Home Drug Guide Methyldopa with Hydrochlorothiazide

Drug Guide

Generic Name

Methyldopa with Hydrochlorothiazide

Brand Names Aldoril 15, Aldoril 25, Aldoril D30, Aldoril D50, Methyldopa And Hydrochlorothiazide

Classification

Therapeutic: Antihypertensive

Pharmacological: Combination of centrally acting agent (Methyldopa) and diuretic (Hydrochlorothiazide)

FDA Approved Indications

  • Management of hypertension

Mechanism of Action

Methyldopa is a centrally acting antihypertensive that is converted to an active metabolite which stimulates alpha-2 adrenergic receptors in the brain, reducing sympathetic outflow. Hydrochlorothiazide is a thiazide diuretic that inhibits sodium reabsorption in the distal tubules of the kidney, leading to increased excretion of sodium and water, thereby lowering blood pressure.

Dosage and Administration

Adult: Dose varies; typical initial dose of methyldopa is 250 mg two to three times daily, titrated up as needed. Hydrochlorothiazide doses start at 12.5-25 mg once daily. Combination doses like Aldoril are adjusted based on patient response.

Pediatric: Use is generally not recommended for children due to limited data.

Geriatric: Start at lower doses due to increased sensitivity and risk of orthostatic hypotension.

Renal Impairment: Adjust dosage; contraindicated in severe renal impairment.

Hepatic Impairment: Use with caution; monitor closely.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Methyldopa crosses the blood-brain barrier; Hydrochlorothiazide distributed widely.

Metabolism: Methyldopa is metabolized in the liver; Hydrochlorothiazide undergoes minimal metabolism.

Excretion: Primarily renal excretion of unchanged drugs.

Half Life: Methyldopa: approximately 2-3 hours; Hydrochlorothiazide: approximately 6-15 hours.

Contraindications

  • Hypersensitivity to methyldopa or hydrochlorothiazide.
  • Concurrent use of monoamine oxidase inhibitors.

Precautions

  • History of hepatic disease, especially with methyldopa.
  • Liver function should be monitored during therapy.
  • Use in patients with renal impairment requires caution and dose adjustments.
  • Pregnancy: Methyldopa is classified as pregnancy category B and is preferred antihypertensive in pregnancy.

Adverse Reactions - Common

  • Drowsiness or fatigue (Common)
  • Orthostatic hypotension (Common)
  • Gastrointestinal disturbances (Common)

Adverse Reactions - Serious

  • Hemolytic anemia (Rare)
  • Hepatitis or hepatic dysfunction (Rare)
  • Blood dyscrasias, including leukopenia, agranulocytosis (Rare)

Drug-Drug Interactions

  • MAO inhibitors (risk of hypertensive crisis with methyldopa)
  • Other antihypertensives (additive effect)
  • Digoxin (monitor levels)

Drug-Food Interactions

  • Alcohol (may enhance hypotensive effects)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function, hepatic function, and complete blood count regularly.

Diagnoses:

  • Risk for falls related to hypotension.
  • Potential for impaired renal function.

Implementation: Administer doses as prescribed, monitor blood pressure regularly, educate patient on orthostatic hypotension precautions.

Evaluation: Assess blood pressure response, side effects, laboratory parameters regularly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Notify healthcare provider if signs of jaundice, sore throat, fever, or unusual bleeding occur.
  • Rise slowly from sitting or lying position to prevent orthostatic hypotension.
  • Avoid alcohol and sedatives unless approved by healthcare provider.

Special Considerations

Black Box Warnings:

  • Potential for hemolytic anemia and hepatic injury with methyldopa.

Genetic Factors: Less relevant for this combination.

Lab Test Interference: May cause false-positive Coombs' test with methyldopa.

Overdose Management

Signs/Symptoms: Hypotension, dizziness, dehydration, electrolyte disturbances.

Treatment: Discontinue medication, treat hypotension with fluid replacement, correct electrolyte imbalances.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under normal conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.