AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question QUESTION: I apologize for not knowing how to followup on my recent question to you regarding Vascar. Allow me to remind you of the pertinent facts: reduced to 25MG Toprol XL from 100MG (daily) and placed on 2.5MG (daily) of Vascar. I'm considering asking my physician to switch me to an ACE inhibitor after doing a lot of research on the Internet. I've come up with three possibilities: Quinapril, Lisinopril and Enalapril. I'm wondering what your opinion is regarding this switch and if I've chosen the possibilities (among several options) that are the safest and most efficacious. I very much appreciate the fact that you make yourself available in this manner on the Internet; if you require more information, please let me know.
ANSWER: It is hard to predict ahead of time how well a new blood pressure medication class will affect your blood pressure. Two thoughts come to mind: why did you physician chose the drug class that he did (you would have to ask him) and whether what you are on is controlling your hypertension. At a minimum you can talk to him/her physician about these issues.
Regards,
Dom Sica, M.D.
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QUESTION: I stopped taking Vascor after experiencing unwanted side effects and doing research regarding this class of drugs; I went back to 50MG Toprol with an immediate interruption of my sleep patterns but lost the Vascor side effects (including weird tinnitus pattern of two tones in one ear.) My BP is about 117/75 during the day down to 110/70 by late afternoon, then 100/65 or lower at night. I saw my physician today and he wanted me to reduce Toprol to 25MG and try Benicar at 20MG. Frankly, I've read about Benicar and it doesn't sound to me like something I want to take; being recently FDA approved and manufactured in Japan?? with some serious potential side effects, I'm just not taking it. I don't know why this doctor is prescribing this and frankly I wonder when the local pharmaceutical agent was in his office and if that's the reason, but I'm definitely NOT going to take it. Toprol affects my sleep and even at 50MG it makes me tired during the day; I jog 2 miles a day, weigh only 118 pounds and am in perfect health. I'm going to try 25MG Toprol daily and monitor my BP. Can you suggest any other medications that are safe so I can get off this beta blocker?
Answer Sounds like the Toprol is causing more trouble than its worth and at that you are currently on a very small dose at 25-mg day. It is unclear how significant your hypertension is and how the diagnosis was originally made. From the values you report I wonder whether you truly have hypertension. I would suggest coming off medication and seeing where your blood pressure values fall. Those values would determine the choice of an alternative therapy (or not) for your blood pressure.
As to the dangers of Benicar I am unaware of them and this is a drug class that I have written about extensively. I would love to see your sources on the dangers of this drug. Also, this compound was originally approved in 2002 so it is in no way recently approved. Finally, the FDA strictly regulates medication manufacturing whether the compound is produced in the States or in another country. Benicar is not manufactured in Japan and shipped to the United States. The company that owns the compound happens to be based in Japan but the manufacturing process occurs in the United States.
Finally, you may have to make a decision whether you have your current physician manage your case, which is a personal matter. If I am reading your e-mail correctly it sounds as if you are losing confidence in this person.
This is way more than I should be commenting on but you had so many questions and statements that required clarification that I tried to answer everything.
