Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 75-year-old male. I had IHD 40 years back. 23 years back, my doctor asked me to add Ismo 10 mg twice a day. Since then, I am taking it twice a day uninterruptedly. Then I was 54 years old. My BP has always been normal in all these years. Maybe 150/80 mmHg or 140/90 mmHg till a few years back. Now it is in normal level say 120/80 mmHg, 120/73 mmHg, 115/70 mmHg, etc. Since a year, I am experiencing low blood pressure at times, giving me vertigo-like dizziness for 1 hour or 2 only in the early mornings and when I take Vertin, it subsides after 1 or 2 hours. Recently, I went to a well-known cardiologist in my area. He checked me and said that I have systemic hypertension and I need not take Ismo any longer as I do not need it. The BP at that time was 130/70. Before my going to the above cardiologist also I have experienced these levels like 120/70 mmHg, 110/69 mmHg, 125/75 mmHg likewise. He further said after stoppage of Ismo, the BP levels come to normal levels and I will not experience dizziness anymore. But, I am afraid of stopping the Ismo abruptly for fear of getting an anginal attack, which I have never experienced. I am afraid whether to ask my doctor about this. So, I have stopped taking one dose of Ismo 10 mg during the night. Slowly I shall stop the other doses also in due course. Kindly give me your valuable advice about Ismo, about stopping Ismo and dizziness. Is there any harm if I stop one dose? Does long usage of Ismo trigger low blood pressure and vertigo? Please enlighten me on this subject.
Hello,
Welcome to icliniq.com.
Firstly, Ismo (Isosorbide Mononitrate) is given for angina or chest pain. If one is not having it without Ismo then it may be stopped. So it is not an absolutely necessary medicine in absence of angina. Next thing, it can cause low BP, (blood pressure) leading to dizziness. But, you mentioned, the lowest BP recorded was 110 systolic, and it is not too low to cause dizziness usually. Have you checked your BP while you being dizzy? Next thing, you said the response to Vertin (Betahistine), which is not likely in Ismo or hypotension induced dizziness. Vertin is for vertigo induced from the internal ear which is a very common problem. Also, importantly. dizziness induced by hypotension or Ismo will occur on standing or walking, but not while lying down or resting. So if it occurs on lying down as well or on neck movements then it is likely from the internal ear. Next, you should get one echocardiogram done to rule out the decrease in heart function as BP is remaining on the lower side. So overall, just go through the above description, and try to decide whether it is Ismo induced or from the internal ear, and you may stop Ismo as advised by the local cardiologist. Also, echocardiogram is necessary.
Patient's Query
Thank you doctor,
I get dizziness while I get up from the bed in the morning, occasionally but not all times. When I bend my head forward or look upward, I will get dizziness. I have BPPV also for the past five years. 20 days back, I felt a rush of blood in my head and fell on the bed. Within one minute, I got up. Again, I felt the same with mild intensity but this time I did not fall on the bed. I felt a different feeling other than vertigo. That is why I approached a cardiologist who said that I have systemic hypertension. My question is does Ismo cause low blood pressure in my case? I have Meniere's disease. 60 % loss in the left ear and 40 % loss in the right. Since I am having systemic hypertension, he has asked me to stop Ismo and Ecosprin forthwith. Apart from vertigo, Can this dizziness be because of Ismo and Ecosprin when there are no vertigo symptoms? He is of the opinion that both these two drugs are causing low bp in my case. He has suggested MRI of the brain and told me some technical terms which i did not understand, something regarding mean bp level, vessels enlargement or some thing like that. But I am dreadful about MRI not because of some irregularity in the brain but I have claustrophobia.
Hi,
Welcome back to icliniq.com.
I think likely cause for dizziness in you is Meniere's disease only, but Ismo can cause low blood pressure and dizziness as well, and you may stop it and see for the response. But, Ecosprin cannot cause either low BP or dizziness. You should also get an ECG and echocardiogram done to look for heart status and rule out the worsening of cardiac function. If you are not able to tolerate magnetic resonance imaging (MRI), then discuss regarding the adequacy of CT scan with your local doctor. So, you may stop both medicines as advised by the local cardiologist, and see for the response. But, if you get an angina, then Ismo needs to be restarted.
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Cardiology
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