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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What is the dosage of Methyldopa?

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7011 Questions

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Posted on Tue, 6 Sep 2016 in Hypertension and Heart Disease
Question: to Dr Sharka, cardiologist...........hello sir, 6 days ago I started taking your recommendation methyldopa along with my other medications, 0.3 clonidine, 2.5 minoxidil, 160/12.5 valsartan, 250 mg methyldopa each 2 times per day, so far no good results, my morning bp systolic pressure is 185/190. my 8 pm nite pressue is 170/175.what is the maximum dosage for methyldopa, I am convinced that it will be necessary to take heavier dosage of something at night to combat my high morning pressures, I would appreciate on your advice as to go from here toward solving my stage 2 problem........best regards. XXXXXXX XXXX
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome back on HCM!

Regarding your concern, I would explain that the dose of methyldopa that you are taking is low. It is necessary taking it three times daily and then after a week you can increase up to 1000mg (one tablet in the morning, one tablet at lunch and two in the evening).

Besides, you should be patient with these therapy changes. As I already explained to you before, every change in the antihypertensive therapy needs a period of up to a week to show its real effects and create a new balance in blood pressure.

So, you should wait up to week after every change to see the effects.

For the moment I recommend increasing the dose of methyldopa to three times daily.

Then we can increase it up to 4 tablets (which is the maximal daily dose) and then wait another 5-7 days to see its effects.

If your blood pressure values are still high even with the maximal daily dose of methyldopa, I would recommend making another change to your therapy: switch from clonidine to doxazosine. You can start with a dose of 4mg once a day (AM or PM) and then increase the dose up to 16mg (taken all as one dose AM or PM, depending on your blood pressure values.

Hope you will find this answer helpful!

I remain at your disposal whenever you have any other questions!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 57 minutes later
thanks for that rapid response, my understanding is the maximum daily dosage is 3 grams or 3000 mg per day, it is available in 250 or 500 mg tablets, is that correct ? my pcp was concerned about prescribing this medication because it is not considered first line medication my medicare, he said he would do it reluctantly but would most likely get a letter from medicare asking why he prescribed this. he was not personnaly familiar with methyldopa but said we could give it a try. thank you for your continued support, thank u .....I'm XXXXXXX XXXXX
doctor
Answered by Dr. Ilir Sharka 11 hours later
Brief Answer:
Please read the following:

Detailed Answer:
Dear XXXXX!

Those mentioned doses (up to 3 grams are a bit high, in fact at the upper tolerable limits).

I was not mentioning to reach those values.

Instead, if necessary to achieve the desired effect, I recommend adding new actors on the scene.

I know it could sound a bit old fashion when discussing Methyldopa along with other newer anti-hypertensive drugs.

But, you should know that Clonidine and Minoxidil also are not considered a first line therapy for high BP and in fact are as old as Methyldopa for the underlying purpose.

Nevertheless, you are actually taking them (Clonidine and Minoxidil) on your daily anti-hypertensive therapy. Probably your pcp is more familiar with them compared with Methyldopa.

My opinion is to start using Methyldopa with the recommended daily dosage and wait the drug completely entering the scene.

Only after that, we could judge whether we can benefit from its pharmacological action, or there is a need to add another medication (I was mentioning Doxazosin instead of Clonidine as I explained you above).

So, in a week we need to review again your therapy.

Meanwhile, you need to be in close contact with your pcp and continue monitoring frequently your BP values.

Please, let me know how things are going on.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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