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Centrally Acting Antihypertensive

Methyldopa (Chronic Hypertension in Pregnancy)

Brand names: Aldomet

Used in: Pre-eclampsia & Obstetric Emergencies

Methyldopa is a centrally acting antihypertensive used mainly 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.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE & ADMINISTRATION Adults : Initiation of Therapy : The usual starting dosage of methyldopa tablets is 250 mg two to three times a day in the first 48 hours. The daily dosage then may be increased or decreased, preferably at intervals of not less than 2 days, until an adequate response is achieved. To minimize the sedation, start dosage increases in the evening. By adjustment of dosage, morning hypotension may be prevented without sacrificing control of afternoon blood pressure. When methyldopa tablets are given to patients on other antihypertensives, the dose of these agents may need to be adjusted to effect a smooth transition. When methyldopa tablets are given with …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-03-28. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It is converted centrally to a false neurotransmitter that stimulates inhibitory alpha-2 receptors, reducing sympathetic outflow and blood pressure.

Prescribing in practice

  • It has a long record of safety in pregnancy and is a first-line option there.
  • Sedation and depression can occur — avoid in a history of depression, and it is usually stopped after delivery (post-natal depression concern).
  • It can cause a positive Coombs test/haemolytic anaemia and, rarely, hepatotoxicity.

Monitoring

Monitor blood pressure; consider FBC and liver function with longer use; review mood.

Counselling the patient

  • Drowsiness is common, especially at first.
  • Report persistent low mood.

Evidence & guidelines

A first-line antihypertensive in pregnancy (NICE NG133) with an established safety record.

Reference: NICE NG133 Hypertension in Pregnancy; RCOG Chronic Hypertension Guidance; 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.

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