AboutDr Alan Galbraith Expertise I can answer most questions on most drugs. 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 Author of "Fundamentals of Pharmacology" 5th Edition published in November 2007 by Pearson Education, Australia.
Many regards from Harsvadan from India. Sir, as you have responded my queries in the past, I am encouraged to ask you this query.
Currently I am on Tenormin 100 Losartan 100 and Indapamide 1.5 Amlodepine 10 mg. Recently in a reputed hospital, I had a healyh check up where all the parameters of the blood were normal except that my 2D echo stated Severe LVH with Dystolic dyfunction EF 65%. Cardiologist made changes ; He suggested Tenormin 100 to Bispoprolol 5 mg Telmisartan 80 in place of Losartan 100 Other drugs to continue. Further, he asked me to take Rosuvastatin 10 mg as according to him all hypertensive patients need to take statin. I have a BP Male 51 years My lipid levels are normal. I have a impaired glucose tolerance for which he suggested Metformin 500mg. I am now at a different place I do not know whether the change is a good one. I seek your guidance as to whether the changed drug regimen is OK. Mainly I have HBP ( Essential HBP)Tachycardia and IGT) I shall be highly obliged to receive your detailed response as you have helped me in the past Ragrds
ANSWER: Dear Harsvadan
I tend to agree with the change to bisoprolol as it is a better beta-blocker for some heart disorders such as you have. The change to telmisartan seems unnecessary to if your BP is being maintained well with the losartan. I am not in favour of chopping and changing drugs if there is no real or valid reason but maybe your cardiologist has. Please check with him. ( Having seen what medical reps can do to change doctors' prescribing habits makes be very cynical of this type of change - I am sure you'll understand what I mean). It all depends upon how impaired your glucose tolerance test is for me to comment on the metformin but I am sure here it will not be prescribed unnecessarily - at least I hope so. With regards to your lipid levels, if your total cholesterol is normal but HDL low compared to the LDL, the statin may be helpful but in Australia hypertension on its own does not indicate the use of a statin and rosuvastatin is rather more expensive than most others but better in some cases of severe hypercholesterolaemia. But in your case I cannot see why a cheaper one eg atorvastatin cannot be prescribed if your specialist insists on using a statin. In most persons they cause no adverse effects at all.
I will be overseas on holiday for three months as from Sunday next, except for a week in Mid-June so if you need me during this period the dates in June are 14th -20th (West Australian time).
Regards
Alan Galbraith
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QUESTION: I have tachycardia missing beats and pvcs. I am comfortable with tenormin which I have been taking since 1989. What he remarked after seeing my prescription was " all the drugs used by me are out of date...." I wonder whether bisoprolol is superior to atenolol.... If bisoprolol is ok i think the dose of bisoprolol 10 mg equivalent to atenolol 100 and not bisprolol 5 mg as prescribed by the dr. I am encouraged to ask you the dose equivalence. Alternatively, if the atenolol is out of date as commented by him, is metoprolol 100 not preferable which is comparatively a familiar drug ?
Answer Dear Harsvadan
In my opinion this is a silly statement. Aspirin has been used for well over a hundred years and still is superior in many ways to some modern equivalents. Morphine has been used (as opium) for thousands of years and still is a superior narcotic analgesic, used much more than all the newer ones put together. You get my gist? I do not always go by dose equivalence as it is my belief that the lower the mgs are the less work the liver and kidneys have to do - remember most drugs in excess can sometimes cause liver and kidney damage, so the less mgs one takes the better. (Please note that this a a sweeping generalisation and there are many exceptions, but it is something not many doctors consider when prescribing). Atenolol is as good a antihypertensive as bisaprolol or metoprolol but the latter are better with certain cardiac problems. If your doctor's reasoning is as in your first statement then I must concur with you opinion. Confront your doctor with my reasonings and see what he says and there are hundreds of examples. Your dose equivalents for treating HBP are spot on.
