a-Methyldopa is not generally believed to be suitable for monotherapy of primary hypertension. Because plasma volume increases as the duration of a-methyl-dopa therapy is extended, the drug should be used in conjunction with a diuretic; this will produce a significantly greater fall in blood pressure than would occur with either drug used alone. Because a-methyldopa lowers blood pressure without compromising either renal blood flow or the glomerular filtration rate, it is particularly valuable in hypertension complicated by renal disease. However, if end-stage renal failure accompanies severe hypertension, a-methyldopa may not be effective.
The presence of a-methyldopa and its metabolites in the urine reduces the diagnostic value of urinary cat-echolamine measurements as an indicator of pheochro-mocytoma, since these substances interfere with the fluorescence assay for catecholamines.
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