Issues with Drug Combination Therapy
I would like to consult a pharmacist regarding the combination use of the following medications:
1.
For essential hypertension, I have been taking Losa F.C.
50mg (1 tablet) in the morning and R.H.H.
0.5 tablets upon waking for over six months.
2.
Due to dizziness, cough, sputum production, and blood pressure rising to 160-170 despite continuous use of the first medications, my clinic physician prescribed the following medications, instructing me to take both sets: Lisinopril 10mg (1 tablet after dinner), Lungtec (bambuterol) 10mg (1 tablet after dinner), Syugeron (cinnarizine) 25mg (0.5 tablet after dinner), Merislon (betahistine) 12mg (1 tablet after each meal), Nospan (dextromethorphan) 30mg (1 tablet after each meal), Tozy (1 tablet after each meal), Amolin (amoxicillin) 500mg (1 tablet after each meal), and ULSTOP (famotidine) 20mg (1 tablet after each meal).
After three days of taking these medications, I returned for a follow-up with no improvement, and my blood pressure rose to 170-180.
The physician prescribed another three days of medication and recommended that I see a neurologist at a major hospital.
3.
After bringing the first and second medications to the neurologist, the following medications were prescribed: Dipyridamole 25mg (1 tablet after each meal) and Diphenidol 25mg (1 tablet after each meal).
At that time, I only remembered to ask the neurologist about the use of blood pressure medications (to continue using them) and forgot to inquire whether the second set of medications should be taken simultaneously.
Therefore, I would like to ask the pharmacist if there is a need to stop or combine the above medications.
Thank you!
Ruth, 60~69 year old female. Ask Date: 2015/11/03
Dr. Liao Lingmei reply Pharmacology
Dear: The pharmacist can assist in confirming issues related to medication therapy, using the information provided to determine whether you should discontinue or combine medications outside of the pharmacist's authority.
However, I can offer you some suggestions for your reference.
For symptoms of cough and sputum production, if you have taken cough suppressants without improvement and have not been diagnosed with respiratory or thoracic diseases, another possibility could be drug-induced side effects.
Both Lisinopril and Losartan can cause cough as a side effect, with Lisinopril having a higher incidence.
Regarding dizziness, Diphenidol can be used to treat vertigo, but the medication R.H.H.
may also be a potential cause of dizziness.
There are many reasons why blood pressure may not be adequately controlled, and the choice of medication is one of those factors.
Currently, many new antihypertensive medications have minimal side effects and are convenient to take.
I still recommend that you visit a cardiology outpatient clinic for a proper evaluation.
After a period of adjusting the appropriate medications and lifestyle changes, you can achieve a better and healthier quality of life.
Wishing you health and happiness!
Reply Date: 2015/11/03
More Info
Managing multiple medications, especially for conditions like hypertension and respiratory issues, requires careful consideration of potential drug interactions and side effects. In your case, you are taking a combination of antihypertensive medications and drugs for cough and other symptoms, which can complicate your treatment plan. Here’s a detailed analysis of your current medication regimen and some recommendations.
Current Medications Overview
1. Antihypertensive Medications:
- Losa F.C. (Losartan): An angiotensin receptor blocker (ARB) used to treat high blood pressure.
- Lisinopril: An ACE inhibitor that can also help manage hypertension but is known to cause a persistent cough in some patients.
2. Cough and Respiratory Medications:
- Lungtec (Bambuterol): A bronchodilator used for asthma and COPD.
- Syugeron (Cinnarizine): An antihistamine that can help with dizziness and nausea.
- Merislon (Betahistine): Used for vertigo and balance disorders.
- Nospan (Dextromethorphan): A cough suppressant.
- Tozy: Typically used for allergies or nasal congestion.
- Amolin (Amoxicillin): An antibiotic for bacterial infections.
- ULSTOP (Famotidine): A medication that reduces stomach acid.
3. Neurology Medications:
- Dipyridamole: Often used to prevent blood clots.
- Diphenidol: Used for treating vertigo and nausea.
Potential Interactions and Considerations
1. Cough as a Side Effect:
- Both Lisinopril and Losartan can cause cough, but Lisinopril is more commonly associated with this side effect. If you are experiencing a persistent cough, it may be beneficial to discuss with your healthcare provider the possibility of switching from Lisinopril to another antihypertensive that has a lower incidence of cough, such as a different ARB or a calcium channel blocker.
2. Blood Pressure Management:
- Your blood pressure readings of 160-170 mmHg indicate that your current regimen may not be adequately controlling your hypertension. It’s crucial to monitor your blood pressure regularly and report any significant changes to your healthcare provider. They may consider adjusting dosages or adding additional antihypertensive medications.
3. Drug Interactions:
- The combination of medications you are taking does not show significant direct interactions; however, the cumulative effects of multiple medications can lead to increased side effects or reduced efficacy. For example, the use of dextromethorphan (Nospan) can cause sedation, which may be compounded by other medications like diphenidol.
4. Monitoring for Side Effects:
- With the addition of multiple medications, it’s essential to monitor for side effects such as dizziness, excessive sedation, or gastrointestinal issues, especially with the use of famotidine and amoxicillin.
5. Consultation with Specialists:
- Since your healthcare provider has recommended seeing a neurologist, it’s important to follow up on this. Neurologists can provide insights into whether your symptoms are related to your current medications or if they stem from an underlying neurological condition.
Recommendations
- Regular Follow-ups: Schedule regular follow-ups with your healthcare provider to assess the effectiveness of your current regimen and make necessary adjustments.
- Medication Review: Consider a comprehensive medication review with a pharmacist or your healthcare provider to evaluate the necessity of each medication and explore alternatives that may have fewer side effects.
- Lifestyle Modifications: Alongside medication, lifestyle changes such as dietary adjustments, regular exercise, and stress management can significantly impact blood pressure control and overall health.
- Emergency Plan: If you experience severe side effects or your blood pressure remains high despite medication, seek immediate medical attention.
In conclusion, managing multiple medications requires a collaborative approach between you and your healthcare team. Regular monitoring, open communication about side effects, and adjustments to your treatment plan are key to achieving optimal health outcomes.
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