Managing Heart Conditions: Concerns About Herbesser, Concoe, and Inderal

Herbesser, Concoe, and INDERAL issues?

Thank you, Director He, for your response amidst your busy schedule.
I often see your enthusiastic answers on this platform.
Thank you.
I have a heart condition and have been taking Inderal (propranolol) for nearly five months, one tablet in the morning, noon, and evening.
Recently, I have been feeling particularly unwell, so I visited the cardiology department again.
This time, the doctor prescribed Herbesser (bisoprolol) half a tablet in the morning and evening, Concor (bisoprolol) 1.25 mg, and half a tablet of Kankun (another brand of bisoprolol), along with Entresto (sacubitril/valsartan).
The doctor did not inform me whether these medications could be taken together, and I am hesitant to make any decisions on my own.
Therefore, I am reaching out online for advice.
Given the dosage prescribed by the doctor, should I stop taking Entresto? Is there a risk of hypotension if I take all three medications together?

Mr. Wu, 20~29 year old female. Ask Date: 2023/03/20

Dr. He Dongjin reply Cardiology

Hello, that's correct.
Kangxin and Entel are similar in their pharmacological mechanisms; the only difference is between long-acting and short-acting formulations.
Indeed, Kangxin and Entel should not be taken together.
Entel should be discontinued before taking the other medications, as taking all three together may increase the risk of hypotension.
This is not common unless the patient already has low blood pressure or has an unusually strong response to the medication.
Peace and care from Changhua Hospital.

Reply Date: 2023/03/20

More Info

When managing heart conditions, particularly with medications like Inderal (propranolol), Herbesser (bisoprolol), and Concoe (metoprolol), it is crucial to understand their pharmacological properties, potential interactions, and the implications for your health.
Inderal is a non-selective beta-blocker that is often prescribed for conditions such as hypertension, anxiety, and certain types of arrhythmias. It works by blocking beta-adrenergic receptors, which can decrease heart rate and blood pressure. Herbesser and Concoe are selective beta-1 blockers, primarily affecting the heart and are used for similar indications, including hypertension and heart failure.
Given your history of heart disease and the recent prescription changes, it is essential to approach this situation with caution. The combination of these medications can lead to an additive effect on heart rate and blood pressure. While beta-blockers are generally safe when used appropriately, taking multiple beta-blockers simultaneously can increase the risk of side effects, including bradycardia (slow heart rate) and hypotension (low blood pressure).
In your case, you mentioned that you have been taking Inderal for five months and have recently been prescribed Herbesser and Concoe. It is important to clarify with your healthcare provider whether it is appropriate to take these medications together. The prescribing physician should ideally assess your overall health status, including your blood pressure and heart rate, before making such recommendations.
If you are experiencing increased discomfort or side effects, it is crucial to communicate this with your doctor. They may suggest monitoring your blood pressure and heart rate closely, adjusting dosages, or even discontinuing one of the medications. It is not advisable to stop any medication without consulting your healthcare provider, as this could lead to withdrawal symptoms or exacerbation of your underlying condition.

Regarding your concern about the risk of low blood pressure, it is indeed a possibility when combining multiple beta-blockers. Symptoms of low blood pressure can include dizziness, lightheadedness, fainting, and fatigue. If you experience any of these symptoms, it is vital to seek medical attention promptly.

In summary, managing heart conditions with multiple medications requires careful consideration and regular follow-up with your healthcare provider. It is essential to have open communication about your symptoms and any concerns regarding your medication regimen. Your doctor can provide personalized advice based on your specific health needs and ensure that your treatment plan is both safe and effective. Always prioritize your health and safety by consulting with your healthcare provider before making any changes to your medication.

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