Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
I am a 65-year-old female, and my current medications are as follows Atorvastatin 20 mg 1 tablet in the evening, Sandoz Perindopril and Indapamide 4 mg/1.25 mg 1 tablet in the morning, Dexilant 30 mg 1 tablet and Calcite D 500 mg - 400 UI in the morning, Riva Atenolol 50 mg in the evening. My blood pressure measurements vary between 140/70 mmHg to 170/94 mmHg. So my above BP medication has been changed. The doctor stopped Riva Atenolol 50 mg in the evening and changed Sandoz Perindopril and Indapamide 4 mg/1.25 mg 2 tablets in the morning. Do you think Riva Atenolol 50 mg should be kept? I had an angina problem before when I did not take the medication. Sandoz Perindopril and Indapamide 4 mg/1.25 mg 2 tablets instead of one is good? What do you suggest? Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for your query. I understand your concern. Your blood pressure is elevated despite being on these two medicines. So, it would be best if you had the addition or dose escalation in the existing medicine. So, I agree with increasing the dose of Perindopril Indapamide to two tablets. However, withdrawal of Atenolol is not required, and it should be continued as it is, in my opinion. This is also because of suspected angina, and sudden withdrawal may sometimes cause withdrawal symptoms. So, Atenolol should be continued, and Perindopril Indapamide may be increased to two tablets. Now, if there is a history of probable angina, you should also discuss with the treating doctor the addition of low-dose Aspirin. I hope this has helped you. Thank you.
Patient's Query
Hello doctor,
The patient is 65 years old and takes medication to keep her BP under control. She is currently not taking any medication for cholesterol because it has been removed from her medication list as part of a trial to determine whether it reduces her body pain (which did not). She had a lipid profile test done today. The results of the test show that her cholesterol levels have increased slightly since she stopped her cholesterol medication. I am attaching the test report to determine whether any cholesterol medication needs to be reintroduced and at what level cholesterol medication needs to be reintroduced if not now. Will she continue to do cholesterol tests every 3 months? Currently, she is taking the following medications:
Morning 1 tablet Sandoz Perindopril 4 mg 1.2 mg, 1 tablet calcite D 500 mg.
Evening: 1 tablet calcite D 500 mg 400 UI, half tablet of 10 mg Amlodipine, 1 tablet Atenol 50 mg.
BP is under control. However, since she has been taking half of 10 mg Amlodipine, her feet have been slightly swollen as a side effect of the medication.
Can she take 1 tablet of Sandoz Perindopril 4mg 1.2 mg (or 1/2 of 1 tablet of Sandoz Perindopril 4 mg 1.2 mg) instead of half of 10 mg Amlodipine?
If yes, which would be better, 1 tablet of Sandoz Perindopril 4 mg 1.2 mg or 1/2 of 1 tablet Sandoz Perindopril 4 mg 1.2 mg) instead of half of 10 mg Amlodipine?
Hello,
Welcome back to icliniq.com
I have gone through the reports. The most important parameter in the lipid profile is LDL cholesterol, which is significantly elevated in the recent lipid profile (the normal level is less than 3.4 preferably less than 2.6). So, cholesterol medicine should be reintroduced now and needs to be continued as cholesterol is increasing after stopping it. She should also continue to have a healthy lifestyle like reducing her intake of oily, fatty meals and regular walking as much as possible. Regarding hypertension, she can take Perindopril indapamide 4/1.25 mg twice daily as well, however total indapamide dose would be 2.5 mg, which is the maximum dose. So, we would want to avoid it just to eliminate any possibility of side effects. So, alternative options would be to take perindopril indapamide 4/1.25 mg in the morning and plain Perindopril 4 mg in the evening. Alternatively, other calcium channel blockers like Cilnidipine 10 mg may be added instead of amlodipine, which is less likely to cause side effects of pedal edema.
I hope this helps.
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Cardiology
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