Choosing anti hypertensive agents?

B) What about other Ca Channel Blockers or combining Nifedipine with Atenolol? Diltizem is also one C Channel blockers may be used safely but side effects are not acquanatied to us (obstetricians). But fact remains that  atenolol may be combined with amlodepine. After alphadopa which was liberally used in the decades of sixties & seventies , there was availability of cal channel blockers, From  late 1980s Labtolol –a new kind of antihypertensive was at our disposal –again safe in Preg. This is basically a combined α & β Sympathetic receptor blockers Marketed as Normadate, Labet Gravidol, Pregnasafe L: Dose Initially 100 mg BD: later 200mg BD, à400 mg BD Max total daily dose is 1200 mg .Not to be prescribed in B Asthma, .However, this antihypertensive is relatively new drug for two decades in contrast to  Alphadopa, Nifedipine which are  used for 6-4 decades. The choice is obviously yours and my advice will don’t be theoretician, .Prescribe the drugs to which you are familiar. May liberally combine with other agent instead of insisting on high dose of single drug. Not to use sleeping tab (diazepam group)

Part: B: Following drugs are foeto toxic: If inadvertently used in Pregancy then may yield to oligohydramnios / Foetal Renal failure.:: Caution , better to avoid in pregnancy  or as soon as preg is confirmed.) ARB Group:- Angiotensin  Receptor Blockers:-like telmesartan, (Reno friendly-popular in established DM) Losartan , Irbesartan, Repace, Repace H, Losartan Beta

2) Drugs better be avoided in addition to above mentioned ARB is ACE inhibiters (Angiotensin Converting Enzyme Blockers) à Ramipril, Enalapril, Lisinopril,  , Cardace- H. Lisinopril. Ramace.

Dose of alpha DOPA:-safe but not that effective:- 25—500 mg TDS/QDS schedule (maximum Total dose per:-day is 2000 mg).

More about Amlodepine:- More about Amlodepine . Some have raised the issuer “Is it safe to prescribe Amlodepine for pregnancy induced hypertension?”. Top of Form

 This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus (AU, US) Use is contraindicated (UK) AU TGA pregnancy category: C

US FDA pregnancy category: C

Comments: -Use of adequate methods of contraception should be encouraged. -If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.

Amlodepine in early pregnancy:-Because animal studies have shown significantly decreased litter size, increased intrauterine deaths and prolongation of gestation and duration of labor when this drug was given before mating, throughout mating, and during gestation.

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There are no controlled data for this drug, but animal models have shown adverse effects on male fertility. AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details. US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. There are no controlled data in human pregnancy. Reversible biochemical changes in the head of spermatozoa occurred in some patients treated with calcium channel blockers

No, category C... You can prescribe Nifedipine or labetalol...

Usually we used it post delivery not during pregnancy... as told it is cat C

Nifedipine is the time tested among calcium channel blockers

When we prescribe something
without evidence and something goes wrong

immediately medico legal case goes in favour of the plaintiff. Saving patient is paramount, but saving self might prove logical in the long run.