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.
I quote below my earlier question and your answer. Rightly, your answer was a very systematic and scientifiacally accurate. I showed you answer to another senior internist. As my borther continued Prazocin 2.5 till last week, he said he was feeling drowsy in the morning and still not comfortable. At his request I took him to another internist with your reply and he very much appreciated your contents and was in full agreement. He asked us to delete prazocin as my brother has only minimal prostrate enlargement with normal PSA. He advised following medicines : ATENOLOL 50 AMLODEPINE 10 LOSARTAN 100 AMELIORIDE 5 + FRUSOMIDE 40. ATTORVASTATIN 10 + FENOFIBRATE 200 MG. Aspirin 75
Whether the above appear OK ? I feel that your goodself suggested HCT 25. Instead of Frusomide 40 and amelioride 5 mg one tablet called BIDRET L by Glaxo is available which contains Amelirode 2.5 and HCT 25.
I shall be obliged to receive your guidance. Thanks and regards in advance
Respected Sir,
Hello once again sir,
This is with regard to my eldest brother who is 67 years old hypertensive. He is on Atenolol 50 Losartan 100 Ramipril 5 mg and Amlodepine 5 mg. He had his regular health check up in which he had all normal blood tests except that his S cholestrol 205 and Triglyceride 298. His BP reading was 156/86 mm hg. In 2003 he had Mild ectasia in coronoray angiography. Internist changed his drugs from today as Atenolol 50 Amlodepine 5 mg HCT 12.5 Losartan 50 and ( Minipress XL )Prazosin 5 mg. As regards Lipid, he said it is familial and hennce lifestyle modifications will lower it automatically. He did not prescribe any lipid lowering drug. He also asked to discontinue Aspirin 75 as my brother has normal angiography and only HBP.
Sir, I would request you to guide us whether the new regime is ok. In my heart of hearts I feel some reservations though I am layman and should not be overwise to sit over the judegment of the doctor. I am encouraged to ask you because of your excellent guidance. Will you please guide me. If you find my contents as overwise, please excuse me in advance. Thanks and regards.
Answer
Dear Harswardhan
As he has been changed drugs today I will not say much more about his recent regime except it is not normal to give ramipril with losartan. His lipids need lowered on the total values but with cholesterol the HDL-C and the LDL-should be taken into account and I think drugs to lower them both should be considered eg a statin for the cholesterol and a fibrate for the TGs. The other drugs could be appropriate as the 156 (systolic)especially should be brought down, although the prazosin may not be necessary. I would give the losartan plus HCT twice per day as a first step before going to prazosin or other antihypertensives. In my opinion prazosin is only used when the others do not work or a quick decrease is wanted. Maybe it can be discontinued after BP checks. I disagree with the discontinuation of the aspirin 75 mg. If this is not causing any stomach problems ,many specialists recommend it to any person over 50 as a prophylactic. Both i and my wife have taken it for 10 years (I am 61).
Answer Dear Harswardhan
I do not want to get too involved with diuretics and their pros and cons in too much detail as it can become rather involved. Frusemide is very potent and can cause both potassium loss and sodium loss from the kidneys which can be problematic. Amiloride is given to counteract this effect. However, with antihypertensives like losartan this type can preserve electrolyte loss from the kidneys and amiloride is therefore not need and can sometimes cause potassium overload so unless your brother has frequent blood electrolyte measurements, I would think the amiloride may not be necessary. HCT is a less potent diuretic than frusemide and is the most widely used of the diuretics and in most countries comes combined with losartan in one tablet, usually at a dose of 12.5 mg. However, BP is sometimes not easy to control and interns very often have to play about with the drugs to maintain a realistic BP. It is very unusual for only one drug to work and the number of combinations is very large. Usually interns are advised to stick to the ones they know best so I would not be too critical without knowing all the details of your brothers history etc which cannot be done properly over the net. Again show your brother's intern what I have said for his opinion.
