Labetalol for high BP - anyone refused to take it or wish they had?

[sabbatica]

Hi All,

I'm 35+1, second pregnancy, and have been taking 200mg labetalol for high BP twice a day for the last week.

I was prescribed it by my consultant as my BP had gone from 120/70 (at start of pregnancy) to 160/100 that day. It had been creeping up slowly since 32 weeks.

I had pre-eclampsia in my last pregnancy, picked up at 38 weeks. This time round there is only trace / plus one protein in my urine and my blood tests look fine.

I feel really unhappy about taking the labetalol as I feel my BP went up as my body is struggling with this pregnancy. The baby is moving and growing well and is measuring at 1.5 weeks above dates according to scan (so 36-37 wks). Taking this medication seems like it is just hiding the problem and it has made me feel ill, very tired, dizzy and weak.

Has anyone out there refused to take BP medication or wish they had not done so? I want to do the very best for my baby, but I also dont want to plaster over a problem by taking a medicine to hide symptoms that indicate a problem.

All advice welcome. Thanks.

Hi sabbatica, so sorry you're feeling so unwell.

I'm not exactly what you're looking for as I did take labetalol from 35 weeks in my last pg.

Have you talked this through with your consultant?

As far as I understand it (and I definitely could be wrong), labetalol IS treating the condition and allowing your baby to stay inside for as long as possible.

I know you can feel weak and dizzy whilst taking it - I certainly did, and maybe it was easier for me as I was admitted to antenatal ward at that point so didn't have to do anything other than lie there.

BUT, if my BP shoots up again in this pg - and I fully expect it will do - I will have no hesitation in taking labetalol again because I know now how very very dangerous PET is for both mum and baby. I don't want to have eclamptic seizures, or risk kidney failure.

You say you think this is a plaster over the problem - is there a different treatment you want?

PS I should have said, I was only on it to get me up to 38 weeks and then had CS as baby would have the best chance if he could stay in at least until then.

I took it and still am, 14 weeks after dd2's birth. I'm not sure what the alternative would have been tbh.

Hi Hambles, thanks for your reply.

Not sure what the alternative I'm hoping for would be, but I've spent 7 days in day assessment (I've refused to stay overnight on the ward at this point) in the last 10 days.

As well as my BP being high I've got other symptoms that could indicate start of pre-eclampsia, being bad frontal headaches, (low) proteinurea, plenty of visual sparks and dropping platelets (my norm is 550 which is very high for a normal, but dropped in last week to 350 and getting lower with every test).

My bloods are fine now but showed high urate levels last week - not sure what that means though!

I think I just feel that my high BP at this stage of pregnancy has happened because my body is struggling with this pregnancy. If the baby is a healthy size and doing well, I don't know if delivering him at 36/37 weeks would be a better option.

As the consultant is too busy whenever I'm in day assessment (lots of surgeries and traumas for patients who need priority), no one has been able to explain the risks if I dont take the labetalol...or the risks if I do take it.

Sorry if I'm explaining this badly, just confused and want to do the best for the baby!

Labetalol is a medication designed to combat high blood pressure. It isn't a plaster over anything, it's treating the problem you have. Your doctors have to weigh up your well being and the baby's wellbeing. I know you are near the end of your pregnancy but if at all possible your baby will benefit from a few more weeks 'cooking'. Are you actually consistently taking it at the moment?

I think the urate levels in your blood indicate that your kidneys were struggling to filter out everything they need to. It's really important that you try and lower your blood pressure because this will help your whole body cope better. Please insist on speaking to somebody medical at the Day assessment centre tomorrow. You really need a better medical explanation of your situation than you'll get from an internet forum.

But treating the blood pressure is a protective measure. Its known that women who have raised bp over 160 (top figure) are at increased risk of brain haemmorage. Its not about masking the problems but treating the associated risks. If you dont feel happy about your treatment go discuss it with your midwife/doc, but please dont just stop your meds.

and being 38/39 weeks is much better for your baby than delivering at 36/37 weeks where possible, they will always aim for that to allow lungs to mature and reduced health problems for baby.
Im sorry you feel crap and unsupported :(

I know what you mean that it's a sign your body is struggling and I would guess as soon as your bloods/wee/bp cross a certain line they will deliver and it will be a question of balancing risks for you and baby.

As I understand it, 38 weeks statistically gives your baby the best chance as it's not just about size, but lung maturity etc.

When I was in hospital with it, I didn't know much and I think I've learnt more about PET since then, just by reading MN and hearing other people's stories.

I do know it is really very dangerous and of course high BP is risky for things like having a stroke.

Having got away lightly last time (no seizures or lasting problems) I am all in favour of receiving similar treatment this time.

There are women here on MN who have had severe PET, and they may know more about the specific pros and cons of the treatment.

You could ask on the pre-eclampsia mentalling thread.

excellent advice up there above my post!

Hi All, cheers for replies.

I wouldn't stop taking meds without discussing thoroughly with consultant beforehand.

Gestational hypertension is thought to be linked to issues with the placenta failing, from the research I can see. Hence why I want to know if treating the hypetension is not actually fixing the main problem. Hypertension is not necessarily pre-eclampsia.

My BP only ever got up to the "moderate" hypertension level as well. I don't want to take this medication if it is only as a precaution because there are issues with breastfeeding linked to it. If it is necessary then I will.

If I have pre-eclampsia and am at risk of harm to the baby, eclamptic fits, organ failure etc then I understand that taking labetalol may reduce the risk of this, but if I only have moderate gestational hypertension then it may not be the best treatment.

I will speak to my consultant, hopefully tomorrow when back in day assessment. I have no intention of taking medical advice from a forum and did not ask for any medical advice. I asked if anyone else had experienced taking labetalol and regretted it. Apologies if my question was misleading.

Hi Sabbatica, you could ask to change med? I was on labetalol with 1st pg as BP and urate levels shot up at 33wks but it made me really nauseous and dizzy so doctor changed it to methyldopa and nifedipine which were much better! I was then in and out of the hospital for 3wks til dc1 w delivered at 36+3, very small (4lb) but perfectly healthy - they were aiming to get me to 37wks to ensure lung maturity etc but he was fine and thankfully didn't have to spend any time on the neo natal unit. The longer you can wait the better for baby but not if the drugs are making you feel worse...maybe ask about a different type of medication?

Sorry - just re-read that and sounded a bit shitty! Didn't mean it to.

I'll ask the consultant tmw if I get a chance to see her, but I do think that what you're all saying sounds correct.

I'm forever uncertain about taking medication without understanding why I'm taking it, which is the case here as no one was free to explain it to be when it was prescribed.

Have had some bad experiences with being given drugs in the past which have had bad side effects and, afterwards, would appear to have been unneccessary.

Cheers all.

Hiya, I've had labetalol at the end stages/following delivery of each of my three pregnancies and agree with you it can have quite nasty side effects. With my last (no.3) pregnancy my consultant opted for methyldopa which I found a little better, but she still had to add in labetalol in the last weeks to help control my BP. With all three I developed PE (had HELLP syndrome resulting in delivery of DS at 30 wks with first pregnancy) but with the last two- managed- pregnancies the BP meds (coupled with low dose aspirin that I'd been on since first pregnant) I believe allowed us to reach a better gestation (DD1 born at 36 wks, DD2 at 37 wks). Basically by lowering my BP my placenta functioned better so allowed them to stay in utero longer, and also reduced the load on my body so improved kidney and liver function. As others have said the baby's gestation is the key thing, not size - from experience there is a big difference in even a few days in terms of lung maturity and ability to feed, so the rationale is definitely to use meds to prolong the pregnancy (coupled with close monitoring). It can't cure PE but it can slow its progress and buy critical time.

I would definitely discuss the choice of BP meds with your consultant, as there are other options- however often following delivery if you plan to breastfeed only a few BP meds are recommended (lebetalol being one of them), and often it can take a few weeks or months for BP to normalise following delivery so meds can be needed for a while.

Really hope PE doesn't raise its ugly head and you get to 38+ weeks x

There are a few threads on here about labetolol at the min - 1 I started and another. Possible risk for bf when on labetolol - you could look up the threads?

Hi OP, I started a thread on this a few weeks ago and had great advice/feedback. I'm 29 weeks with consistently high normal BP. My consultant and I struck a deal that close monitoring would be ok to see how things go as my bloods were normal and baby measuring in 75 per centile. Good luck, I really get where you're coming from on this. babys experiences post birth are worth reading just so you are alert .

Labetelol is to keep YOU safe - and it is possible to have pretty nasty complications/PE despite having only slight hypertension. My blood pressure was rarely over 150/95 - yet I managed to have severe pre-eclampsia, a baby with severe IUGR (below 0.4th centile) and HELLP syndrome - so please don't think that mild hypertension isn't serious!

Anti-hypertensives do not treat the underlying placental insufficiency that often accompanies HT/PE - as PE sets it's own course & develops at it's own pace (often rapidly) - however they do keep you safer - eclamptic fits, bleeds behind eyes, liver/kidney damage etc

you could ask about Nifedipine as an alternative, but to honest at this stage it's probably not worth changing & there are side-effects with all medications.

Please keep taking the medication - for you and your baby.

As a survivor of severe pre-eclampsia (my DD didn't though) I would urge you to keep taking it.

As said above, labetalol is to keep you safe. The BP level you are at (160/100) is where the risks of having a stroke (brain haemorrhage) really start to increase. Its just not worth risking that. Labetalol won't slow down the rate of progression of pre-eclampsia so you need to keep having the protein and bloods as well. But stroke is the main serious risk for you at the moment.

If you are having trouble with side effects though, I would ask to try a different drug. Labetalol is not the only one appropriate.

There was a recent trial that suggested it is safe to deliver at 37 weeks for the baby, for someone in your position. I think you could ask about this and if delivery would be considered at this point. But at 35 weeks there are still significant problems sometimes with lung development, even if the baby is large. If you can, its best to try to keep going a bit longer.

I'm worried about your symptoms though, please go back and get rechecked if anything at all worsens (even if you havve only just had the tests done). Pre-eclampsia can sometimes get worse vey fast.

Good luck

I think you are being stupid. The medics are just trying to keep you and your baby as safe as possible. Take the bloody drugs. As you know high bp could be lethal for you and your baby and this drug will lower your bp.

BANG out of order Myleene - op came on here to ask a reasonable question and has clearly stated that she'd never self medicate.

Forgot to add that, after delivery, when the anti-hypertensives were reduced (PE resolves upon delivery of the baby) my BP shot up dramatically - so even though I was unsure if they were really doing much for me pre-natally - they certainly were controlling my blood pressure!

I continued on Nifedipine for 2 months after my DS was born early, despite having low blood pressure all my adult life - until pregnancy, that is!

In answer to your questions OP, I actually regret NOT having the anti-hypertensives earlier in pregnancy. This was simply because I was completely asymptomatic of PE & was only picked up "accidentally" at my 28 week check. It is not uncommon to feel completely well with very severe pre-eclampsia. If I hadn't had that check, I'm not sure if we'd both be here today.

Without exaggeration, we both nearly died. I would give ANYTHING to go back in time & have any treatment available. Anything that would have minimised what we both went through.

Keep taking the tablets!!

I just get annoyed with people who think medics have anything other than the best interests of the patient at heart in this situation. I'm sorry, but I think it would be completely stupid not to take the bp meds. Sorry to be so blunt. Switch to a different drug maybe, but surely the side effects aren't bad compared to the alternative. Medics don't prescribe any meds to pregnant women willy-nilly let alone labetatol. The dizziness and tiredness is just likely to be the effects of the high bp.