Trying to Achieve the Best Results with the Least Amount of Compromise. A Continuous Guessing Game.

Speaking about the benefits and side effects of Amlodipine and Nexletol            

If you remember earlier in the year, I started two different therapies: Amlodipine, to regulate my blood pressure and Nexletol (or Bempedoic Acid), an add-on drug to my cholesterol-lowering therapy. I have written before about Nexletol and what side effects I experienced as I started it (https://livingwithfh.blogspot.com/2020/07/personal-side-effects-of-bempedoic-acid.html). And I also wrote about how well it worked for lowering my LDL levels (https://livingwithfh.blogspot.com/2020/09/results-after-latest-addition-to-my.html). The truth is: it worked really well. Better than the cardiologist expected it to work. That was the great news! 

 

Amlodipine worked well for lowering the blood pressure, too. It was amazing to see how much the blood flow to my heart, brain, and legs increased as I could clearly tell when I was able to exercise longer and more strenuously, or in more strenuous conditions, like in extreme heat, during this past summer.

 

However, I also noticed that while I was on both drugs for the past few months, I developed more side effects or some of the existing ones got worse. Some of the more troublesome ones were:

• A hoarse voice, sometimes to the point of losing it altogether.
• Muscle spasms for no reason, even at rest.
• The joint pain I speak about in the entry linked above got worse.
• Extremely sensitive gums, to the point that even a soft-bristle brush would hurt and make them bleed.
• Slower than normal urination.

I would not call any of these side effects debilitating, by any means, but I was worried that they might be telling of other, more serious problems that might develop underneath. So, at my appointment later last month, I mentioned all these to my doctor. He knew pretty surely that the gum problems were caused by Amlodipine – I also knew this, as this is a well-documented side effect for this drug, publicized everywhere I could find. However, he didn’t know which drug was causing all the other symptoms.

 

To address these things, he ran some tests first, to ensure my liver and kidneys are fine. The tests came back normal for both. He also ran a Uric Acid test to see if I started to develop gout – Nexletol (Bempedoic Acid) is known to cause gout in some cases, and my sensitive and painful joints were a concern. The levels were normal here, as well.

 

Then, he took me off the Amlodipine for two weeks. The gums got better, but none of the other symptoms budged. He’s prescribed something else for lowering the blood pressure (Losartan), but he also has me monitor my blood pressure more or less daily. So far, the highest I have had it (and it’s not consistently this high) was around 145/60. Usually, it’s around 135/55, as an average, but sometimes lower than that. He said I don’t need to take anything for blood pressure unless I start feeling weak, dizzy, or if I have palpitations. I don’t experience these, so at this time I am taking nothing. However, I do feel like I am more winded and lack enough blood flow to exercise more vigorously. My chest becomes tighter and my carotids and calves also become more cramped when I exercise now. Although I can still exercise fairly well (I went for a 3 mile hike this past weekend at altitude and in cold weather and did fine) I will talk with him about this change at our next appointment. For now, no blood pressure meds, at least not on a daily basis. I have a prescription of Losartan, if needed.

 

After that experiment, he took me off the Bempedoic Acid for a month. That month will be up sometime in the beginning of November. Since I stopped it (about a week and a half – two weeks ago), my urinary problems are all cleared up, my joints feel better but still not pain-free, my voice is better, but still not completely hoarseness-free, and there is no change in my muscle spasms. The one month is not up, so I am still watching.

 

We will see what this experiment will show and what he’ll recommend next. I asked him if I could take half of a Bempedoic Acid and try to build it back up slowly (given that there is only one strength for it, so he can’t recommend a lower dose). He said he’ll look into whether we can cut this pill for a lower dose. I guess the drug is new enough where this is not known?! We have made no more decisions beyond trying to figure out what a break from drugs will look like in terms of well-being.

 

For those of you still looking for the perfect therapy for FH, I can say: it’s more of an art than a science, really. All my life, I have tried different drug combinations and different doses, and decided what the best regimen is for me with the least amount of negative impact. I have never found a side effect-free regimen. Maybe other patients have, but I cannot say that was my experience.

 

Right now, I am still on Lipitor, Zetia, and Praluent for cholesterol lowering. I am also aware that because Nexletol is no longer in the picture, my LDL levels are probably climbing back up. I am also wondering if the muscle spasms and the hoarse voice could not be from the Praluent, and just recently have become more pronounced and bothersome. They are also side effects mentioned in relation to Praluent (I have taken Praluent for 4 years now). With so many drugs at play and all of them coming with their own side effects, it’s hard to pinpoint which one is the culprit. 

Sometimes I wonder if it’s the combination of two or more of the drugs that cause the side effects. Unfortunately, I have not found a simple answer here. My goal is to get my numbers (cholesterol and blood pressure) closest to their healthy targets with the least amount of compromise of quality of life. And to this purpose, I am still very much on a journey instead of feeling like I have reached a destination.