Table 4.

First–line medication choices in treatment of hypertension of pregnancy

DrugDoseAdverse Events in PregnancyComments
Methyldopa (PO)500 mg to 3 g in two divided dosesPeripheral edema, anxiety, nightmares, drowsiness, dry mouth, hypotension, maternal hepatitis, no major fetal adverse eventsContraindicated in depression
Labetalol (PO)100–1200 mg/d in two to three divided dosesPersistent fetal bradycardia, hypotension, neonatal hypoglycemia, asthmaRisk of bronchospasm, bradycardia
Labetolol (IV)10–20 mg; repeat 20–80 mg iv every 30 min or 1–2 mg/min; maximum of 300 mg/dPersistent fetal bradycardia, hypotension, neonatal hypoglycemia, asthmaAvoid in asthma or heart failure
Nifedipine (PO)30–120 mg/dHypotension and inhibition of particularly if used in combination with magnesium sulfateContraindicated in aortic stenosis; Immediate release nifedipine not recommended
Hydralazine (PO)50–300 mg/d in two to four divided dosesHypotension, neonatal thrombocytopenia, lupus-like syndrome, tachycardiaFlushing, headache
Hydralazine5–10 mg iv/im; may repeat every 20–30 min to a maximum of 20 mgTachycardia, hypotension, headache, fetal distressHypotension and inhibition of labor, especially when combined with magnesium sulfate
Nicardipine (IV)Initial: 5 mg/h increased by 2.5 mg/h every 15 min to a maximum of 15 mg/hHeadache, edema, tachycardiaIncreased risk of hypotension and inhibition of labor, especially when combined with magnesium sulfate
Nitroprusside (IV)0.3–0.5 to 2 μg/kg per minute; maximum duration of 24–48 hRisk for fetal cyanide toxicityUse >4 h and dose >2 μg/kg per minute associated with increased risk of cyanide toxicity; use only as a last resort
  • PO, oral; IV, intravenous.