by firstname.lastname@example.org (322 Posts), Tue Sep 26, 2006 07:10 pm
Verapamil is safe in pregnancy and for the breast feeding mother, having not been shown to cause birth defects above background risk nor newborn problems while breastfeeding.
In general a mother with chronic hypertension on medication is well advised to be evaluated by her obstetrician as early as possible during pregnancy, so that she can be evaluated medically (collect a 24 hour urine to determine the presence and amount of proteinuria, for instance) and a determination made to continue or change medications.
ACE inhibitors are usually stopped because of fetal risks; calcium antagonists like Verapamil can be continued. If a diuretic is needed to help an antihypertensive drug work best in a mother with fairly longstanding and significant hypertension, it can be continued--furosemide is usually preferable to hydrochlorthiazide--and the lowest effective and required dose is usually used. In many practices, the use of Aldomet has just about disappeared since it is a very weak agent (that's why it almost never is used in a nonpregnant female or a male patient). Calcium antagonists have been more frequently utilized in my pregnant patient population since once a day dosing is possible and they are more efficacious than Aldomet.
If antihypertensive therapy is stopped altogether in early pregnancy because blood pressures are "normal", this can change at a later time and should be revisited at each prenatal encounter.