Centrally acting α2-agonist
Methyldopa
Brand names: Aldomet
Adult dose
Dose: Initial 250mg BD–TDS, increase every 2 days; max 3g/day
Route: PO
Frequency: BD-QDS
Clinical pearls
- Long-established safe option for hypertension in pregnancy (NICE NG133) alongside labetalol/nifedipine
- Switch postpartum (depression risk in postnatal period)
Contraindications
- Active liver disease
- Depression
- Phaeochromocytoma
- Porphyria
Side effects
- Sedation
- Postural hypotension
- Hepatotoxicity (haemolytic anaemia + LFTs)
- Depression
- Positive Coombs test
- Galactorrhoea
- Withdrawal hypertension
Interactions
- Lithium toxicity
- MAOIs
- Iron salts (reduced absorption)
Monitoring
- BP
- LFTs
- FBC + Coombs
Reference: BNF; NICE NG133; https://bnf.nice.org.uk/drugs/methyldopa/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Spinal Anaesthesia Hypotension Management · AAGBI; ASA
- Pre-Eclampsia / Eclampsia in ED · NICE NG133; RCOG Green-top 10A
- Suspected Ectopic Pregnancy · NICE NG126; RCOG Green-top 21
- Polycystic Ovary Syndrome (PCOS) · International PCOS Guideline 2023; NICE CKS
- Pre-eclampsia Management · NICE NG133 2019
- Ectopic Pregnancy · NICE CG154 / RCOG GTG 21