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Centrally acting α2-agonist

Methyldopa

Brand names: Aldomet

Used in: Pre-eclampsia & Obstetric Emergencies

Methyldopa is a centrally-acting antihypertensive used in obstetrics as a long-established oral treatment for hypertension in pregnancy.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is converted centrally to alpha-methylnoradrenaline, which stimulates central alpha-2 adrenoceptors to reduce sympathetic outflow and lower peripheral vascular resistance.

Prescribing in practice

  • It has a long record of fetal safety in pregnancy but is best avoided in women with a history of depression and is conventionally discontinued shortly after delivery because of the risk of postnatal depression.
  • Sedation, dizziness and dry mouth are common, particularly on initiation and dose increases.
  • It can rarely cause a positive direct antiglobulin (Coombs) test, haemolytic anaemia and abnormal liver function.

Monitoring

Monitor blood pressure and, with prolonged therapy, full blood count and liver function.

Counselling the patient

  • Drowsiness is common early in treatment; take care with driving until you know how it affects you.
  • Do not stop the medicine suddenly without advice.
  • Tell your clinician about low mood, as this medicine is usually changed around the time of delivery.

Evidence & guidelines

Methyldopa remains a recommended first-line option for hypertension in pregnancy in NICE guidance, supported by extensive long-term safety data.

Reference: NICE NG133; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways