Our cardiac meds – in real life, not just in studies

16 Sep

by Carolyn Thomas    @HeartSisters    September 16, 2018

If you – like me – have had a heart attack, you are now likely taking a fistful of medications each morning, everything from anti-platelet drugs to help prevent a new blockage from forming inside your metal stent to meds that can help lower your blood pressure. All of these cardiac drugs have been studied by researchers before being approved by government regulators as being safe and effective for us to take every day.

But one particular study on this subject published in the Journal of the American College of Cardiology(1) raised a unique point:

“Little is known about the benefits and risks of longterm use of cardiovascular drugs. Clinical trials rarely go beyond a few years of follow-up, but patients are often given continuous treatment with multiple drugs well into old age.”  

You too may have been told that many of your meds will become part of a morning routine for the rest of your natural life. Heart disease, unlike an acute medical crisis such as appendicitis, means a chronic and progressive diagnosis. Doctors can stent us or bypass us or zap our electrical circuits or replace wonky bits with implantable marvels, but those are short-term solutions. They cannot fix what damaged our precious hearts in the first place, often decades earlier. See also: The Cure Myth

And one of the biggest risk factors for having another heart attack down the road is having already had one – hence your doctor’s concern that you take your current cardiac meds exactly as directed. It’s also why drugs remain the first-line tools in the physician’s toolbox.

The lead author of this particular study in JACC is Professor Desmond Julian, a distinguished U.K. cardiologist credited with establishing the world’s first ever Cardiac Care Unit in Sydney, Australia. It turns out that Professor Julian had a uniquely personal reason for worrying about just how safe cardiac drugs are over the longterm.

Nine months before the JACC paper was published, he described his own medical experience, in correspondence with the British medical journal, Lancet.(2)  Professor Julian had experienced “two potentially fatal events” which he also describes as “almost certainly due to taking beta blockers” for 15 years (drugs usually prescribed to control heart rhythm, treat angina, or reduce high blood pressure). After the first event, he developed severely low blood pressure when exercising; after the second, he was diagnosed with an abnormally slow heart rate due to a cardiac rhythm problem called sinoatrial heart block. Both abnormalities ceased when his beta blockers were ultimately stopped.

But he had also developed a debilitating cough from taking medications called ACE inhibitors for 10 years, and aspirin-induced gastrointestinal bleeding after being on that drug for 15 years. As Professor Julian wrote:

“We suspect such risks are not uncommon. The two episodes due to the beta blocker could have been fatal if immediate help had not been available, and the death would NOT have been attributed to the drug.

“Therefore, we feel it is important to challenge the assumption that the efficacy and safety of drugs given in the relatively short term remain the same over the long term and into old age.”

“Although there is abundant evidence of the value of four groups of drugs (aspirin, beta-blockers, statins, and angiotensin-converting enzyme [ACE] inhibitors) in the prevention and treatment of heart disease in the first few years after an acute coronary event, there is inadequate evidence for the continuation of these drugs beyond that time.

“Millions of patients with coronary heart disease have been receiving cardiovascular drugs for years, in the absence of any evidence from clinical research trials to justify their use beyond 5-10 years.

“Additional concerns have arisen with the introduction of the fixed-dose polypill as a potential life-long therapy. Reliable evidence on withdrawal versus continuation of drugs is also needed, so we can establish when to stop long-term use of cardiovascular drugs that are effective and safe in the short term.”

Professor Julian and his team concluded their paper with a number of recommendations related both to future research and to improvements in patient care:

1. The gap in knowledge regarding the longterm efficacy and safety of cardiovascular drugs needs wider recognition. Their study cited drug trials in which the term “long-term use” referred to a median 33 months of follow-up, or worse, a real-world Swedish registry in post-heart attack patients(3) defined a longterm perspective as only one year of follow-up.
.
2. The untested assumption that short-term drug benefit over a few years post-MI extends into long-term followup and older age needs to be challenged.
.
3. The trial evidence for beta blockers, which began before the introduction of primary PCI, is outdated, meaning their role particularly needs to be questioned. They propose a potential randomized trial for gradual withdrawal of beta-blockers
.
4. We need to encourage more Randomized Controlled Trials (RCTs) to continue into long-term follow-up, and to reflect real-world practice, such as including increased numbers of older patients.
.
5. Regulatory placebo-controlled trials tend to lead to a growing list of approved drugs, so a new paradigm (e.g., more head-to-head trials) is needed.
.
6. The problems of polypharmacy need to be tackled.
.
7. Deprescribing should be considered more often, and requires more objective evidence for its practice.
.
8. RCTs that study withdrawal of longterm medication are needed; the case for a withdrawal trial of beta-blockers is particularly pertinent.
.
9. More research on the effectiveness and potential harms of cardiovascular drugs is needed in older patients, who often have co-morbidities and are sometimes frail.
.
10. Regulators, professional societies, the cardiology research community, and health care providers all need to engage with these problems of long-term prescribing of multiple drugs.
.
11. Both cardiologists and primary care physicians should pay greater attention to each patient’s longterm needs, by regularly reviewing, for example, whether multiple long-term medications are truly of benefit.

.

If you’re a heart patient wondering how long it might take for any or all of these recommendations to be acted upon, do not hold your breath.

We know that the lag time between emerging research and resulting evidence-based changes in how medicine is practiced can take years. The delay has been called “change implementation failure” among health care organizations; it’s generally estimated that it takes an average of 17 years for research evidence to actually reach clinical practice at the bedside.(4) Prescribing these drugs to virtually all heart attack survivors is a well-established and popular medical practice, and this practice will not go away quietly. And the powerful drug industry will hardly sit by in the face of any recommendation to support reducing the pool of potential sales.

So what can patients do while we wait? First, if you have been taking beta blockers for several years, ask your own physician to review this new Norwegian study on heart attack patients that suggests there is no association between beta blockers and all-cause mortality.(5) It explains why decades of routine clinical practice recommending these drugs has been based on older studies performed in a pre-bypass surgery/pre-stent era when heart attack patients were treated with only bed rest and morphine.

.
1. Xavier Rossello, Stuart Pocock, Desmond Julian, “Long-Term Use of Cardiovascular Drugs: Challenges for Research and for Patient Care.” Journal of the American College of Cardiology, ISSN: 2015. 1558-3597, Vol: 66, Issue: 11, Page: 1273-1285
2. Desmond Julian, “Effects of long-term use of cardiovascular drugs”. Correspondence| Volume 385, ISSUE 9965, P325, The Lancet, January 24, 2015
3. T. Jernberg, P. Hasvold, M. Henriksson, et al. “Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.” Eur Heart J, 36 (2015), pp. 1163-1170
4. Trochim W “Translation Won’t Happen Without Dissemination and Implementation: Some Measurement and Evaluation Issues.” 3rd Annual Conference on the Science of Dissemination and Implementation, Bethesda, MD: 2010
5. Dahl Aarvik M, Sandven I, Dondo TB, et al. Effect of oral beta-blocker treatment on mortality in contemporary post-myocardial infarction patients. Eur Heart J Cardiovasc Pharmacother. Published online September 8, 2018.

Q: How long have you been taking your cardiac meds?

.

 See also:

20 Responses to “Our cardiac meds – in real life, not just in studies”

  1. Erudite Scholar October 16, 2018 at 4:49 pm #

    If you have ever suffered a heart attack or you are at risk of a heart attack, you need to seek specialized medical care immediately.Healthy eating, exercising, quitting smoking and taking medication are some of the steps one can take to live a healthier life.

    Like

  2. Gerard Marshall September 24, 2018 at 6:01 pm #

    I am regarded as a fit and healthy 62 year old man who prior to 5 years ago in August 2013 had a double bypass in the GHI in Glasgow UK.

    I take first thing in the morning before breakfast bisoprolol 1.25mg, a rampiril 2.5mg, clopidogrel 75mg, simvastatin 40mg and lansoprazole 30mg all of which have been prescribed since the operation. I do not take aspirin because of vulnerability to stomach ulcer.

    I have a changed diet with lots more fruit, vegetables, fish, chicken, rarely consuming red meat with less fat, salt and more control of alcohol consumption. My sleep pattern has been very poor since my operation. I have had aching muscles also since the operation, the latter having benefited from halving my statin intake.

    My friends suggest a different statin. I have read that ACE inhibitors can significantly disrupt sleep. I take regular exercise, attend gym and hill walk. My father and his brothers in their 60s have had heart diseases diagnosed. I smoked cigarettes until 1993 when I stopped.

    I would like to move off or change my medication.
    Gerard Marshall

    Liked by 1 person

    • Carolyn Thomas September 27, 2018 at 8:34 pm #

      Hello Gerard – First I want to congratulate you on successfully undertaking so many heart-healthy steps (cutting back on alcohol, quitting smoking, improving your diet and regular exercise!) – and taking your meds regularly. Most cardiologists would consider you to be a dream heart patient!

      I’m not a physician so cannot comment specifically on your medications, except to say generally that some heart patients who cannot tolerate aspirin do take clopidogrel (brand name Plavix) as you are. The beta blocker you’re taking is specifically the drug Dr. Julian is concerned about taking longterm (e.g. over five years).

      Ask your doctor for an appointment to do a full medication review to see which if any of those meds can be reduced in dosage or eliminated or replaced with an alternative drug that is safer. Do some homework beforehand (check sites like Drugs.com for alphabetical lists of specific drugs and possible side effects).

      Most sources recommend taking simvastatin in the evening, not in the morning, so also confirm with your doctor about timing. Your friends may be right – Many patients have found that switching brands of statins (each one has a slightly different formula) may in fact reduce troubling side effects, so ask about that too, as you already have seen evidence that reducing your statins result in less leg pain. Good luck to you…

      Like

  3. Meghan September 23, 2018 at 6:57 am #

    A bit late getting in on this but thanks again Carolyn for this great article. After reading this I decided to review all the medications I’m taking. Last Friday I had an appt with my family doctor, an older woman who I really don’t like much, but I’m trying to listen to what she says because she does have a good perspective on some of my health issues. We discussed what I was taking, had taken, and in her opinion need to take but I’m refusing to for various reasons. I think she immediately labeled me as noncompliant in her mind and she tossed me off when I said I research everything — “Well, you just keep on researching your medications.”

    The appointment went downhill from there. She yelled at me that I needed to “do something” about the back pain I have and prescribed physical therapy, which is probably a good thing and I’ll at least consult with a therapist about it. She was literally shouting at me at times. She even criticized my parenting of my older children (in context of my depression over empty nesting). I came out of the session feeling a bit beat up. Later as I thought about it, I got angrier and angrier. She’s kind of insensitive but at this appt she acted like a crazy loon. I think the criticism over parenting was what caused the she-bear in me to rise! It just takes me awhile to sort out what happened and react sometimes.

    I’m definitely switching family doctors. I’ll take the good advice she’s given and find someone who is more gentle and understanding. I’ll follow up with the nurse practitioner that I really like who does listen.

    Also, I’m going to go through my cardiac meds and check all side effects and list whatever is a red flag, and discuss them with my cardiologist at my appt with her in October. I especially question the statins and whether or not they are causing back pain and muscle weakness, which is why the family dr wants me in physical therapy.

    I do wonder if you can answer a question for me (the family dr and I argued over this). Is ibuprofen safe for cardiac patients, and does taking it in high doses cause heart blockages? I’m convinced that when I did this for arthritis, that’s what caused me to end up with two stents, especially in the case of the second one after I stopped taking Brilinta and an orthopedist’s physician assistant told me it was safe to take up to 1800 mg of ibuprofen a day (I generally took 1200). It was so great to not have pain all the time but the heart symptoms I developed on that medication regimen were worse than the first, and I ended up with a second 90+% blockage in the LAD and a second stent. I was under the impression that ibuprofen could have caused this. I no longer take it (but miss it!). Do you know anything about this or where I might find definitive info? I really need to settle this in my mind. Thanks!

    Like

    • Carolyn Thomas September 23, 2018 at 6:52 pm #

      Meghan, you are asking a very important question that all heart patients must know about: the FDA has issued a warning about the link between a class of pain meds called NSAIDs and heart disease risk, even short-term. These include over-the-counter drugs like ibuprofen (Motrin, Advil) and naproxen (Aleve) and prescription drugs like Celecoxib (Celebrex), diclofenac (Cataflam, Voltaren).

      Aspirin is also in the NSAID family of drugs, but it does not pose a risk of heart attack or stroke, so is not part of the FDA warning.

      Here’s what the Harvard Heart Letter has to say about this warning:

      “Heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID. The risk increases with higher doses of NSAIDs taken for longer periods of time.

      “The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.In view of the warnings, it is best for people with heart disease to avoid NSAIDs if at all possible, and for everyone who is considering taking an NSAID to proceed with caution.”

      Read the rest of the Harvard document for more info, or just Google any major university site as this is a very timely topic.

      Like

      • Meghan September 25, 2018 at 6:45 am #

        Carolyn, THANK YOU for this information and for leading me to find resources to confirm what I’ve believed. I actually wonder if the whole problem with my heart blockages was ibuprofen from the very beginning, because I seem to be fine since not taking it anymore and had my worst symptoms when I was on a high dose for a long time. Continuing to research this topic!

        Like

  4. Jean Jordan September 17, 2018 at 10:22 pm #

    Hello Carolyn,
    Six years ago at the end of February I had a heart attack at age 75. I had a stent inserted and was given about 5 prescriptions including Atorvastatin, 80 mg per day. I had never heard of statin drugs at the time, though now I certainly have.

    I felt fine the for the next few days and when I went home from the hospital. After two weeks I had a treadmill test but I was now too weak to finish. At the end of March I had blood work done but no one picked up on the bold print meaning “too high” for some of the readings.

    At the end of May I had my prescriptions renewed. I was by now definitely not well. From being a very active person, swimming and walking regularly, I could now barely walk. When I met a friend in town, we chatted for a few minutes and I asked her about our book club meeting the previous week because I couldn’t remember much of the discussion. I asked her whose house it was at because I couldn’t remember the setting or who was there. She stared for a few minutes and then replied, “It was at your house.”

    That was the turning point for me. I made an appt. for the following week and by that time I could hardly walk. I shuffled over to my doctor’s office. She took one look at me, took my blood pressure and immediately told me to stop the statin drug and another drug, and to cut my blood pressure drug in half. She also put me on the wait list for the cholesterol clinic. That took about two years to get in. When I finally saw the doctor there he asked, after reading my list of meds, who said I should take magnesium and CO-10. I answered, my naturopath. He nodded and said, “That’s good”, then showed me his large container of magnesium on his bookshelf which he gets wholesale. I agree that, as women, we need to ask more questions and not just accept everything we are told. A male friend, who had also had a heart attack and given a statin prescription was given 5 mg every other day. Why such a discrepancy? At least, my health has improved and I am doing fine with two low dose heart drugs and lots of exercise.

    So now I know, I am intolerant of statin drugs. Had I stayed on that medicine I don’t think I would have survived for much longer. When I asked one of the cardiologists at the information meeting why they were giving everyone statin drugs, the answer was, “Because we want to HIT IT HARD!”

    Well, they certainly hit me hard! I am wondering if anyone else has had this kind of problem?

    Liked by 1 person

    • Carolyn Thomas September 18, 2018 at 5:30 am #

      Hello Jean – I’m so glad to hear that you are “doing fine” now compared to your previous nightmare symptoms. A number of studies suggest that – compared to younger adults – people 75 or older are more likely to suffer serious side effects from using statins. Besides the commonly reported muscle problems you mention, statins in older people can also cause falls, memory loss and confusion, and nausea, constipation, or diarrhea. Speaking of falls, these are particularly worrisome and are also linked to taking blood pressure meds that result in dangerously low BP.

      Most statin researchers (funded largely by the drug companies that manufacture statins) did not enroll participants over 75 in their studies, so it’s impossible to predict that what works for younger people is also safe and effective for elderly patients.

      You were very smart to take pro-active steps when you did. Keep it up!

      Like

  5. Brenda Plakholm September 17, 2018 at 10:14 am #

    Re long term use of cardiovascular meds: I’m questioning this at the moment. I had triple bypass surgery 5 years ago. I’ve been experiencing some off and on symptoms since Christmas so I consulted with my cardiologist and had both a MIBI and a CATscan. Definitely not happy with the results.

    Two out of the three bypasses are completely stenosed and the cardiologist has advised me that it would not be to my advantage to try and salvage them. In the interim I have been prescribed a beta blocker for a six month period and re-referred to the Cardiac Rehab Program. If at the end of six months, I am still having issues a stent will be considered. My query to the cardiologist next time I see him is Was there any point to taking statins as I still developed blockages – and I also have concerns about the Beta Blocker after reading your article.

    I have an appointment coming up the end of October where I will voice these concerns.

    Liked by 1 person

    • Carolyn Thomas September 17, 2018 at 1:48 pm #

      “Definitely not happy” is probably the understatement of the year, Brenda. This scenario with your bypass grafts is very distressing. I’m not a physician so cannot comment specifically on your situation, but I can tell you that prescribing beta blockers for short term usage by heart patients (e.g. your 6-month trial) has been well studied. It’s longterm beta blockers (no studies done on that) which Dr. Julian is concerned about.

      I’m curious about why stents are not being considered right away for “completely stenosed” grafts. Perhaps collateral arteries are already providing blood flow around those blockages? This could also be the reason for the rehab referral. There are several reasons for these decisions, which I hope will be very clearly explained to you next month.

      Meanwhile, I’m glad you’ll be back at Cardiac Rehab. Good luck to you…

      Like

  6. Charlotte Burnham September 16, 2018 at 10:19 am #

    This very issue is playing out in my life right now, but for me, it’s with the prescription meds I’ve been taking long term for a kidney transplant I received 24 years ago.

    One of them has been around for a very long time, and I do remember being warned of the potential side effects of long term use, but I was young, fairly strong (and otherwise healthy), and didn’t have any other good options, so I went ahead and have taken this cortico-steroid every day since then.

    There is another immunosuppresant drug that had been recently approved by the FDA at that time (within the previous 5-10 years I believe) that was improving the success rates of transplantation in a staggering way. Some of its known side effects were made known to me, and again, I felt like my options were limited and “long term” was a great unknown that I would have to deal with later.

    In the last six years, I’ve developed a series of painful, debilitating symptoms that can’t seem to fit into any doctor’s checklist of a specific disorder, disease or syndrome. My suspicion for the last couple of these years has been that it could be my body responding to the long-term use of any one of the transplant meds or the combination of them.

    My argument for this, specifically, is this: there are very, very few people who received an organ transplant in the early to mid 1990s and are still walking around with that organ still functioning, and they are still taking the same prescription combination. And out of that small group of us that does exist, I am unaware of any studies, or tracking of any kind that is being done about our overall health outcomes as we, and our grafts, age.

    It was only last month while talking with my primary care doctor once again about how we still can’t come up with a name for what’s wrong, or any kind of real plan for me that he finally proposed his hypothesis that maybe this is my body reacting to 25 years of cortico-steroids.

    I actually didn’t laugh at him (I know I’ve offered this as a suggestion several times in the last few years already) and agreed with him. At least the conversation can begin.

    But, our conversation also circled back to where I was in 1994. If I want to keep the kidney, which is still working well enough to keep me off of dialysis, which keeps my overall health (including cardiac health) in better shape, these medications are not optional. However, the medications are causing secondary effects that are diminishing my quality of life in alarming ways and at an increasingly rapid rate. I do have choices. It’s just that there really aren’t good ones.

    I know I’m talking about the realm of transplantation here, but it relates precisely to your post! The new heart and BP meds are being generated and released into the market all the time. We, the patients don’t really feel like we have a lot of choice about whether or not to take what our doctors prescribe. That may be because we don’t know enough about what the meds do, we are afraid to question our doctors, or we are afraid to put ourselves back at a higher risk of having another cardiac event. And, these meds usually do what our doctors expect them to do. For a while or for a few years, even. But, the bigger question becomes, when do they start to do more harm than they are providing benefit?

    And, maybe in cardiac medicine, there will be better answers than we have right now for transplantation. Maybe, there will be other ways (updated reparative surgeries, newer meds …) to provide benefit for cardiac patients over the long term rather than just keep us on the same old meds we’ve been taking for years.

    Liked by 1 person

    • Carolyn Thomas September 16, 2018 at 1:56 pm #

      Thank you Charlotte for your eloquent and thoughtful comment in response to this post. I think you’re so right – there are strong parallels between your transplant drugs and the longterm cardiac meds that this particular study focused on. And you were a “young, fairly strong and otherwise healthy” person when you had surgery – just the kind of highly motivated patient who doesn’t think twice about things like serious side effects over decades to come….

      I just had coffee the other day with a woman whose husband had undergone a lung transplant a couple of years ago. She is very active in the transplant community and told me that a shocking percentage of organ donors simply stop taking their anti-rejection meds eventually.
      Quality of life is, in my opinion, an often-ignored element of how medicine is practiced. The need to keep mortality rates down at first seems to win over patient reports of distressing side effects of doing so as the years go by.

      We need and deserve to know what the specific price is that we’ll have to pay for those years…

      Like

  7. Deborah Walker September 16, 2018 at 8:21 am #

    Once again, Oh Psychic One, you have written a great article about something that has been troubling me.

    18 months post-op (thoracic aortic aneurysm) I’m wondering if I still need to be on the “fistful”. However, I haven’t brought it to the attention of the doc because my blood pressure still fluctuates from a bit too high to “stand up and faint”.

    Now I’m wondering if the beta blockers are causing the dangerously low BP. I’m printing this to take to my next medical appointment.

    Liked by 1 person

    • Carolyn Thomas September 16, 2018 at 8:42 am #

      Hi Deborah! I’m hardly psychic – I’m just interested in the same things that YOU are interested in, clearly! 🙂

      I’m thinking that, not surprisingly, doctors treat to numbers. (BP a “bit too high”? Must prescribe more drugs/different drugs to get it down!)

      One of the most shocking things about the study I mentioned here was the accepted definition of “longterm” in medical research. A Swedish study(3) on the safety/efficacy of cardiac drugs that was over in ONE YEAR is called “longterm” – even in the title of the published study!?!

      For some people, staying on a specific drug may well be very important, year after year. For others, a medication review is appropriate (and likely overdue!) Good luck to you…

      Like

  8. Sandra Sizer September 16, 2018 at 6:57 am #

    Because I started having problems early on, I’ve been on some of my heart meds for decades. Way back when, I know that the beta blocker, ACE inhibitor, and statin saved my life.

    But at this juncture I wonder just what exactly is going on. I know these meds affect my brain chemistry: first, thanks to metaprolol, I lost my synesthesia — not a big deal in anybody’s book but mine, and considered very minor compared to saving my life, but I cherished it. [My form meant hearing music in ribbons of color.]

    Now my sense of taste and smell are markedly diminished. Some of this is, I know, due to age, but now I understand it’s also partly due to a side effect of the meds. I wonder if some of my fatigue/lassitude is due to bradycardia.

    I’ve been saying for quite a long time that I think I’d feel better if I were pumping more pressure. And what about the mysterious bruises that appear with no apparent cause? Could it be that the 81mg aspirin I’m taking is responsible? If so [and I think it probably IS so] then what assurance do I have that it’s not causing bleeds in my brain? I have no wish to become “Methusalahina”, thank you anyway, and if the meds are reducing the quality of my life, then …

    Why is it so impossible for [most] doctors to understand that for some of us, it’s not the quantity of life, it’s the quality?

    Liked by 1 person

    • Carolyn Thomas September 16, 2018 at 7:13 am #

      All good questions, Sandra! I haven’t ever heard that word “Methusalahina” before, but I agree with you: most of us have no desire to live forever if it means our quality of life is deteriorating! Time to book a full medication review appointment with your GP, I’d say.

      Similarly, just this week, a routine lab tests showed a sudden significant drop in my blood potassium levels since starting a new (second) blood pressure med prescribed to keep my BP within the (new) lower guidelines. Solution: eat more bananas, and come back in a few weeks for more tests. But ironically, it turns out that one of the important roles of potassium is to maintain a healthy blood pressure.

      So the scenario is this: I’m taking these new BP meds, which unfortunately lower potassium, which was helping my BP in the first place… Arrrrgh!

      Like

      • sandra sizer September 16, 2018 at 7:31 am #

        You’ve never heard “Methusalahina” before because I invented it this morning just for my comment 😉

        I had the potassium problem too, which was too acute to be solved by bananas. In the beginning the KCl scrip really did help, but eventually I weaned off it. I have been squawking about feeling overmedicated and I have rejected at least half a dozen meds my cardiologist suggested would help. He, thank God, has gone along with me. Now we shall see how he reacts when I propose reducing the current regime.

        Liked by 1 person

        • Carolyn Thomas September 16, 2018 at 7:39 am #

          Keep up that squawking, Sandra! I’m thinking the same about my bananas option, but until my own deprescribing medication review, I’ll keep eating them… Unless you actually change doctors and find one who really looks suspiciously at a lengthy Rx list (this does happen!), it will remain the patient’s job to stand up and start squawking about a meds review!!

          Like

  9. Andrea R September 16, 2018 at 6:02 am #

    Hi Carolyn. This is such an important post. As you pointed out, we are given these meds with no idea of they affect our bodies twenty or thirty years down the road. In addition, how will the combination of medications affect our bodies twenty or thirty years from now?

    I was prescribed 90 mg nifedipine for Prinzmetal’s Angina, which was controlling it (and the Raynaud’s) fairly well. When I had a stroke, the first night in the rehabilitation center, my blood pressure dropped (while I was on the toilet, no less!) and I almost passed out. The doctor lowered the nifedipine to 30 mg. Several weeks ago I was hospitalized for chest pains and they determined for some reason (still not entirely clear to me), I now had another form of angina. When they tried to raise the nifedipine to 60 mg, my BP tanked. My cardiologist added Ranexa which is helping.

    I am currently taking 24 medications (3 of them PRN, or as needed), not including supplements. I am 57 years old. They just keep adding, never taking away. None of my doctors speaks with another. No PCP has the time to call all of my specialists and take the time to discuss what can be discontinued.

    Liked by 1 person

    • Carolyn Thomas September 16, 2018 at 6:47 am #

      Thanks for this, Andrea. Your story is alarmingly common: yet another drug is prescribed to counter the other drugs’ side effects. We hear a lot about the risks of high blood pressure, but LOW blood pressure is not a benign side effect if it increases the risks of fainting and falling. You sound like an ideal candidate for deprescribing, but it seems that this has to start with you: please make an appointment with your GP (to start) to discuss a full medication review. Good luck to you…

      Like

Your opinion matters. What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: