Table 2.

Commonly used antihypertensives in Preeclampsia with severe symptoms

Drugs	Indication	Dose	Comment
First line
Methyldopa	PE with severe symptomsHypertension in pregnancy	0.5–3 g/day PO in 2 divided doses	Established long term safety.Breast milk compatibleMild hypertensive effect and slow onset of action, hence may not be used alone
Labetalol	PE with severe symptoms, usually IV formulation	Start with 20 mg IV bolusMayrequiredouble dose 10 min later	Rapid onset of actionStudies confirm safety in pregnancyMay cause maternal hepatotoxicity
Hydralazine	PE with severe symptoms, usually IV formulation.Long-acting nifedipine	5 mg IV slowly over 1 to 2 min30–90 mg once daily. May be increased at 7- to 14-day intervals, to maximum dose of 120 mg a day.	Usually breast milk compatible. More adverse effect than labetalolHypotensive effect is less predictable
Nefidipine	PE with severe symptoms, immediate release oral formulation	Start with 10 mg POMay repeat dose 30 min later	Use particularly when IV access is not available.May cause rapid drops in BP. Concern of serious side effects when used simultaneous with magnesium sulfate.
Second line
Nicardipine	Resistant acute-onset severe hypertension when first line has failed	Give as IV infusion of 3 to 9 mg/hour	Delay onset of action (5–15 min). Titrate slowly to avoid overdose
Sodium Nitroprusside	Acute life threatening hypertension associated with PE	Start with 0.24 µg/kg/min.May titrate to maximum dose of 5 µg/kg/min	Rarely used in dire emergency.Give for shortest amount of time to avoid toxicity (cyanide & thiocyanate)

IV: intravenous; PE: preeclampsia; PO: per oral.