Side effects of blood pressure medication during pregnancy

Albuterol During Pregnancy

Is Albuterol safe during pregnancy? This is a common question for women who take albuterol and discover they are pregnant. Albuterol is used to treat bronchospasms. It is important to talk with your healthcare provider before you start or stop using albuterol during pregnancy and whether the benefits outweigh any risks.

Albuterol and Pregnancy

  • Brand names: Albuterol, AccuNeb, Combivent, Combivent Respimat, Duoneb, ProAir HFA, Proventil HFA, Ventolin HFA, VoSpire ER, Xopenex HFA
  • Manufacturer: Bausch & Lomb, Dey, Mutual, Mylan, Boehringer Ingelheim, Merck, GlaxoSmithKline, Dava, Sunovion, Teva

Therapeutic Effect: Reduces airway resistance and relieves bronchospasm.

Pregnancy Safety Rating: Category C; do not use while nursing.

Pregnancy Recommendation: Compatible

Side Effects:

Below are some side effects that may be experienced when using albuterol during pregnancy

  • Frequent:Nausea (15%); restlessness, nervousness, tremors (20%); dizziness (less than 7%); headache (27%); blood pressure changes, including hypertension (5%-3%); throat dryness and irritation, pharyngitis (less than 6%); heartburn, transient wheezing (less than 5%).
  • Occasional (3%-2%): Asthenia, insomnia, altered taste. Inhalation: Dry, irritated mouth or throat; bronchial irritation, cough.
  • Rare:Diarrhea, dry mouth, drowsiness, flushing, anorexia, diaphoresis.

Pregnancy/Lactation Considerations: This medication appears to cross the placenta. It is unknown if albuterol is distributed in breast milk, and it may hinder uterine contractibility.

Pregnancy Summaries:

The following summaries are cited directly from the sources of Briggs, Freeman, & Yaffe and the Reprotox Toxicology Center.

Briggs, Freeman, & Yaffe – Albuterol (salbutamol) has not caused structural anomalies, but there is evidence of an association with functional and neurobehavioral toxicity with prolonged use. Similar to other β-mimetics, the drug can cause maternal and fetal tachycardia and hyperglycemia.

Nevertheless, the drug should not be withheld because of pregnancy, but excessive use should be avoided. If albuterol is used in pregnancy for the treatment of asthma, health care professionals are encouraged to call the toll-free number (877-311-8972) for information about patient enrollment in an Organization of Teratology Information Specialists (OTIS) study.

Reprotox Toxicology Center – Albuterol can interfere with embryo development in mice but not rats or rabbits. Two epidemiology studies have suggested an increase in specific birth defects associated with albuterol use in early pregnancy, but the defects were different in the two studies, and the findings may have been due to chance.

Albuterol (salbutamol; Proventil; Ventolin; Airet; Volmax) is a beta-sympathomimetic used in the treatment of asthma. This agent has also been used to inhibit preterm labor. Based on available safety studies, a 2004 NIH report on the treatment of asthma during pregnancy recommended albuterol (#1015) as the preferred beta-agonist (34).

The R-enantiomer is called levalbuterol and is marketed as Xopenex for the treatment of asthma. In preliminary reports, various teratogenic effects, including cleft palate, were found when albuterol was administered to pregnant mice, but similar effects were not found in rats or rabbits (1,25).

No abnormalities were found in the offspring of three women who received albuterol continuously beginning early in the second trimester (2-4).

In a study on 259 pregnant asthmatics who used inhaled beta sympathomimetics, 180 of whom used these agents during the first trimester, there was no increase in congenital anomalies or adverse perinatal outcome attributable to the therapy (5).

Most of these women used metaproterenol (#1132), although isoetharine (#2062), epinephrine (#1083), isoproterenol (#1888), and albuterol were also used. The Swedish Medical Birth Registry reported an association between albuterol use during pregnancy and cardiac defects in the offspring with an adjusted relative risk of 1.38 (95% confidence interval 1.12-1.70) (35).

The large number of comparisons in this study raise the possibility that the albuterol-related finding was a chance association. The National Birth Defects Prevention Study presented a case-control study of facial clefts that showed an association with early pregnancy used of albuterol (36).

The odds ratio for isolated cleft lip was 1.79 (95% CI 1.07-2.99) based on 18 exposed cases and the odds ratio for isolated cleft palate was 1.65 (95% CI 1.06-2.58) based on 25 exposed cases. There was no significant association between albuterol use and cleft lip with cleft palate.

The authors indicated that their findings may have been due to the medication, the underlying asthma, or to chance.

There is a experience with the use of albuterol as a tocolytic agent in late pregnancy (6-15,26,37). Typically, albuterol will increase maternal cyclic-AMP, glycogenolysis, lipolysis, and insulin levels, but will decrease serum potassium levels (7,12-14).

Effects on the circulatory system include an increase in heart rate and a drop in blood pressure (7,8,10). Although these effects are more prominent in the mother, the fetus may show similar responses (28). By contrast, inhaled albuterol at recommended doses did not appear to affect maternal blood pressure, heart rate, or Doppler flow velocity studies of the uterine and fetal central circulation (23).

The placental transfer of albuterol has been demonstrated in an in vitro system using perfused term human placentas (16). In contrast to the available reports on intravenously administered albuterol, some clinical studies have found no significant increase in the length of gestation associated with the chronic oral administration of albuterol (15,17).

However, a more recent study by Thai clinicians, using a higher dose (32 mg/day) than the older studies (20 mg/day (15,17,32,33), reported oral albuterol did prolong gestation in a population of 132 pregnancies (31).

Tachycardia was detected in 86% of the mothers, and neonatal complications, including respiratory distress were observed in more than 20% of the neonates (31). One newborn exposed in utero to albuterol had a significant elevation of growth hormone levels (18).

Long term adverse effects in the offspring, including alterations in growth, have not been noted with beta-sympathomimetics as a group (19-22). One small study identified an increased incidence of prenatal exposure to beta-sympathomimetics (ritodrine (#1548) or albuterol) among premature infants with retinopathy (24).

The authors of this study, reported in a letter-to-the-editor, suggested that these agents reduce retinal perfusion and predispose eye tissues to damage by other factors.

Administration of albuterol to the mother in the second and third trimesters of pregnancy has been used successfully to treat fetal heart block (27,29,30). We did not locate reports on the use of albuterol during lactation.

Next Steps:

The American Pregnancy Association recommends consulting your obstetric healthcare provider and any prescribing physician before starting or stopping medications.

If you are pregnant and have questions related to medication use during pregnancy, the Reprotox Toxicology Center is the most comprehensive and user-friendly resource on medication use during pregnancy. You can subscribe for only $17.00 per month– Subscribe Now.

The American Pregnancy Association does not prescribe medication, nor do we serve as a consult for medication use during pregnancy. It is imperative that you discuss the use of any medication during pregnancy with your health care provider.

The purpose of this document is to provide you with information to support discussions with your health care provider.

Hudgson, Barbara and Kizior, Robert, Saunders Nursing Drug Handbook 2015, Elsevier, St. Louis, MO. ISBN: 978-1-4377-2334-2.

Briggs, Gerald, Freeman, Roger and Yaffe, Sumner, Drugs in Pregnancy and Lactation, 9th Ed., Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, PA. ISBN: 978-1-60831-708-0, 2011.

Bromocriptine by Pharmel

02238193 BROMOCRIPTINE 5MG CAPSULE

How does this medication work? What will it do for me?

Bromocriptine belongs to a group of medications called Ergot alkaloids. It is used To treat Parkinson’s disease and conditions caused by too much of the hormone, prolactin. These conditions include some types of menstrual problems, increased milk production, female infertility, male development problems, and small tumours called Adenomas.

For Parkinson’s disease, bromocriptine works by behaving like dopamine, a chemical in the brain, which is involved in producing the symptoms of this disease. Bromocriptine may be used alone or with levodopa to reduce symptoms of Parkinson’s disease.

For conditions associated with too much prolactin, bromocriptine works by blocking the release of prolactin from the pituitary gland in the brain.

Bromocriptine is used to treat Acromegaly (overproduction of growth hormone causing unusual enlargement of the hands, jaw, and feet) by decreasing the production of growth hormone.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

This medication is available as a 2.5 mg tablet.

This medication is available as a 5 mg capsule.

How should I use this medication?

The specific dose of bromocriptine will depend on the condition being treated and the needs of the person.

The initial adult dose for all conditions is 1.25 mg to 2.5 mg taken at bedtime with food to determine the likelihood and severity of side effects. Your doctor will recommend increasing the dose slowly until an effect is seen. Depending on the medical condition being treated, a total daily dose of 20 mg to 40 mg may be required.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

To reduce side effects such as upset stomach and nausea, bromocriptine should always be taken with or immediately after food.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store is medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e. g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take bromocriptine if you:

  • Are allergic to bromocriptine or any ingredients of this medication
  • Are allergic to other ergot alkaloid medications
  • Have coronary artery disease or other severe heart conditions
  • Have high blood pressure disorders of pregnancy or a history of high blood pressure during pregnancy

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • Abdominal pain
  • Constipation
  • Depression
  • Diarrhea
  • Dizziness or lightheadedness, especially when rising from a lying or sitting position (more common during the first few days of treatment)
  • Drowsiness or tiredness
  • Loss of appetite
  • Nausea
  • Nightmares
  • Problems sleeping
  • Sensation of spinning
  • Stuffy nose
  • Vomiting

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • Abdominal or stomach pain (prolonged or severe)
  • Confusion
  • Difficulty starting urine flow
  • Hallucinations (seeing or hearing things that aren’t there)
  • Increased frequency of urination
  • Loss of appetite (prolonged)
  • Signs of depression (e. g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • Signs of too much medication (tingling or pain in fingers and toes, cold feet, muscle cramps in feet and legs)
  • Uncontrolled movements of the body, such as the face, tongue, arms, hands, head, and upper body
  • Weakness

Stop taking the medication and seek immediate medical attention if Any of the following side effects occur:

  • Convulsions (seizures)
  • Fast heartbeat
  • Nervousness
  • Shortness of breath (unexplained)
  • Signs of bleeding in the stomach (e. g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
  • Signs of heart attack (e. g., fainting, nausea and vomiting [prolonged or severe], chest pain, [severe], increased sweating)
  • Signs of stroke (e. g., headache [unusual], vision changes, difficulty speaking, difficulty walking, sudden weakness)
  • Weakness (sudden)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Drowsiness/reduced alertness: This medication may cause dizziness and drowsiness or suddenly falling asleep. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Fertility: Bromocriptine may reverse infertility for women by restoring normal menstrual cycles and ovulation. Women who do not wish to get pregnant should use a reliable method of birth control.

Heart disease: Bromocriptine can cause dramatic changes in blood pressure, affecting heart conditions. As well, because it is known to cause a significant drop in blood pressure when treatment is started, it is important to rise from lying or sitting positions slowly, until your blood pressure increases to the point where severe dizziness is not a problem.

If you have a history of heart attack, heart disease or are taking medication for blood pressure or heart conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have reduced kidney function or severe kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: The liver helps to remove bromocriptine from the body. If you have reduced liver function or severe liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Bromocriptine may cause low blood pressure, particularly during the first days of treatment. If you have low blood pressure or are taking medication to control high blood pressure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Lung problems: Long-term treatment (6 to 36 months) with bromocriptine in doses ranging from 20 mg to 100 mg daily has been associated with lung problems including Pulmonary fibrosis (a condition where the air sacs of the lungs are replaced by scar tissue, making the lungs stiff). If you experience unusual back pain, swelling of the lower legs or feet, or difficulty breathing, contact your doctor immediately.

Mental health: The use of high doses of bromocriptine, such as those used for Parkinson’s disease, may be associated with mental confusion and mental disturbances. When bromocriptine is combined with levodopa, side effects may increase including auditory or visual hallucinations (seeing or hearing things that are not there). These effects usually disappear with lower bromocriptine doses.

Pregnancy: Bromocriptine may be taken by women who are pregnant if the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Bromocriptine reduces the production of breast milk. The use of bromocriptine after childbirth is more likely to cause serious blood pressure changes and heart problems, as well as seizure. For these reasons, it should not be taken by women who are breast-feeding.

What other drugs could interact with this medication?

There may be an interaction between bromocriptine and any of the following:

  • Alcohol
  • Antipsychotics (e. g., clozapine, olanzapine, quetiapine, risperidone)
  • "azole" antifungals (e. g., itraconazole, ketoconazole, posaconazole, voriconazole)
  • Buspirone
  • Clarithromycin
  • Domperidone
  • Efavirenz
  • Other ergot derivatives (e. g., dihydroergotamine, ergotamine, methylergonovine)
  • Haloperidol
  • Imatinib
  • Isoniazid
  • Macrolide antibiotics (e. g, clarithromycin erythromycin, telithromycin)
  • MAO inhibitors (e. g., maprotiline, moclobemide, phenelzine, sertraline)
  • Mirtazapine
  • Nicardipine
  • Nitroglycerin
  • Octreotide
  • Phenothiazines (e. g., chlorpromazine, fluphenazine, thioridazine)
  • Pimozide
  • Protease inhibitors (anti-HIV medications; atazanavir, indinavir, lopinavir, ritonavir, saquinavir)
  • Quinidine
  • SAMe
  • Selective serotonin reuptake inhibitors (SSRIs; e. g., citalopram, fluoxetine, sertraline)
  • Sibutramine
  • Tramadol
  • Tricyclic antidepressants (e. g., amitriptyline, desipramine, nortriptyline)
  • "triptan" migraine medications (e. g., eletriptan, rizatriptan, sumatriptan, zolmitriptan)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • Stop taking one of the medications,
  • Change one of the medications to another,
  • Change how you are taking one or both of the medications, or
  • Leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

High Blood Pressure (Hypertension) Medications

Jim Morelli, MS, RPh

Jim Morelli holds a B. S. from the Massachusetts College of Pharmacy and Allied Health in Boston and an M. S. in civil engineering from Tufts University. He is registered as a pharmacist in the state of Georgia.

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Home > high blood pressure (hypertension) medications article

What is high blood pressure (hypertension)?

High blood pressure, also known as hypertension, affects nearly a third of all Americans. With hypertension, too much force is exerted on the arteries as blood is pumped through. This results not only in damage to the blood vessels themselves, but to other organs forced to bear the stress.

Blood pressure is assessed using two parameters — the systolic and diastolic pressures — which measure, respectively, the maximum pressure exerted in the arteries as the heart contracts, and the minimum pressure in those vessels between cardiac contractions. In adults, blood pressure is considered normal if the top number (systolic pressure) is between 90 and 120 and the bottom number (diastolic) is between 60 and 80.

High blood pressure medication list

There are several classes of blood pressure medications. Each class lowers blood pressure in a different way.

Diuretics increase urination which reduces sodium and fluid in the body. That can help lower blood pressure because it lowers blood volume. Mild hypertension can sometimes be treated using diuretics alone, although they are more commonly used in combination with other high blood pressure medications. Examples of diuretics include:

One side effect of diuretics is a loss of potassium, which is carried out of the body in urine along with the sodium. Potassium is needed for proper muscular movement and a deficiency of this mineral can result in fatigue, weakness, leg cramps, and even problems with the heart. So often, patients on traditional diuretics will be advised to take their medication with a potassium-rich food, such as orange juice or a banana, or they’ll be prescribed a potassium supplement.

Some diuretics were subsequently developed to address the issue of potassium loss. These blood pressure medications are known as “potassium-sparing” diuretics. They include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium).

Finally, there are the combination diuretics, which include a potassium-sparing agent and a traditional diuretic. These include amiloride hydrochloride and hydrochlorothiazide HCTZ (Moduretic), spironolactone and HCTZ (Aldactazide), and triamterene and HCTZ (Dyazide, Maxzide).

Beta blockers

Beta blockers lower blood pressure by acting directly on the heart. These high blood pressure medications reduce heart rate and force of pumping, as well as reduce blood volume. Beta blockers include:

ACE inhibitors

Angiotensin is a hormone in the body that causes blood vessels to narrow. The angiotensin-converting enzyme (ACE) inhibitors decrease the production of angiotensin and, in turn, that helps lower blood pressure. Examples of ACE inhibitors include:

Angiotensin II receptor blockers

The hormone angiotensin narrows blood vessels, but to do its job it needs a place to bind. That’s where angiotensin II receptor blockers come in. They prevent angiotensin from binding to receptors on the blood vessels and that helps lower blood pressure. Angiotensin II receptor blockers include:

Calcium channel blockers

Calcium increases the strength and force of contractions in the heart and blood vessels. Blocking its entry into smooth muscle tissue reduces this effect. Calcium channel blockers lower blood pressure by relaxing blood vessels and reducing heart rate. Examples of calcium channel blockers include:

Alpha blockers

Alpha blockers cause blood vessels to dilate, thereby lowering blood pressure. These medications are also used to treat prostate enlargement in men. Alpha blockers include doxazosin mesylate (Cardura), prazosin hydrochloride (Minipress), and terazosin hydrochloride (Hytrin).

Alpha-2 receptor agonist

Methyldopa, formerly known under the brand name Aldomet, is one of the oldest blood pressure medications still in use. It was first introduced more than 50 years ago. Methyldopa works in the central nervous system to lower blood pressure. While its general use has declined over the years, methyldopa is considered the first-line of treatment for high blood pressure that develops during pregnancy.

Central agonists

Some hypertension medications work in the central nervous system rather than directly on the cardiovascular system. Central agonists thus have a tendency to cause drowsiness. Drugs in this class include clonidine hydrochloride (Catapres) and guanfacine hydrochloride (Tenex).

Peripheral adrenergic inhibitors

There was a time when the high blood pressure medication list was very short indeed. In the 1950s, reserpine was one of the few products on the market to treat hypertension. It is rarely used due to its numerous side effects and drug interactions. The peripheral adrenergic inhibitors work in the brain to block signals that tell blood vessels to constrict. They are mostly used when other high blood pressure medications fail to solve the problem. Guanadrel (Hylorel), guanethidine monosulfate (Ismelin), and reserpine (Serpasil) are peripheral adrenergic inhibitors.

Vasodilators

Vasodilators relax artery wall muscles, and that causes blood pressure to drop. These drugs are usually not used alone — and, in the case of Minoxidil (Loniten) — used only in severe hypertension. Hydralazine (Apresoline) and minoxidil (Loniten) are vasodilators.

What are the most common blood pressure medications?

In terms of dollar sales, recent statistics put the angiotensin II receptor blocker valsartan (Diovan) in the lead for high blood pressure medications, followed by the beta blocker metoprolol, the generic combination of valsartan and HCTZ, olmesartan (Benicar), and olmesartan and HCTZ (Benicar HCT).

In terms of prescriptions written, the ACE inhibitor lisinopril (Prinivil, Zestril) tops the list, followed by amlodipine besylate (Norvasc), a calcium channel blocker, and generic hydrochlorothiazide (HCTZ).

What is the best high blood pressure medication?

Selecting the “best” high blood pressure medication depends on several things, including the general health of the patient, his or her age, ethnicity, and whether or not they have any co-existing medical issues or drug sensitivities.

For example, in a hypertensive patient with asthma, it may be inadvisable to prescribe a beta blocker, as these drugs can aggravate that respiratory condition. Similarly, in patients prone to constipation (the elderly, for example) use of certain calcium channel blockers might best be avoided — along with diuretics — as both these classes of drugs can inhibit proper bowel function.

African-American patients respond to some antihypertensive medications better than others.

Certain groups of patients require use of a specific class of high blood pressure medication. These include:

Pregnant Women

The drug of choice for hypertensive, pregnant women is one of the oldest high blood pressure medications on the market. Methyldopa, which works to lower blood pressure through the central nervous system, has the lowest risk of harming the mother and developing fetus. Other possible safe options include labetalol, beta blockers, and diuretics. Two classes of drugs which should never be used during pregnancy include the ACE inhibitors and the angiotensin II receptor blockers.

African-Americans

Hypertension in African-Americans tends to occur earlier in life and tends to be more severe. Plus, some medications that work to lower blood pressure in other ethnicities may have limited effect on African-Americans. Thiazide diuretics (such as HCTZ) or a calcium channel blocker are recommended first choices along with the possible add-on of a second drug from either the ACE inhibitor class or the angiotensin II receptor blocker group.

Elderly Patients

With age, comes an increased risk for systolic hypertension which can be aggravated by severe atherosclerosis. According to one study, the diuretic chlorthalidone (Hygroton) had significant benefit in elderly patients with systolic hypertension. Along with a diuretic, some calcium channel blockers, ACE inhibitors and angiotensin II receptor blockers may also be good choices. However, beta blockers may not be as effective for hypertension in those over 60; though they may be good choices if co-existing heart disease is present. It also may be preferable in elderly patients to give two high blood pressure medications at a low dose versus one at a higher dose.

What are common high blood pressure side effects?

Different classes of blood pressure medications have different side effects.

Diuretics can lead to an increase in potassium loss, known as hypokalemia, which, in turn can affect muscular function — including the muscles of the heart. There is also an increased risk for gout with diuretics — as well as the possibility of weakness, thirst, dehydration, and increased urination. Changes in blood sugar levels are also possible. Skin reactions, some severe, are possible with thiazide diuretics (such as hydrochlorothiazide). Potassium-sparing diuretics, such as spironolactone (Aldactone) may cause breast enlargement in males.

Beta blockers

Beta-blockers cause the heart to slow down and so some of their side effects can be traced to that mechanism of action. Dizziness, weakness, fatigue, and fainting are possible. Beta-blockers also affect the respiratory system, so other side effects include shortness of breath, difficulty breathing, and chest pain. Beta-blockers should not be withdrawn suddenly, as that could result in a heart attack or sudden death.

ACE inhibitors

The most common side effect from ACE Inhibitors is also an unusual one — a dry cough. Usually it goes away with continued use of the drug, but that could take weeks. ACE Inhibitors could reduce blood pressure too much, resulting in hypotension which could, in turn lead to headache, dizziness, fainting, and reduced kidney function.

Angiotensin II receptor blockers

The most common side effect from the angiotensin receptor blockers (ARBs) is an increased potassium level in the blood, known as hyperkalemia. Dizziness is also common, along with fatigue. Upper respiratory tract infections have also been reported — along with gastrointestinal issues such as upset stomach and diarrhea.

Calcium channel blockers

Up to a third of patients may experience the following side effects with calcium channel blockers: Swelling of the ankles and other extremities, flushing, and dizziness. Other common side effects include heartburn and nausea.

Alpha blockers

A common, transient, but distressing initial side effect of the alpha blockers is postural hypotension. This is a sudden drop in blood pressure when standing up. It can be severe enough to cause dizziness or even fainting. In addition, the alpha blockers can result in increased heart rate, headache, nausea, and weakness.

Methyldopa

Methyldopa is mostly well tolerated, but some patients may experience dizziness, drowsiness, weakness, headache, and dry mouth.

Central agonists

Up to 40% of patients taking clonidine (Catapres) will experience dry mouth and about a third will have drowsiness, headache, and sleepiness. Other common side effects include constipation, dizziness, and local skin reactions with use of the Catapres-TTS skin patch. Reserpine use is linked with possible side effects including nightmares, stuffy nose, depression, and an inability to fall asleep. Diarrhea and heartburn are also possible. Guanadrel and guanethidine can cause diarrhea and other gastrointestinal issues – as well as dizziness and drowsiness.

Vasodilators

Taking minoxidil might result in excessive body hair growth, as well as weight gain and dizziness. Hydralazine is linked to headaches, heart palpitations, swelling around the eyes, and aches and pains in the joints.

Is it safe to take high blood pressure medication during pregnancy?

Some high blood pressure medications should absolutely NOT be used during pregnancy as they may harm the mother and developing fetus. These medications include the ACE inhibitors and the angiotensin II receptor blockers. Reserpine may also be harmful during pregnancy and should only be used when no other alternatives exist.

Safe medications to use include methyldopa and potentially some diuretics and beta blockers, including labetalol.

Is it safe to drink alcohol while taking high blood pressure medications?

Some high blood pressure medications initially cause drowsiness, dizziness, and lightheadedness. Some even cause fainting on the first dose. The body usually adjusts to the effects of these medications and the side effects disappear. Consuming alcohol during the early phase of antihypertensive treatment could be risky because alcohol can also cause dizziness, drowsiness, and lightheadedness.

Also, alcohol consumption causes a transient rise in blood pressure that could persist if the drinking is beyond the level of “moderation.”

Does high blood pressure lead to weight gain?

Some high blood pressure medications can, in fact, lead to weight gain. Common offenders include older beta blockers such as propranolol (Inderal) and atenolol (Tenormin). There could be several reasons for this — including the fact that the medications can make patients feel tired and thus less likely to exercise. Minoxidil tablets (Loniten) — used only when other antihypertensive medications have failed — can also cause weight gain. Weight gain is also listed as a common side effect of doxazosin (Cardura). Diuretics are more likely to cause weight loss.

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is labetalol, and how does it work (mechanism of action)?

Labetalol is a drug that is used for treating high blood pressure. And is related to carvedilol (Coreg). Nerves from the adrenergic nervous system travel from the spinal cord to arteries where they release norepinephrine. Norepinephrine attaches to adrenergic receptors on arteries and causes the arteries to contract, narrowing the arteries, and increasing blood pressure. Labetalol blocks receptors of the adrenergic nervous system. When labetalol attaches to and blocks the receptors, arteries expand, resulting in a fall in blood pressure. The FDA approved labetalol in August 1984.

What brand names are available for labetalol?

None. Normodyne and Trandate are discontinued.

Is labetalol available as a generic drug?

Do I need a prescription for labetalol?

What are the side effects of labetalol?

The most common side effects of labetalol are:

Postural hypotension (a rapid decrease in blood pressure when going from the lying or seated position to the standing position that may cause light-headedness or fainting) occurs rarely. Patients should be observed for this possible side effect within two to four hours of the first labetalol dose and after any changes in dose.

Other important side effects include:

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What is the dosage for labetalol?

The recommended starting oral dose of labetalol is 100 mg twice daily and the dose can be increased by 100 mg twice daily every 2-3 days based on the response of the blood pressure. Usual maintenance doses are 200-400 mg twice daily. Patients with severely high blood pressure may require 1.2 to 2.4 g daily.

Side effects may be less if labetalol is given in three daily doses rather than two. Stopping or changing the dose of the drug should be directed by a physician because serious side effects may occur. The initial intravenous dose of labetalol is 20 mg injected over 2 minutes. Additional injections of 40 or 80 mg may be administered every 10 minutes as needed up to a total dose of 300 mg. Labetalol also may be administered by intravenous infusion at 1-2 mg/minute.

Which drugs or supplements interact with labetalol?

Labetalol can mask early warning symptoms of hypoglycemia (low blood sugar) such as tremors and increased heart rate which are the result of activation of the adrenergic nervous system. Therefore, people with diabetes taking medications that lower blood sugar such as insulin or oral antidiabetic medications may need to increase the frequency with which they monitor their blood sugar in order to prevent hypoglycemia.

If combined with adrenergic stimulating drugs used for treating asthma, for example, albuterol (Proventil, Ventolin) or pirbuterol (Maxair), the adrenergic blocking effects of labetalol may counteract the effects of the stimulating drugs and reduce their effectiveness for treating asthmatic attacks. More of the adrenergic drug may be needed.

Glutethimide (Doriden) may decrease the effectiveness of labetalol by increasing its elimination. When both drugs are used together, more labetalol or less glutethimide may be needed.

Cimetidine (Tagamet) may increase the effectiveness of labetalol by blocking its elimination and increasing its levels in the blood. Therefore, less labetalol may be needed when cimetidine and labetalol are used together.

Halothane anesthesia may contribute to the blood pressure lowering effects of labetalol.

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    Is labetalol safe to take if I’m pregnant or breastfeeding?

    There are no adequate studies of labetalol during pregnancy.

    Labetalol is excreted in human breast milk. Therefore, it should be used cautiously in nursing mothers because of the risk that the infant may develop a slow heart rate.

    What else should I know about labetalol?

    How should I keep labetalol stored?

    Tablets should be stored between 20 C – 30 C (36 F – 86 F).

    Labetalol (Normodyne, Trandate) is a medication prescribed for the treatment of high blood pressure. Side effects, drug interactions, and pregnancy safety should be reviewed prior to taking this drug.

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