Methyldopa interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

  What to do: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

  8 sources

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595

Conditions

Conditions in which Methyldopa needs care, as documented in this source.

• Liver Diseases

  Major

  The use of methyldopa is contraindicated in patients with active liver disease, such as active hepatitis or active cirrhosis, and in patients with previous methyldopa- associated liver disorders. Hepatotoxicity is an uncommon but toxic effect of methyldopa. Therapy with methyldopa should be administered cautiously in patients with a history of or predisposition to liver disease.

  13 sources

  1. Goldstein GB, Lam KC, Mistillis SP "Drug-induced active chronic hepatitis." Dig Dis 18 (1973): 177-84
  2. Bonkowsky HL, Brisbane J "Colitis and hepatitis caused by methyldopa." JAMA 236 (1976): 1602-3
  3. Miller AC, Reid WM "Methyldopa-induced granulomatous hepatitis." JAMA 235 (1976): 2001-2
  4. Rodman JS, Deutsch DJ, Gutman SI "Methyldopa hepatitis: a report of six cases and review of the literature." Am J Med 60 (1976): 941-8
  5. Cacace LG, Cohen M "Alpha-methyldopa (aldomet) hepatitis." Drug Intell Clin Pharm 10 (1976): 144-52
  6. Sotaniemi EA, Hokkanen OT, Ahokas JT, et al. "Hepatic injury and drug metabolism in patients with alpha-methyldopa-induced liver damage." Eur J Clin Pharmacol 12 (1977): 429-35
  7. Thomas E, Rosenthal WS, Zapiach L, Micci D "Spectrum of methyldopa liver injury." Am J Gastroenterol 68 (1977): 125-33
  8. Puppala AR, Steinheber FU "Fulminant hepatic failure associated with methyldopa." Am J Gastroenterol 68 (1977): 579-81

  Show all 13 sourcesShow fewer sources

  9. Bezahler GH "Case report: fatal methyldopa-associated granulomatous hepatitis and myocarditis." Am J Med Sci 283 (1982): 41-5
  10. Neuberger J, Kenna JG, Aria KN, Williams R "Antibody mediated hepatocyte injury in methyldopa induced hepatotoxicity." Gut 26 (1985): 1233-9
  11. Moses A, Zahger D, Amir G "Cholestatic liver injury after prolonged exposure to methyldopa." Digestion 42 (1989): 57-60
  12. Lawson DH, Gloss D, Jick H "Adverse reactions to methyldopa with particular reference to hypotension." Am Heart J 96 (1978): 572-9
  13. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Anemia, Hemolytic

  Moderate

  Hemolytic anemia has occurred rarely during therapy with methyldopa and may be associated with a (+) direct Coombs. Therapy with methyldopa should be administered cautiously to patients with anemia or a predisposition to hemolytic syndromes. Clinical monitoring of hematopoietic function, including a baseline hematological profile, is recommended. If Coombs- positive hemolytic anemia occurs, the cause may be methyldopa and the drug should be discontinued

  4 sources

  1. Distenfeld A, Florita C, Gelfand ML "Hemolytic anemia induced by alpha-methyldopa." N Y State J Med Feb (1970): 570-3
  2. Nelson RB Jr, Nelson RB III "Methyldopa-associated intravascular hemolysis." Arch Intern Med 137 (1977): 1260-1
  3. Roy A, Ghosh ML "Coombs positive haemolytic anaemia due to methyldopa." Br J Clin Pract 35 (1981): 54, 58
  4. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Cerebrovascular Disorders

  Moderate

  Rarely, involuntary choreoathetotic movements have been observed during therapy with methyldopa in patients with severe bilateral cerebrovascular disease. If these movements occur, therapy should be stopped.

  1 source

  1. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Diseases requiring dialysis

  Moderate

  Methyldopa is removed by dialysis. Patients receiving methyldopa and undergoing dialysis may occasionally become hypertensive.

  4 sources

  1. Yeh BK, Dayton PG, Waters WC III "Removal of alpha-methyldopa (aldomet) in man by dialysis (35155)." Proc Soc Exp Biol Med 135 (1970): 840-3
  2. Myhre E, Brodwall EK, Stenbaek O, Hansen T "The renal excretion of methyldopa." Scand J Clin Lab Invest 29 (1972): 201-4
  3. Myhre E, Stenbaek O, Rugstad HE, et al. "Pharmacokinetics of methyldopa in renal failure and bilaterally nephrectomized patients." Scand J Urol Nephrol 16 (1982): 257-63
  4. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Edema

  Moderate

  Methyldopa may cause edema or weight gain associated with sodium retention. Therapy with methyldopa should be administered cautiously in patients adversely affected by sodium and water retention.

  2 sources

  1. Varkel Y, Braester A, Nusem D, Shkolnik T "Methyldopa-induced syndrome of inappropriate antidiuretic hormone-secretion and bone marrow granulomatosis." Drug Intell Clin Pharm 22 (1988): 700-1
  2. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Leukopenia

  Moderate

  Rare reports of reversible reduction in white blood cell count, primarily neutrophils, have been noted. White blood cell counts returned to normal with discontinuation of methyldopa. Therapy with methyldopa should be administered cautiously in patients with a history of or predisposition to decreased white blood cell or neutrophil counts. Clinical monitoring of hematopoietic function is recommended.

  1 source

  1. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Pheochromocytoma

  Moderate

  Methyldopa causes fluorescence in urine samples at the same wave lengths as catecholamines, falsely high levels of urinary catecholamines may be reported. This will interfere with the diagnosis of pheochromocytoma. It is important to recognize this phenomenon before a patient with a possible pheochromocytoma is subjected to surgery. Methyldopa is not recommended for the treatment of patients with pheochromocytoma.

  3 sources

  1. Cregler LL, Mark H "Second-degree atrioventricular block and alpha-methyldopa: a probable connection." Mt Sinai J Med 54 (1987): 168-70
  2. Rosen B, Ovsyshcher IA, Zimlichman R "Complete atrioventricular block induced by methyldopa." Pacing Clin Electrophysiol 11 (1988): 1555-8
  3. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

• Psychotic Disorders

  Minor

  Rare symptoms of psychoses, such as hallucinations and delirium, and vivid dreams and nightmares have been reported during methyldopa therapy. Therapy with methyldopa should be administered cautiously to patients with a history of or predisposition to these conditions.

  5 sources

  1. Endo M, Hirai KO, Ohara M "Paranoid-hallucinatory state induced in a depressive patient by methyldopa: a case report." Psychoneuroendocrinology 3 (1978): 211-5
  2. Wurzelmann J, Frishman WH, Aronson M, et al. "Neuropsychological effects of antihypertensive drugs." Cardiol Clin 5 (1987): 689-701
  3. Labbate LA, Holzgang AJ "Manic syndrome after discontinuation of methyldopa." Am J Psychiatry 146 (1989): 1075-6
  4. Tchen P, Luchins DJ, Rose RP "Possibility of depression as a side effect of methyldopa." Am J Psychiatry 147 (1990): 128
  5. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc (2001):

Therapeutic duplication

Drug classes that overlap with Methyldopa, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• centrally acting antihypertensiv

  The recommended maximum number of medicines in the 'centrally acting antihypertensives' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'centrally acting antihypertensives' category.

  Example product in the source data (US market): Clorpres