Serotonin antagonism and serotonin antagonists in pregnancy: Role of ketanserin

Most agree that antihypertensive medication should be used to treat severe hypertension during pregnancy, but its role in patients with mild to modera te disease is debated. None of the regularly used drugs is completely safe for mother and fetus. Ketanserin decreases systolic and diastolic blood pre ssure in nonpregnant patients with acute and chronic hypertension, Its sele ctive serotonin S2-receptor antagonist activity encouraged investigations i nto a possible role in pregnant women. These reports can be divided into fo ur groups. Several studies confirmed that intravenous ketanserin decreases blood pressure significantly in patients with severe preeclampsia. There ar e indications that it may be at least as effective as dihydralazine, possib ly with fewer side effects. Its role in chronic hypertension has not been s tudied adequately but one randomized, controlled trial indicated efficacy c omparable with that of alpha-methyldopa. Thirdly, it was concluded in a sin gle descriptive study that the administration of ketanserin to patients wit h HELLP syndrome allowed delivery to be postponed for 5.3 days. Lastly, in a randomized, placebo-controlled trial, the addition of ketanserin to aspir in in patients with mild to moderate midtrimester hypertension was associat ed with a significant decrease in the number of cases of preeclampsia and s evere hypertension, as well as a trend to less perinatal mortality, lower r ates of abruptio placentae, and early-onset preeclampsia. Additional studie s are needed to adequately assess a possible role for ketanserin with acute hypertension or moderate chronic hypertension.