I were you. The one thing I agree with your OB that you should ALSO be seen by another doctor who specializes in High Blood Pressure, especially now....
What I would suggest doing is asking your local pharmacist, they tend to know more about drugs than doctors since this is all they study. I always ask my pharmacist questions and rely on them heavily; moreso than any doctor I know.
Then I would also contact the manufacturer of the drug. Do a search on the internet with the drug name and you should find the maker. Then call their customer support.
Atenolol is in the FDA pregnancy category D. This means that atenolol is known to have harmful effects on a developing baby. Low birth weight and other effects have occurred. Do not take atenolol without first talking to your doctor if you are pregnant or could become pregnant during treatment.
From the University of Marylland medical center:
Do not use in pregnancy and do not get pregnant. Use birth control that you can trust while taking this medicine.
There is an alternative that women have taken when pregnant but I forgot which, so one of the good ladies (with a good memory) will have to fill that in.
Of all the hypertension drugs, Aldomet (methyldopa) is considered one of the safest during pregancy and seems to be the universal drug of choice if you get pregnant. It's a a central acting agent like clonidine. The recommended starting dose is 250 mg BID, although higher doses may be necessary to give you good BP control.
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 if you get on it, absolutely discuss this with your doctor.
As for Beta Blockers, e.g.atenolol, everything I have read says stay away unless there are absolutely no alternatives, ESPECIALLY IN THE 1st TRIMESTER.
In late pregnancy it can cause neonatal hypoglycemia and bradycardia (slow heart rate).
A few sources I found say 1st choice would be Methyldopa,
2nd choice- Calcium Channel Blockers- specifically Nifedipine.
ACE Inhibitors and ARBs are contraindicated because serious problems can occur for the baby, (particularly kidney problems) in the second and third trimester.
Now bear in mind that it's not unheard of for these "less safe" drugs to be given during pregnancy BUT the benefits must be weighed against the risks.... Strong evidence of a risk of loss of pregnancy or birth defects should be balanced against the value of treatment for the mom.
Palamedes and I researched this a while ago and both of us came up with a lot of conflicting info regarding the thiazides during pregnancy. Categories B to D! For the life of me though, today I can't find where I once read that certain thiazides were considered category D.
Most literature (in the USA) says: Category B...chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone. Category C....bendroflumethiazide, benzthiazide, hydroflumethiazide, methyclothiazide, trichlormethiazide.
Definitions: CATEGORY B- "Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women"
Ergo: limited information which doesn't actually indicate RISK but doesn't rule it out either!
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 no matter what category, we know that thiazides can cause hypotension or electrolyte imbalance in the mom, therefore possibly affecting the fetus.