Q from TTC+35er re: chronic hypertension meds

kikibird · May 2010

Hi all, I just started TTC and had a question about an issue that maybe some of you have experience with...

Did anyone here have chronic hypertension before getting pregnant? Were you on medication, and are you staying with the same medication throughout your pregnancy? Specifically is anyone on either labetalol or methyldopa (Aldomet)?

I'm asking because I saw my cardiologist yesterday and he switched me from labetalol to methyldopa, saying that methyldopa was safer. I was surprised at this, because both my PCP (who prescribed it) and my gynecologist thought labetalol was perfectly fine (and I know a lot of women take it).

Have any of you heard any issues about the safety of either of these during the first trimester?

Thanks in advance, sorry this post is so long!

Best wishes to you all ---

ccds · May 2010

Hi there. I had chronic hypertension before I got pregnant. My PCP put me on Labetalol because I told her that I wanted to get pregnant. When I did get pregnant, by OB said that Labetalol was the safest prescription out there for me and baby while pregnant, so she kept me on that. I have been taking it with no problems so far. Actually, my dosage was reduced by a third in the 2nd tri because my blood pressure was dropping too low.

I don't know much about methyldopa, but I would really do some research about this before switching.

Let me know if you have any more questions.

Christina

kikibird · May 2010

Thanks for your response, Christina!

I was put on labetalol for pretty much the same reason, yet my cardiologist is saying that it's methyldopa that's the safest med out there. So confusing to hear contradictory information from the doctors... especially when I like and trust them all.

From what I've read so far, methyldopa is an older medication, and perhaps that's why it's used more often by some doctors... been around longer and tested longer I guess.

The thing that makes me nervous at the minute is that, if I'm lucky, I could get pregnant any day now, so I feel like I have little time to figure this out. I did switch to the methyldopa last night because the cardiologist seemed so certain about it. He did suggest learning more though, so I have to give him credit for at least listening to me. Maybe I should give the gynecologist and/or PCP a call to see what they think of the switch.

I guess I have one other question for you: did your doctors ever consider stopping your medication when you found out you were pregnant?

Thanks again!

ccds · May 2010

My opinion is to listen to your cardiologist about blood pressure medication for you, but I would listen to your OB for the safest for baby. He/She would know more than the cardiologist about which medicine is safer for baby--IMO. Definitely talk to your OB about the new meds and see what they say.If your OB recommends the labetalol and there's no compromise to your care, I would go with the labetalol. Also check and see if the methyldopa is safe during breastfeeding. It might be, but definitely worth a check before you switch.

My blood pressure was 150/120 before being pregnant and with the labetalol. Once on the labetalol and before being pregnant, I was able to keep it to about 185/85 or so. Once I did get pregnant, coming off of it was never a question for my dr. The only adjustment that was made was a decrease in the dosage in the 2nd tri. During the 2nd tri, your blood pressure drops on its own due to the increased blood flow demand, so I had to reduce the dosage to stay around 115/75. My dr is still very concerned about it rising up in the 3rd tri again, so it's a waiting game at this point.

Not sure about your dr, but my blood pressure and age (37, soon to be 38) puts me in a high risk category. I have Kaiser and they outfitted me with a blood pressure monitor. I take my blood pressure 2x per day, and a nurse calls me weekly to check in. I also have to check my urine for protein (sign of pre-eclampsia which I'm at a higher risk for because of the pre-existing blood pressure). I also have more drs appts than most. I go about every 2-3 weeks. And the dr warned me that I could end up on bed rest at some point--more likely because of the high blood pressure. She's also making me go off work 4 weeks before the due date (if not sooner) in an effort to keep the blood pressure under control at the end of the pregnancy. I hear that the pressure shoots up toward the end so you need to be proactive about managing it. One plus because of the hypertension....I have rec'd an ultrasound at every appt to check on baby's growth. That's always a good thing!

I'm not trying to scare you...sorry if it is coming across that way. Just wanted you to know some of the other things that you may deal with because of the hypertension. It's all manageable though...

Good luck and let me know if you have any more questions.

kikibird · May 2010

Thanks for sharing your experiences, it's really helpful to hear. And no, you're not scaring me, no worries! I've been reading up on this for a while and pretty much expect to be a high risk patient (I'm 39) when the time comes around (and would prefer the extra attention, anyway). I have a bp monitor at home already, but have been lax about checking lately; will have to get back in the habit.

That's a good point re: my OB being more attuned to what the baby would need than the cardiologist. I called my OB's office and left her a message. I'm really curious to see what she thinks. Left a message for my primary care physician too. The three doctors know each other, so hopefully this will spark some conversation among them, or at the least, further awareness. I go back to the cardiologist in a month, and the OB wants to see me in 3 months if I'm not pregnant already, so hopefully we can keep on top of this!

I hope your pregnancy continues uneventfully, and the bestest of wishes for a happy and healthy baby!

Thanks so much for taking the time to chat. I really appreciate it!

kikdoc · May 2010

I was on an anti-hypertensive prior to pregnancy for rhythm rather than for blood pressure, so I was able to safely wean and have been off since about week 3 or 4 of pregnancy. But I am weighing in here regarding my experience with getting multiple different opinions on meds during pregnancy. I have an anti-epileptic medication that I have not been able to stop because of risk. My GP, my internist, my neurologist, and my OB all gave me different answers on what I could/should take. I found that the OB actually had the most level-headed response (vs. NO...TAKE NOTHING, or here, try this totally new drug you have never been on before). I finally ended up in the office of a specialist I was referred to who had extensive experience seeing patients with my medical history AND pregnancy. That made all the difference to me, and I was finally able to relax and know that I was receiving appropriate and safe care for me and LO. Hope this is helpful.

kikibird · May 2010

Thanks kikdoc, that is a helpful perspective. Shows me it's all the more important to hear what my OB has to say. I don't know if I'd be referred to a perinatologist, but when the time comes I'll definitely ask about it. I kind of already feel it might be helpful now to work with someone who knows more about HBP and pregnancy issues. But I think my OB is a good start.

Best wishes for your pregnancy!

ccds · May 2010

Kikjbird--Glad the info helped. I'd be curious to find out what your OB says about the other meds...just in case I ever end up on them in the future. So pls keep post and update, if you don't mind.

And again, if you have any other questions, feel free to ask.

Good luck TTC!

kikibird · May 2010

ccds:
Kikjbird--Glad the info helped. I'd be curious to find out what your OB says about the other meds...just in case I ever end up on them in the future. So pls keep post and update, if you don't mind.
And again, if you have any other questions, feel free to ask.
Good luck TTC!

Thank you! I'm still waiting for an answer from my docs, but I will definitely keep you posted!

kikibird · May 2010

(Was going to add this as an edit but it really is a new thought):

I also want to ask my ob/gyn about how to best make the switch. I tested my bp when I got home tonight (usually it's around 125/85 with the labetalol) and now it's around 145/95. I read somewhere you shouldn't stop labetalol abruptly but the cardiologist didn't say anything about that, just to start taking the methyldopa at the next dose.

So now I'm feeling like I should stick to the labetalol until I talk to someone who knows both meds. And I can't tell if I'm feeling a little weird - lightheaded - because I'm hungry (felt the same at lunchtime) or because of the switch of meds. Ugh. I specifically tried to get this medicine stuff straightened out months ago so I would be all set when it was time to TTC...

ccds · May 2010

I had the same feelings even when I first increased my labetalol (before I was pregnant) and then again when I decreased the dosage (beginning of 2nd tri). My OB warned me that lightheaded feelings, tingling of the scalp, and general "wooziness" could be side effects because of the increased/decreased levels. I would definitely call your OB/PCP right away and let them know what is going on. Also, the 145/95 is high so the other medicine doesn't seem to be controlling your BP at the current dosage. Obviously, I'm not a dr, but I wouldn't gamble on your health. Make the call and see what they say about switching.

kikibird · May 2010

I still haven't heard back from my OB, but I called the cardiologist back today to ask about the high BP temp I got last night. In the meantime I took another dose of the labetalol, and then a half dose this morning (while still taking the other med). I used to take atenolol for another heart issue I used to have, and the way I was feeling after stopping the labetalol reminded me of times I'd forgotten to take atenolol. I think it's because they're both beta blockers. Anyway, it all seems to reinforce the hunch that I need to wean a little from the labetalol if I'm going to switch.

I heard back from the cardiologist this afternoon, well from the other doctor in the practice via the nurse since my doctor wasn't in today. They said that I shouldn't have to wean fom labetalol, but that I could do so if it made me feel better (and I do think they meant this literally, and not just in a pacifying manner). Said take half doses today and tomorrow, then quarter doses on Friday, while still taking the methyldopa.

My BP is back in my normal range, and I don't feel side effects so, so far, so good.

I'll try my gynecologist again tomorrow if I don't hear from her in the morning. I remember when she and I discussed medication a while ago she had mentioned both labetalol and methyldopa (though she called it by its brand name Aldomet) as both being good choices while TTC, so I have a feeling she'd be okay if I switched. It was my primary care physcian who prescribed the labetalol (haven't heard from her either... it's a little bit frustrating that no one's calling me back).

Anyway, still trying to get answers, but I'm definitely feeling better. I guess continue to stay tuned, and thanks for checking in again!

kikibird · May 2010

Heard back from my OB/GYN today, and she agreed with the switch to methyldopa. Said that she also considers it the safer of the two meds to take, and that I should continue to take it until I get pregnant and throughout a pregnancy as well.

My reaction: I think either med would be fine, neither is perfect, but I'm cool with making the switch. Would have been nice to have sorted all this out a few months ago, but better now than later.

So I'll keep monitoring my pressure readings (been checking a few times a day and my bp is staying in the normal zone now), and check in with the cardiologist in a month (sooner if I see anything unusual with my readings).

ccds · May 2010

thanks for the update! I have an appt with my dr next week and will bring up this medicine to her. I don't think she will switch me now, but figured it can't hurt to check into it with her.

Good luck with everything! Hope to see you on this board on a regular basis very soon!

Christina

kikibird · May 2010

ccds:
thanks for the update! I have an appt with my dr next week and will bring up this medicine to her. I don't think she will switch me now, but figured it can't hurt to check into it with her.
Good luck with everything! Hope to see you on this board on a regular basis very soon!
Christina

Let me know what your doc says, though I agree with you, I doubt there's any reason to switch your meds, especially as you're doing well with them.

PM me if you don't see me around (though I love lurking over here and seeing all the TTC+35 success stories).

Thank you - I hope to be over here soon too!

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