Dr. Shubadeep Debabrata Sinha
Infectious Diseases
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
Hi doctor,
My mom had three strokes five days ago. While in the hospital, they said that she has diabetes, plagues in her artery, and some damage in her liver from taking too much Aleve (Naproxen). She is home now, and they advised her to take Amlodipine Besylate 10 mg, Atorvastatin 80 mg, Clopidogrel 75 mg, Hydrochlorothiazide 12.5 mg, and Lisinopril 20 mg once a day, and Metformin 850 mg thrice a day. She also takes one shot of Insulin and Aspirin once a day. I have changed her diet, and she started to eat lots of clean vegetables, different types of beans, some chicken, salmon, and fruit smoothies. With her diet change, is it necessary to take all that medicine? I want her not to take so much medicine.
Hi,
Welcome back to icliniq.com.
Please share her reports for stroke episodes.
Are you talking of myocardial infarction (MI) with coronary artery blockage or a neurological stroke comprising ischemia in the brain due to cerebrovascular-related blockage?
It appears that the medicines she is prescribed are suggestive of a previous episode of MI. These medicines are essential for preventing further attacks, and in clinical practice, these medicines' intake must be continuous and monitored, and doses tailored accordingly.
Amlodipine, Lisinopril, and Hydrochlorothiazide are antihypertensives, which also have preventive properties against recurrences of stroke and MI. Similarly, Atorvastatin, an antihypercholesterolemic medicine, will prevent the formation of blockage in arteries, in conjunction with Aspirin and Clopidogrel, antiplatelet agents.
It is good that you are giving her a healthy diet, but my suggestion would be to consult a qualified nutrition specialist and provide accordingly.
Patient's Query
Hi doctor,
Thank you for your reply.
The three stokes were from the right side of her brain. I am concerned because the Metformin she has to take 3 times a day is causing her to puke every time. So every day 3 times a day, she is throwing up, which causing her to be unable to eat much. Also, on her discharge papers, it says TIA (Transient ischemic attack) stroke. If these medicines are necessary, then I think the dosage is too high. She is weak and tired all time, every day. This is not helping her to have a good quality of life.
Hi,
Welcome back to icliniq.com.
Typically tablet Metformin is started at 500 mg once daily and gradually increased to a maximum dose of about 2g/day. Higher doses could cause vomiting and nausea. Usually, additional hypoglycaemic medicines (oral hypoglycaemics and Insulin) are started along with antihyperglycaemic (for example, Metformin) drugs if higher dosages of Metformin are necessitated.
Also, I need to know if she is taking gastroprotective agents like Pantoprazole alone or in combinations such as prokinetic agents (e.g., Cinitapride, Domperidone, etc.)?
Why was Metformin started, and why and how many units of Insulin are being given daily? When was her diabetes/hyperglycemia are confirmed?
It would be advisable to share all clinical reports, including blood test reports for diabetes, hypertension, stroke-related discharge summary, brain MRI (magnetic resonance imaging)/CT (computed tomography) scan, and treatment reports.
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Infectious Diseases
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