Drug Interactions

One of the hardest things to handle in dealing with the medical world is to the relativity of treatments and the un-sureness, evasiveness, almost wishy-washy-ness of medical professionals. Studies evolve all the time, and change the recommendations for some treatments sometimes drastically, overnight – so you never quite know what you need to be on and for how long and how will affect you, really. And no one knows. It’s a risky business.

I have decided a long time ago to have no regrets! I will do what the doctors tell me to do today, with the information they have at the time. And if the information they have now will prove incorrect after studies and many years of practice, well, then, we’ll stop what we’re doing and move on with whatever health we have left. I mean, what would be the alternative, and what would be the point of regrets?!

The alternative is to do nothing, of course. Take nothing. Use our judgment when we choose our lifestyle and hope for the best. I used to take nothing for years – and I felt not so good. Sure, there is no day in my life free of pain or discomfort now, too, but overall, I feel better, more functional, I can do more and that’s why I’ll take whatever drugs they have available for now.

Long intro, I know. My point in this piece was going to be about how un-sure and relative doctors and their helpers are when they are prescribing meds. So, my heart doctor just added a blood pressure medication to my treatment, because some days (key word is “some”, here), my blood pressure is high. OK! I knew this day is coming. With my heart problems and with everyone in my family (even the non-FH folks) with high blood pressure, it was almost a no brainer. Well, I am not sure what it is, but this new medication (Diovan) makes me dizzy, out of focus, and hot in my brain (for lack of a better medical word) right after I take it. I am not sure whether it’s the medication itself (those are some of the side effects), or the fact that I take a beta blocker (Atenolol) on top of it? Or because I take Atenolol+aspirin+Diovan at the same time? Or because I take aspirin, too, with all that? I have no clue.

A google search on the drug interactions of Diovan reveals (on drugs.com) that it interacts with both aspirin and Atenolol. As for the latter – the combo of Diovan+Beta blocker+ ACE inhibitor drug is fatal, and “the mechanism is unknown”. I am not on an ACE inhibitor drug, but made me wonder.

So, I call my doctor to ask: should I be taking all these 3 together? Should I be taking the whole 40 mg pill of Diovan on top of the 100 mg of Atenolol? Should I be taking an aspirin with everything? Should I take Diovan only in the second part of the day, since my BP usually goes up at night only?

I get a call form the doctor’s PA and she is full of “if”-s and “not sure”-s. She usually is, but this is somewhat important, I am thinking – playing with my heart (literally), not to mention my liver and what goes through it!

They prescribe this triple combo to people ALL the time and they have no issues, she says. They have never seen Diovan react with ANY drug (go to drugs.com or any other site that provides this and see the list of interactions). I should take it at noon, since the BP is high at night, OR I should take half of it in the morning and half at night OR I should take it ONLY when I take my BP and it’s high – and that also means “not every day”, if my BP is not high every day. Again: which is it?!

I mention to her that it says on the bottle and in the drug’s description online that I can’t skip dosages and I have to take it daily almost at the same exact time every day – and not on and off. She concludes: “Umm… no – that’s not true”.

So, who do you trust? What do you read? Who is the authority here? My mom has a good friend that’s a pharmacist and she told me years ago she argues with doctors all the time about how meds work and react and the doctors just won’t listen. She said it’s all about the chemistry – the chemistry you put in the drugs and the chemistry in your body and how they react with each other. Doctors have a good knowledge of the anatomy of the body but chemistry – not so much, not always, it seems. So, she sees them prescribe random stuff all the time. I am not saying my doctor did, but I surely wish I knew more about why I feel like walking on a cloud half an hour after I take this thing and for about 2 hours after that.

Anyway, I am not convinced at all that this is what I should be taking, if anything for my “randomly high” BP. I am not sure what I’ll do next, but a couple of days’ break from it might clear my head. Literally.

The Yo-yo Blood Pressure and More Drugs

I went to see my cardiologist about a month ago. When they took my routine blood pressure at the office , it was something like 158 over 95. So, he was all alerted. I have had “occasional” high blood pressure before, but nothing consistent.

I can’t remember what I took once, years ago for it, but because the numbers are so inconsistent, whatever they put me on then took my blood pressure way too low on days when it was normal, giving me a feeling of faint-ness, fatigue, dizziness that was bothersome.

As you know, blood pressure medicine is an “all or nothing” deal. You can’t just take them “when you have symptoms”. You take them for the rest of your days. So, they decided, then, years ago, to just increase my Atenolol, which I was already taking, in hope that that will help my BP, too.

And my BP has been mostly normal, but there are some days when … well, it shoots to 158 over 95. So, the current cardiologist asked me to keep a blood pressure diary for a month and come back for a decision… These are some of the numbers I took last month: 134x66, 140x60, 156x72, 120x80, 177x81, 107x54, 131x67. I can’t think of a rhyme or a reason why these up-and-downs are happening, but they do. Usually, as an average, I’d say it’s somewhere between 135-140 over 65-85, thereabouts.

So, the verdict was … more drugs. He added Diovan to Atenolol. It’s “just” a 40 mg dose, for now, which he is pretty sure won’t bring the blood pressure too low on days it’s normal, but it will help with bringing it low enough on the days when it’s high. We shall see. My pharmacy doesn’t have it, so I am waiting for a couple of days to be ordered in. I will report on the progress or happenings as they happen, of course. Surely, the doc said I “should not notice many side effects”, but I know better!

Now, I have to keep yet another BP diary for another month to 6 weeks while getting used to this new drug, and then go back in. I see my doctors more than I see my parents, and that becomes sort of ironic (not to mention WAY too much!) some days.

I have also started taking the 50,000 UI Vitamin D (once a week) yesterday. As I mentioned before, I have already been on 800 UI a day of Vitamin D because I have a deficiency (but who doesn’t, right?!), but now, my D numbers are way lower than half of what’s allowed, so … I am on this horse pill dosage.

Because D increases the amount of Calcium your blood vessels absorb and deposit, I have stopped taking my daily Calcium for now, while on this high dose of the vitamin.