AboutDr Alan Galbraith Expertise I can answer most questions on drugs, both medical and "recreational". Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease.
Organizations Institute of Biology, London.
Publications Principal author of "Fundamentals of Pharmacology" 4th Edition published in November 2003 by Pearson Education, Australia.
Question I have refrred my question previously and I am highly obliged to receive your valuable guidance from time time. I appreciate your nobility for educating the patients. As I had mentioned, I take Tenormin 100 HCTZ 25 Amlodipine 10 and Losartan 100. Recently, owing to transfer in new place in India, my new doctor gave following observations to my current drug regiment.
1. Use of four drugs concurrently for controlling blood pressure is required in very few resistant cases. Besides more drugs you consume, more side effects will emerge if not immediately, then in due course as a result of prolonged use.
2. As per globally accepted guidelines on the treatment of blood pressure in patients younger than 55 (like you, particularly sexually active males) first choice initial therapy should be enalapril (sold as Enam) 5-10 mg 1-2 times a day. If two drugs are required, then amlodipine (sold as Amlodac) 5 mg daily in the morning OR a diuretic such as metolazone (sold as Metoz) 2.5 mg in the morning should be added.
3 If the blood pressure is still not controlled then treatment with three drugs may be required. These should be: enalapril, amlodipine (Amlodac) and Metoz. Atenolol (such as Tenoclor) and similar other agents such as atenolol need to be avoided because they perform less well than other drugs and the increasing evidence that they carry an unacceptable risk of provoking diabetes. Moreover in sexually active males they can cause erectile dysfunction.
In fact I have missing beats tachycardia and therefore I am taking atenolol. I am bit confused. In fact I am very much comfortable with the drugs I am taking. Sir, Will you give me proper guidance for me. I shall be obliged
Answer Dear Harisidhh
I tend to agree with the guidelines but there my agreement stops for you. If you are stabilised on your original regime, which is not over-the-top, considering your tachycardia, I see no reason to change to a new set of drugs. Losartan is similar in a way to Enalapril but does not have so many adverse effects so why change to a drug that has to be taken twice per day from one that is given once only. HCT is a diuretic and is very often favoured over others as it is well tested and has been available for umpteen years. The risk of getting diabetes from atenolol is minimal and as long as your diet and weight are OK the risk is even less. This risk is not normally considered unless there are other factors involved which may increase the risk of diabetes.
My opinion therefore, would be for you to maintain the status quo.
