문정동내과 임신부 고혈압인 경우 어떤 약제를 선택할 것인가?

문정동내과 임신부 고혈압인 경우 어떤 약제를 선택할 것인가?

임신부 중증 고혈압에서 IV 혈압약과 경구 약제 선택에 대한 내용은 다음과 같습니다. https://blog.naver.com/sjloveu2/222343205376

임신부에서 중증 고혈압, Severe hypertension in pregnancy

 

원인에 상관 없이 만성 고혈압이든, 임신성 고혈압이든, 전자간증이든 중증 산모 고혈압 (수축기 160 이상,...

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중증 고혈압이 아닌 경우 약제 선택에 대한 내용은 다음과 같습니다. 보통 labetalol, long-acting CCB (예, 니페디핀 서방정), methyldopa를 시작합니다.

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Drug doses for oral treatment of hypertension in pregnancy

Drug	Class	Initial dose	Usual effective dose range	Maximum suggested total daily dose	Comments
Labetalol	Combined alpha and beta blocker	100 mg 2 times daily, increase by 100 mg twice daily every 2 to 3 days as needed	200 to 800 mg in 2 divided doses	2400 mg	Can cause bronchoconstriction. Avoid in women with asthma, chronic obstructive lung disease, heart failure, bradycardia, or greater than first-degree heart block.
Hydralazine NOTE: Due to reflex tachycardia, monotherapy with oral hydralazine is not recommended; hydralazine may be combined with methyldopa or labetalol if needed as add-on therapy	Peripheral vasodilator	Begin with 10 mg 4 times per day, increase by 10 to 25 mg/dose every 2 to 5 days	50 to 100 mg in 2 to 4 divided doses	200 mg*
Nifedipine extended release¶	Calcium channel blocker	30 to 60 mg once daily as an extended release tablet, increase at 7 to 14 day intervals	30 to 90 mg once daily	120 mg	Do not administer sublingually.
Methyldopa	Centrally acting alpha agonist	250 mg 2 to 3 times daily, increase every 2 days as neededΔ	250 to 1000 mg in 2 to 3 divided doses	3000 mg	Sedation is a common side effect.

* Chronic hydralazine doses above 100 mg daily are associated with an increased risk for developing lupus erythematosus, particularly in women and slow acetylators; ascertainment of acetylator status is recommended before increasing dose above 100 mg per day in many countries.

¶ Use of immediate-release nifedipine (oral or sublingual) is not recommended because it may cause significant rapid decreases in blood pressure.

Δ The full hypotensive effect of an initial dose or adjustment of methyldopa may not occur until after 2 to 3 days of continuous use.

Adapted from:

Seely EW, Ecker J. Chronic hypertension in pregnancy. N Engl J Med 2011; 365:439.

Magee LA. Treating hypertension in women of child-bearing age and during pregnancy. Drug Saf 2001; 24:457.

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만일 한 가지 약제의 최대 용량으로 이전에 언급한 목표 혈압까지 도달하지 못하면, 2차 약제 또는 3차 약제를 추가합니다. 혈압이 고혈압 약물에 잘 반응하지 않는지 모니터링 하는 것이 중요한데 약제에 잘 반응하지 않는다는 사실이 전자간증의 징후일 수도 있기 때문입니다.

문정동내과 임신부 고혈압인 경우 어떤 약제를 선택할 것인가?

REF. UpToDate 2021.05.09

 

 

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