Chosing antihypertensives preconceptionally or at early pregnancy?? Safety of antihypertensives in pregnancy-a hard task

Chosing antihypertensives preconceptionally or at early pregancy?? Safety of antihypertensives in pregnacy :

The following drugs are safe in pregnancy, These are A) Calcium Channel Blockers like Amlodepine,, Nifedipine, Alphadopa, Bisoprolol( -sometimes cardiologists change the atenolol drugs to Bisoprolol on knowing that she is planning for Pregancy. Of all the available the advantage of Nifedipine are many.

ABC of Nifedipine:- Ca Channel Blockers ; Most commonly trusted after Labtolol: Nifedipine is in advantageous position that it can be combined with alpha-DOPA (if available locally ).  But Nifedipine (a vasodilator) can’t be combined with Mag So4 for long time -->may cause sudden severe fall of BP. So unless warranted seriously someone who is on Nifedipine  one should not supplement seizure prophylaxes agent(Mag So4) by Mag So4 , If concomitant with great caution.  Nifedipine may cause flushing, tachycardia headache (may confuse the obstetrician, SR-slow release formulation is desirable to avert sudden fall of BP. Trade names are Depin Tab 20 mg retard /30 mg retard Tab(Cap nit preferred) Calcigard (Torrent) Retard 10/20 mg; Dose is initially in nonemergent condition:-initiate with 10 mg BD, Later 20 mg Retard(SR) 1 BD. Maximum is 60 mg OD.

 Bisoprolol is selective β blockers may be safely used in initial phases of pregancy. Safe. Than Nifedipine or Labetolol

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)