Methyldopa

• Chronic HTN pre-pregnancy (continue if controlled)
• Second-line when Labetalol & Nifedipine unsuitable

Converted to α-methylnoradrenaline → stimulates central α2 receptors → ↓ sympathetic outflow → ↓ SVR & BP.

• D — Depression (avoid in PND history)
• O — Orthostatic hypotension
• P — Positive Coombs test (haemolysis)
• A — Abnormal LFTs / hepatitis
• D — Drowsiness / sedation

Start

250 mg BD–TDS

Titration

Increase every 2 days

Max

3 g/day in divided doses

• AbsoluteActive liver disease, prior methyldopa-induced hepatitis
• AbsolutePhaeochromocytoma
• AbsoluteCurrent or past depression (RCOG — avoid postpartum)

• Sedation, depression
• Dry mouth
• Postural hypotension
• Haemolytic anaemia (+ve Coombs)
• Hepatitis (rare)

• • Excellent safety record — used for >50 years.
• • No teratogenicity, no FGR signal.
• • STOP within 48 h postpartum — risk of postnatal depression.

• MAOIs

  Avoid

  Hypertensive crisis — avoid

• Iron salts

  Caution

  ↓ methyldopa absorption

• Lithium

  Caution

  ↑ lithium toxicity

• 💡 Always swap to alternative within 2 days postpartum.
• 💡 Check LFTs and FBC at baseline, 6 and 12 weeks.