Table 4.
Preferred Agents for Antihypertensive Treatment in Pregnancy
| Starting Dose | Titration | Maximum Dosage | |
|---|---|---|---|
| First Line | |||
| Labetalol | 100-200 mg PO BID | Q 2-3 days | 2400 mg/24 h |
| Nifedipine ER | 30-60 mg PO Q day | Q 7-14 days | 120 mg/24 h |
| Alpha-methyldopa | 250 mg PO BID-TID | Q 2 days | 3000 mg/24 h |
| Second/Third Line | |||
| Hydralazine* | 10 mg PO QID | Q 2-5 days | 300 mg/24 h |
| Thiazide diuretics | 12.5 mg PO Q day | Q 7-14 days | 50 mg/ 24 h |
| Clonidine | 0.1- 0.3mg PO BID 0.1mg transdermal QD |
Q 7 days Q 7- 14 days |
0.6mg/24 h 0.3mg/24 h |
| CONTRAINDICATED: ACEI/ARB, Renin Inhibitors, MRAs | |||
| IV therapies for the urgent treatment of severe hypertension in pregnancy | |||
| Initial Dosage | Dose Titration | ||
| Labetalol | 10-20 mg IV | 20-80mg IV Q 20-30 min to max 300mg or 1-2 mg/min IV gtt | |
| Nifedipine IR | 10-20 mg PO | Repeat x 1 in 20 minutes, then 10-20mg Q2-6h | |
| Hydralazine* | 5 mg IV or IM | 5-10 mg IV Q 20-40min or 0.5-10 mg/h IV gtt | |
*
do not use in isolation due to potential for reflex tachycardia
ACEI – Ace-Inhibitor, ARB – Angiotensin Receptor Blocker, MRAs – mineralocorticoid receptor antagonists