Methyldopa remains widely used for chronic hypertension in pregnancy in India. Which feature of methyldopa most commonly limits its long-term acceptability?

• A Severe orthostatic hypotension
• B Rebound hypertensive crisis on withdrawal
• C Fetal growth restriction
• D Depression, lethargy, and sedation ✓

Explanation

Methyldopa is a centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow. It has decades of safety data including follow-up of exposed children, making it a favoured agent in pregnancy. Its main drawback is central nervous system side effects: depression, sedation, and lethargy, which lead many women to stop it. Orthostatic hypotension is mild, it does not cause fetal growth restriction, and rebound crisis is characteristic of clonidine rather than methyldopa.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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