Obat-Obat Antihipertensi Selama Kehamilan
| Medication | Safety of Use during Pregnancy | Comments |
|---|---|---|
| CENTRAL SYMPATHOLYTIC | ||
| Methyldopa | ++++ | Extensive use, most studied, and best safety record of any antihypertensive used during pregnancy. It reduces vascular resistance while preserving maternal cardiac output and uteroplacental perfusion. Considered safe to use when breast-feeding |
| Clonidine | +++ | Not assessed for chronic hypertension during pregnancy. No adverse effects when used for hypertension during the third trimester. Potential for rebound when discontinued abruptly |
| α- AND β-BLOCKERS | ||
| Labetalol | ++++ | Used in several trials without adverse effects. α-Blocking results in vasodilation (including uteroplacental blood vessels), and β -blockade prevents reflex tachycardia. Cardiac output is unchanged. Low concentration in breast milk |
| β-BLOCKERS | ||
| Atenolol, metoprolol, pindolol, propranolol | +++ | Probably safe for third-trimester use, but neonatal bradycardia, respiratory distress, and hypoglycemia have been reported. Use earlier in gestation may result in intrauterine growth retardation. Atenolol and metoprolol are concentrated in breast milk; propranolol has low concentrations in breast milk |
| DIRECT ARTERIAL VASODILATOR | ||
| Hydralazine | ++++ | Extensively used during pregnancy. It causes vascular dilation and reflex tachycardia. Primarily used parenterally for acute management of hypertension or with methyldopa or a β-blocking agent |
| CALCIUM-CHANNEL BLOCKERS | ||
| Nifedipine (most commonly used because of its primarily peripheral effects), diltiazem, verapamil | +++ | Probably safely used in the third trimester. Their use maintains uteroplacental perfusion; may also have tocolytic effects. Sublingual nifedipine has been associated with hypotension and fetal distress. Avoid use with magnesium sulfate because combination risks profound hypotension |
| DIURETICS | ||
| Hydrochlorothiazide, chlorthalidone, furosemide | ++ | Use during pregnancy is controversial and often discontinued as blood pressure decreases early in pregnancy. If used before pregnancy, it can be continued, but its use should not be initiated during pregnancy. Concentrations in breast milk are low. May reduce milk production |
| ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS | ||
| Captopril, lisinopril, benazepril, enalapril, losartan, valsartan, candesartan | 0 | Use is contraindicated during pregnancy because it affects renal development in the second and third trimesters. Miscarriage, fetal death, malformations, and neonatal renal failure can result. No reports of adverse effects from brief use, limited to the first trimester. Few data on the effects of angiotensin II receptor antagonists, but presumed similar and also contraindicated |
Drugs listed have established effects during pregnancy. Antihypertensive agents not listed may be safe during pregnancy; however, until safety is known, those drugs should be switched to one of the safely used listed agents.
Referensi:
Cecil Medicine 23rd Edition (Saunders) 2008
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