Centrally-acting antiadrenergic agent
ATC code: C02AB02 (Methyldopa (levorotatory))
Converted to alpha-methyl-norepinephrine, stimulates brainstem alpha-2 receptors, reduces sympathetic outflow. Lowers peripheral vascular resistance without heart rate change. Longest clinical experience in pregnancy (since 1960s), with no teratogenicity confirmed.
First line
Hypertension in pregnancy. Per 222 (2020), SEGO 2023, and 2011, first-line with the longest clinical track record. Dose 250-500 mg 2-4 times daily, max 3 g/day. Onset 2-3 h, peak at 6-8 h. No fetal distress, no impact on fetal peripheral resistance.
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Safe. Drug of choice. Used since the 1960s without teratogenicity.
Fully compatible. Hale L2. RID 0.2-0.34%. Possible maternal sedation – discuss alternative if marked.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Methyldopa is evaluated for the following indications with varying evidence strength: Hypertension in pregnancy (evidence tier A), Hypertension during breastfeeding (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Methyldopa (≥ 1 in 100): Sedation, Dry mouth, Headache, Orthostatic hypotension, Libido changes, Weight gain. See the Safety section for uncommon and serious reactions.
FDA category B. Safe. Drug of choice. Used since the 1960s without teratogenicity.
Fully compatible. Hale L2. RID 0.2-0.34%. Possible maternal sedation – discuss alternative if marked.
Methyldopa is contraindicated in: Hypersensitivity; Active hepatitis, cirrhosis; History of depression (relative); Pheochromocytoma. Full list in the Safety section.