Managing Side Effects of Heart Medications: When to Consider a Change

Medication issues

Dear Dr.
He,
I would like to inquire about heart medications.
Three years ago, I had an abnormal exercise electrocardiogram that indicated myocardial ischemia, and my heart rate was around 110 beats per minute.
My doctor prescribed Bisoprolol 100 mg and Concor 1.25 mg, one tablet each per day.
I have been taking them for three years, but I have been experiencing persistent dizziness, fatigue, and excessive sleepiness at work.
Recently, I visited a urologist due to urgency in urination and erectile dysfunction.
The doctor mentioned that Concor could cause sexual dysfunction as a side effect and suggested that I ask my physician to switch to a medication with similar efficacy to Concor but without the sexual side effects.
I would like to ask Dr.
He if Concor indeed has the side effects I mentioned, and whether switching medications could alleviate these issues.
However, I am concerned because I have been on this medication for three years, my heart rate has decreased to below 100 beats per minute, and my episodes of chest tightness have significantly improved and are quite stable.
The side effects are quite bothersome and uncomfortable.
Should I request my physician to change my medication? I am also worried that the new medication may not be as effective or that I might not tolerate it well.

I appreciate your guidance and suggestions on this matter.
Thank you.

Mr. Wang, 50~59 year old female. Ask Date: 2020/11/04

Dr. He Dongjin reply Cardiology

Hello, yes, it is true that Concerta can have side effects related to sexual dysfunction.
If you have been taking it for three years, did you experience these side effects before? If they have only recently appeared, they may not necessarily be related to the medication.
Changing medications might result in reduced efficacy.
It is advisable not to rush into asking your physician to change your medication; you can first consider stopping it to observe any changes before deciding whether a switch is necessary.
Changhua Hospital cares about your well-being.

Reply Date: 2020/11/04

More Info

Managing side effects from heart medications can be a complex issue, especially when you've been on a regimen for an extended period. In your case, you've been taking Beraprost (伯基) and Concor (康肯) for three years, and while you've noticed improvements in your heart rate and chest discomfort, the side effects such as dizziness, fatigue, and sexual dysfunction are understandably concerning.

First, let's address the medications you are currently taking. Beraprost is a prostacyclin analog used primarily for pulmonary arterial hypertension and can help improve blood flow and reduce symptoms associated with heart conditions. Concor, on the other hand, is a beta-blocker (bisoprolol) that is commonly prescribed for managing high heart rates, hypertension, and heart failure. While beta-blockers are effective in controlling heart rate and reducing the workload on the heart, they can indeed have side effects, including fatigue, dizziness, and sexual dysfunction.

The symptoms you are experiencing, such as persistent dizziness and fatigue, are common side effects of beta-blockers. The sexual dysfunction you mentioned is also a known side effect of Concor, which can be distressing and impact your quality of life. Given that you've been on this medication for three years, it's reasonable to consider whether a change is necessary.

When contemplating a medication change, it's essential to weigh the benefits against the side effects. Since you have experienced significant improvements in your heart rate and chest discomfort, it might be beneficial to discuss these concerns with your prescribing physician. They can assess whether the benefits of continuing Concor outweigh the side effects you are experiencing.

In terms of alternatives, there are other medications that can help manage heart rate and blood pressure without the same side effects. For example, other classes of medications such as calcium channel blockers or certain ACE inhibitors may be options worth exploring. These alternatives can provide similar therapeutic effects without the sexual side effects associated with beta-blockers.

It's also important to consider lifestyle modifications that can complement your medication regimen. Regular exercise, a balanced diet, and stress management techniques can significantly impact your overall heart health and may help alleviate some of the side effects you are experiencing.
Before making any changes to your medication, it is crucial to have a thorough discussion with your healthcare provider. They can provide guidance on the best course of action, including potential alternatives and how to transition safely from one medication to another. Additionally, they can monitor your response to any new medication and adjust the treatment plan as necessary.

In summary, while it is understandable to be concerned about the side effects of your current medications, it is essential to approach this issue collaboratively with your healthcare provider. They can help you navigate the options available, ensuring that you continue to receive effective treatment for your heart condition while minimizing any adverse effects on your quality of life.

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