Nifedipine safe for high blood pressure in early pregnancy?

[Lubyloo]

Have also posted this in Health

My consultant has prescribed nifedipine for my high blood pressure. He knows we are TTC, we discussed taking medication in pregnancy and he told me that women with pre-eclampsia take this with no problems.

However everything I read contraindicates nifedipine in pregnancy and seems to go against NICE guidelines. There does seem to be medication which is safe to have in pregnancy so I'm not sure why he hasn't prescribed this.

Does anyone have experience of taking this drug in pregnancy? I know people have taken it later in pregnancy but I'm worried about the early stages when the foetus is developing. I don't see my consultant for another three months so it is a while to wait until I can question him!

taken from emc.medicines.org.uk/ which is a very reliable proper site, this is an exceprt from the manufacturers info for this drug - adalat is one brand name for nifedipine

Adalat is contra-indicated in pregnancy before week 20 (see Section 4.3).

In animal studies, nifedipine has been shown to produce embryotoxicity, foetotoxicity and teratogenicity (see Section 5.3 Preclinical safety data).

There are no adequate and well-controlled studies in pregnant women.

From the clinical evidence available a specific prenatal risk has not been identified, although an increase in perinatal asphyxia, caesarean delivery, as well as prematurity and intrauterine growth retardation have been reported. It is unclear whether these reports are due to the underlying hypertension, its treatment, or to a specific drug effect.

The available information is inadequate to rule out adverse drug effects on the unborn and newborn child. Therefore any use in pregnancy after week 20 requires a very careful individual risk benefit assessment and should only be considered if all other treatment options are either not indicated or have failed to be efficacious.

hthx

I was given nifedipine for pre-eclampsia but only after about 32 weeks. I also had methyl dopa, apparently this has been around for ages and is fine in pregnancy (although not sure about very early stages), don't think you'd be wanting to take it throughout though as it made me feel really dopey!

My friend has high blood pressure (not pg related) and has taken a beta-blocker (labetolol? or did I just make that up?) throughout 2 pregnancies with no side effects. From the info moaningminnie has come up with I would be a bit dubious about taking nifedipine, sounds like you need to have another discussion with your consultant. Good luck with ttc!

Thanks for that info Moaning Minnie. It does seem to agree with other things I have read about nifedipine.

I have to go to GP in two weeks for a BP check and will discuss with him. However, I feel he may frown on me querying the consultant's view. I will mention labetolol to him Liege. I hope everything was ok for you and baby.

The ironic thing is that the GP referred me to the consultant specifically because he knew I was TTC and wanted the consultant to prescribe drugs that would be safe!

I have high bp and have been on nifedipine throughout my 2 pregnancies - it is a drug that has been around for years and the reason that they use it is that they know it is safe. The study that is quoted above was a study on animals and involved extremely high doses of nifedipine. Why do you think your consultant would put you on it if it wasn't safe - it's his job to know these things!!

Methyldopa is the other drug that is commonly used safely throughout pregnancy but the side effects of methyldopa can be very extreme - it made me so sleepy all the time that I was unable to do my job properly - I'd literally fall asleep at my desk. Labetolol is a betablocker so if you are asthmatic or have various other conditions this will not be suitable for you.

Hi Lubyloo - I'm not sure whether nifedipine is safe in pregnancy, however my consultant precribed me methyldopa for my high blood pressure when I was pregnant,
, as he said it was a very safe drug for both mother and baby. However it can make you and the baby a bit drowsy for a few days when you first start taking it, but luckily I found that things soon settled down. I'm not sure about nifedipine during pregnancy I'm afraid. Why dont' you ring NHS direct, they have looked information up on drugs for me in the past and whether it was safe to take paracetemol while on a particular drug.

Good luck

Tinasan - the reason why I am querying it is because the Blood Pressure Association states that "calcium-channel blockers should not be taken if you are pregnant, trying to become pregnant, or breastfeeding, because they may affect your baby's development. Instead your doctor will prescribe one of the other types of blood pressure drug that will not cause any unwanted effects to the baby."

The leaflet that comes with the tablets also says the same thing. I know that there are tablets that aren't contraindicated so I was wondering why he hadn't put me on one of those. Having had three pregnancy losses I am very anxious not to do anything to jeopardise a pregnancy.

Did you take nifedipine right from the very early days of your pregnancy then Tinasan or did you start it a few weeks in?

Helenlouisey Thanks for the suggestion. I think NHS Direct would just look at the patient information leaflet which advises not to take it in pregnancy.Hope you and baby were ok.

I had been on nifedipine for a few years before ttc, the reason that the consultant prescribed it was because I knew I was going to ttc at some point and she wanted to ensure that the medication I was taking would be completely safe, even if I became pregnant unexpectedly. When I fell pregnant both times I was on nifedipine (this second time, on the maxiumum possible dose) and it is made absolutely clear every time I go to see the blood pressure consultant at the hospital that it is safe to take. When you have your scans, they take particular care to check the blood flow to the placenta as this is what can be affected by hypertensive problems. In fact your baby's development would be more likely to be affected if you don't take the hypertensive drugs, as high BP can cause placetal problems resulting in growth problems for the baby, and of course pre-eclampia towards the end of the pregnancy.

Nifedipine, methyldopa and Labetolol have been used absolutely safely for years and years for pregnant women and this they are prescribed for women with BP problems in pregnancy - in an ideal world no-one would take any drugs when pregnant, but they need to weigh up the risks of you not taking them, and decide which is safest in your particular case. I know that some of the more modern calcium channel blockers are not prescribed to pregnant women as they don't know if they are safe - this might be why there is that text on the BPA website. I think you need to relax and put your faith in what your blood pressure consultant tells you, and not blanket information that is on the NHS Direct or similar - your consultant is an expert and knows all the details of your individual case! Good luck TTC

Thank you so much for your reply Tinasan! You have put my mind at rest and you are right that I need to put my faith in the experts! I find it hard to get pregnant and then actually stay pregnant so am rather anxious. How did your BP cope with your pregnancies?

I hope I've put your mind at rest a bit, there are enough other things to worry about in pregnancy! My BP was actually ok in the first one (controlled by the nifedipine) although in the last trimester it did start to slowly increase. In the end I was on the maximum dose of nifedipine and also methyldopa (you really don't want to take this one unless you have to!). Baby was just over seven pounds and completely healthy. This time around I'm now 26 weeks and have been on the max dose of nifedpine throughout (my bp never went back to what it was after the first baby). I've an appointment at the bp clinic at the hospital on Monday so I'll find out how it is then - although it was at this stage last time that it started to creep up.

Sorry to hear that you have trouble staying pregnant, it must be a very nerve-wracking time when ttc. Lots and lots of luck for this month!