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Old 06-07-2005, 10:03 AM   #1
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Messing with my hbp meds

After a long struggle to find meds that worked without too annoying side effects, I got control with a ccb Tiazac 180 mg and clonidine .1 mg 3 times a day. Since last fall, I've lost 32 pounds and am close to my doctor set goal weight of 134 pounds. I'm also eating a lot more healthy and watching salt intake, and exercising regularly.

My medicated bp dropped during this time so that I averaged in the 100s-110s/60s, with some drops into the upper 90s/mid to upper 50s. I figured this was lower than my bp needed to be, so I wondered if I could get by with just the Tiazac now. I've been cutting back on the clonidine, which is harder to keep track of at 3 times a day dosage. No change with .075 mg 3 times a day. Not much change with .075 at bedtime and .05 twice during the day. For the last few days I've gone to .05mg twice a day.

At .05 mg clonidine twice a day and once daily Tiazac 180 mg, I am finding not as much control as I'd like. I'm finding occasional bp and heart rate spiking, but that seems to have settled down more today, so don't know if it is withdrawal (although I'm told at such low dosages rebound should not be a problem), or heat and dehydration from too much yardwork in the sun and not enough sleep, or some endocrine weirdness. This morning, after Tiazac and before .05 clonidine my bp was 155/94 pulse 87. The last couple mornings, after the .05 clonidine, my bp has settled into the 120s-130s/upper 70s-80s and heart rate all over the place from upper 60s to upper 80s.

I am discouraged with this result. I really wanted to cut down to just the Tiazac, but diet and exercise will not eliminate my need for medication.

I don't know what to try from here. I have a doctor's appointment in mid July, and still want to experiment on my own a bit.

I don't want to take a diuretic, because I am perpetually a bit dehydrated, and I run to the bathroom enough, especially at night. I also had a bad experience with the diuretic in Hyzaar.

I won't take another beta blocker again, since I had a terrible time with one.

I have some captopril 25 mg that I never really tried back before I got control. I did get a bad cough from Lotrel and no bp control. I thought I'd try captopril after I got off clonidine if I still needed more control than just the tiazac.

I could give the current clonidine dosage of .05 mg twice a day a bit more time to see if my blood pressure settles to that low dosage, or I could start adding in the captopril 25 mg and see what happens. I don't much like the resting bp to go into the 150s/90s, even for a little while. I have no idea if I would get a cough from captopril, or if it would lower my bp.

I could just up the clonidine to .05 mg three times a day and see what happens (I sorta skipped that step on the way down), and forget about the captopril.

I could stick with the smallest amount of clonidine, even with 3 times a day dosage, and wait for my doctor's appointment. I'm thinking then of asking for an ARB like Avapro to go with the calcuim channel blocker I'm taking. I tried Diovan by itself back in the beginning and didn't get any bp lowering.

I'd like to keep the clonidine for times when I needed a bit more control, but I don't like having to keep up with it 3 times a day for regular control. It also makes me sleepy in the daytime, so I'd like to get off it as a regular med if I could.

Anybody got any suggestions for me?

 
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Old 06-07-2005, 03:48 PM   #2
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Re: Messing with my hbp meds

mgreylorn,
I understand why you want to get off the 3 times a day thing with the clonidine. Taking meds 2 times a day is enough to remember.

I tried to give up my 1 time a day .05 clonidine because my BP ave was around 111/65. I first took 1/2 of .05 and then skipped a day. My BP went slowly back up to the 150/88 range. I went back to the .05 and 2 days later it's back to 114/68. I can't undertand why. I can't believe a tiny dose like that could make that much difference. So I am suspecting it may be rebound although my doc says it's not.

How long have you taken the clonidine? I was on .1mg for 3 years and weaned off in a week without any problems (at least none that I am aware of because at that time I didn't have a monitor).

If I were you I would try an ARB with the tiazac. What is combined with the diltiazem to make tiazac? Is it an ACEI? I would suggest avapro or benicar ( I liked benicar because avapro caused me to be anxious and have palps )
Can't you start the ARB while slowly weaning off the clonidine? It takes up to 2 weeks to see the full benefit of an ARB so I would think your BP wouldn't go too low while weaning.

I hope you find a solution. I couldn't take clonidine in the day time. About 1 1/2 hours after the dosing I'm asleep. So it only works for me at night.

Let us know how it goes,
Cass

Last edited by CASSIEBEL; 06-07-2005 at 03:51 PM.

 
Old 06-07-2005, 08:47 PM   #3
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Re: Messing with my hbp meds

Tiazac plus avapro works for me. You sound like the perfect candidate for it. Tiazac almost but not quite gets the job done for you. Avapro gives a small but real push, and in my case I think its effect is enhanced somewhat by the CCB. You also need only take it one time a day, and it is, in my case, absolutely side-effect free.

 
Old 06-08-2005, 12:45 PM   #4
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Re: Messing with my hbp meds

Why are you disappointed with "120s-130s/upper 70s-80s"??? You are in the normal range. Are you diabetic?

 
Old 06-14-2005, 11:17 AM   #5
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Re: Messing with my hbp meds

Tiazac is a calcium channel blocker only. I've been on clonidine in patch and then pill form for about a year and a half. I went to .05 mg clonidine 3 times a day rather than sticking out twice a day because we had to drive to Atlanta and back for a wedding on a long weekend just this past weekend. I didn't take readings during that trip and I don't think I've settled into the .05 mg 3 times a day yet to get steady readings. Cassiebel, that is great you can get such a lasting bp drop with .05 mg clonidine once a day. I could deal with that, but unfortunately that doesn't look like it would work for me.

The reason I'm disappointed with 120s-130s/70s-80s is because I was hoping I'd have those numbers with tiazac only. I clearly need more than just the tiazac - the question is what else with it.

I tried Diovan by itself when I was just starting the road to medication and it didn't give me side effects and didn't seem to impact blood pressure. At that time I wasn't doing home readings, so only have the doctor's office numbers.

I've been thinking of asking my doctor for avapro or benicar to go with the tiazac, or some form of ARB. I hear nice things about avapro and benicar from people on this board. Pal, do you take avapro and tiazac at the same time of day, or one in the morning and one in the evening?

I might still try the captopril experiment before my doctor's appointment. I took one pill last week and felt a bit of throat scratchiness - probably my imagination due to my previous experience with Lotrel. I didn't want to cough through the wedding, so didn't take any more of them.

Thanks for your suggestions guys and gals.

 
Old 07-05-2005, 09:59 AM   #6
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Re: Messing with my hbp meds

I've been on the captopril 25 mg for two weeks and may have a bit of a cough, but not much. Because I expect to cough on an ACEI, I notice every single cough whereas I didn't before I started the drug, so its hard to tell if I really am coughing a bit more than normal, of just imagining it.

I tried cutting one of the 25 mg doses in half and taking it with the whole dose for a couple of days. I think I did cough more then, and got a strange "lump" in my throat. I went back to 25 mg and the lump and extra cough went away. I am hesitant to increase dosage to 50 mg, for fear I will still cough if I go back to 25 mg.

I cut back my clonidine to .05 mg three times a day to .05 mg twice a day, while I was taking the 25 mg captopril and 180 mg tiazac. This worked pretty good, but I still wanted off the clonidine, so I went to .05 mg once a day and then none. I've been on clonidine so long that I had some withdrawal effects, even though at such low doses one is not supposed to have them. I took my last dose on June 30 and by July 3 started feeling more normal. I think I am still adjusting though. My bp is averaging around 125/69 and heart rate is starting to settle out to around 75.

I go see my doctor on the 11th and we shall see what she says. I think I'd like my average resting to be a bit lower than what it is, because it doesn't take much excitement or movement to push readings up to the low 140s/low to mid 80s. I'm hoping my body is still adjusting to regulating without the clonidine and the numbers will get lower over the next week or so. I'm not sure I can increase the ACEI and not cough, so I think I will ask for an ARB. I'd rather just do two drugs, but a low dose CCB, ACEI and ARB would not be bad I guess.

One of the reasons I wanted off the clonidine is because of some reactions I have been having. I am not sure if they come from the drug or some endocrine malfunctioning that clonidine quiets. At 49, I think I have some perimenopausal symptoms, which might account for endocrine strangeness. I'm getting a blood test at the doctor's, so I'm going to ask them to look at everything. Hopefully 2 weeks off clonidine by then will take that drug out of the equation.

Last edited by mgraylorn; 07-05-2005 at 10:03 AM.

 
Old 07-05-2005, 12:37 PM   #7
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Re: Messing with my hbp meds

mgreylorn,
I just wanted to mention my experence on an ACEI & ARB. When I took both of them my BP went up. I don't understand why, though. All the info I can find about this combo says it's supposed to be great together.

I willl be interested in hearing how this works for you if you decide to go this route.

I understand why you want to get off clonidine. So do I

Cass

 
Old 07-05-2005, 12:53 PM   #8
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Re: Messing with my hbp meds

Cassiebel, I'll keep that in mind. I've had reactions like that - one drug fine, add another and bp goes up, or increase the doesage of a drug and bp goes up. That's what led me to clonidine in the first place, it was one of the only ones to "play nice" with my primary bp drug.

Since I can't increase the dosage of either the CCB or ACEI I am taking, I'm hoping I can do my CCB and an ARB, and tollerate an increased dosage of the ARB to get my bp a bit better. If that doesn't work, then I'm hoping small doses of the CCB, ACEI and ARB will do the trick.

 
Old 07-11-2005, 01:24 PM   #9
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Re: Messing with my hbp meds

Saw my doctor today. She collected a quart of blood (;-> ), and it will be awhile before the results of the blood tests come back. She was happy with my 35 pound weight loss, down to the weight she suggested, and even though I still have a roll of belly fat, did not suggest I drop any more weight. She told me to do crunches (50 per day) to try to get some of that off. Sigh. I hate crunches.

My office bp was 125/87, which was exactly the same as 6 months ago. Both of these are low white coat numbers for me. I get readings similar on systolic at home but my diastolic are lower - in the 70s. I joked that her moving office to a new building I left the white coat in the other location. I showed her my home resting numbers which are mostly in the 120s/70s, with some higher and lower around that. I thought she'd want to get those numbers lower, but she was satisfied with them! I asked about increasing the captopril or changing to an ARB, but she wanted me to stay where I was on the captopril for now. I'm still undecided if I have some ACEI cough. I think I am coughing a bit more, but I don't feel like I am going to cough up a lung like I did with Lotrel. She suggested I experiment by dropping the captopril for a few days and see if it made a difference before thinking about going to an ARB. If I go to an ARB, she likes Micardis by the way.

I was very surprised with the verdict to stay with my current drugs and amounts. On the other hand, with the weight loss, dropping clonidne only since June 30, and only being on captopril since June 20, I think the rationale is that my cardiovascular system is still in flux and that my pressure may drop a bit on its own. Actually I was thinking along the same lines. As I look at my home readings, I am gradually getting a few more of them in the 110s/60s range and last night I had one resting reading of 107/60. My pulse has come up into the 80s since I stopped the clonidine, when it had been in the 60s. My pre medicated pulse was in the 80s, and my doctor said the 60s may be too low for me.

So all in all it was a good doctor visit (barring something horrible showing up in the fasting blood work). I'm hoping I will get a bit further drop in bp and pulse as my body adjusts. If my numbers stay the same as they are now, I wonder if she will be as pleased in my followup in 4 months.

 
Old 07-11-2005, 04:10 PM   #10
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Re: Messing with my hbp meds

Quote:
Originally Posted by mgraylorn
Saw my doctor today. She collected a quart of blood (;-> ), and it will be awhile before the results of the blood tests come back. She was happy with my 35 pound weight loss, down to the weight she suggested, and even though I still have a roll of belly fat, did not suggest I drop any more weight. She told me to do crunches (50 per day) to try to get some of that off. Sigh. I hate crunches.

My office bp was 125/87, which was exactly the same as 6 months ago. Both of these are low white coat numbers for me. I get readings similar on systolic at home but my diastolic are lower - in the 70s. I joked that her moving office to a new building I left the white coat in the other location. I showed her my home resting numbers which are mostly in the 120s/70s, with some higher and lower around that. I thought she'd want to get those numbers lower, but she was satisfied with them! I asked about increasing the captopril or changing to an ARB, but she wanted me to stay where I was on the captopril for now. I'm still undecided if I have some ACEI cough. I think I am coughing a bit more, but I don't feel like I am going to cough up a lung like I did with Lotrel. She suggested I experiment by dropping the captopril for a few days and see if it made a difference before thinking about going to an ARB. If I go to an ARB, she likes Micardis by the way.

I was very surprised with the verdict to stay with my current drugs and amounts. On the other hand, with the weight loss, dropping clonidne only since June 30, and only being on captopril since June 20, I think the rationale is that my cardiovascular system is still in flux and that my pressure may drop a bit on its own. Actually I was thinking along the same lines. As I look at my home readings, I am gradually getting a few more of them in the 110s/60s range and last night I had one resting reading of 107/60. My pulse has come up into the 80s since I stopped the clonidine, when it had been in the 60s. My pre medicated pulse was in the 80s, and my doctor said the 60s may be too low for me.

So all in all it was a good doctor visit (barring something horrible showing up in the fasting blood work). I'm hoping I will get a bit further drop in bp and pulse as my body adjusts. If my numbers stay the same as they are now, I wonder if she will be as pleased in my followup in 4 months.
Congrats on the doc visit. Your numbers look great to me. I sometimes think we get a little carried away wanting to just keep getting lower and lower. personally I feel just plain bad when my BP goes below 110.

Did you have a hard time getting off clonidine? I would like to stop it too because I feel really tired in the AM when I take it before bed.

Cass

 
Old 07-12-2005, 08:45 AM   #11
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Re: Messing with my hbp meds

The reason I wish the numbers were a bit lower is that I try to make a concerted effort to be still and relax before I take my readings (most of the time). I am almost never that relaxed in normal behavior, so I wonder how high my "normal" numbers are. I'm not sure my "relaxed" numbers are an accurate baseline. If my "relaxed" numbers were in the 110s/60s, and my "normal" numbers were 10 points higher than that then no worry. I don't start to feel sluggish until my numbers drop into the 90s/50s.

Cass, I did have a bit of trouble getting off the clonidine. Not as bad as Toprol a beta blocker, but I did have some withdrawal. I'd been on clonidine about a year and on doses as high as .2 mg three times a day. I found that no matter what dose, I'd start to withdraw after about 7 hours - rapid heartrate, jittery feeling. Oddly enough, that would go away after a half hour, hour, and then I would be fine 9 hours out, with only small increase in bp. I don't understand what was happening there, but that was the case most days. I gradually reduced dosage and was fine at .05 mg three times a day, with not much change in bp. When I went to .05 twice a day I was concurrently starting captopril the ACEI. Pressure was up a bit but still good, and I didn't have the 7 hour withdraw.

Reduction was going so well that I tried to go cold turkey at .15 mg per day and got hit with withdrawal after 15 hours. This was rapid heartrate, bp spike into the 150s/90s and jitters/anxiety. My pharmacist said I should not have any problem going off it at this dose, but I clearly did. I wasn't worried about it, I expected to go off and be fine but got hit with the withdrawal, so it wasn't a case of worrying to make it so. That was when I went back to .05 mg twice a day and did fine. I did that for a few days and then stopped. I had some withdrawal at about 23 hours with a small spike, again only into the 150s/90s, but I didn't take any more. While not feeling outright bad, I just didn't feel quite right for about a day and a half. I had a longer adjustment to getting off Toprol with relapses months out, but I have not had that with clonidine.

While I am still up several times in the night, I am a bit less sleepy during the day since I have been off clonidine. I am also handling the heat stress and dehydration of yard work better since I have been off clonidine.

Cass, you aren't taking much clonidine, right? Don't you just take .05 mg at bedtime, or .1 mg total? I'd guess that you would not have much trouble getting off a very low dose. And if you did start to feel funny you could always take a dose, or half a normal dose and feel better in 30 minutes.

 
Old 07-12-2005, 01:51 PM   #12
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Re: Messing with my hbp meds

Quote:
Originally Posted by mgraylorn
The reason I wish the numbers were a bit lower is that I try to make a concerted effort to be still and relax before I take my readings (most of the time). I am almost never that relaxed in normal behavior, so I wonder how high my "normal" numbers are.
I am a hyper personality too. I also wonder if my readings are correct because I sit and relax for 5 min before taking my BP. I would bet my normal numbers are more than 10 points higher than my relaxed readings.

Quote:
Cass, you aren't taking much clonidine, right? Don't you just take .05 mg at bedtime, or .1 mg total? I'd guess that you would not have much trouble getting off a very low dose. And if you did start to feel funny you could always take a dose, or half a normal dose and feel better in 30 minutes.
Yes, I usually just take .05 at bedtime, sometimes .1 if necessary. My Bp is so weird, I have beautiful day numbers between 95/65 - 130/78 but about 8 at night they start to creep up. I take my meds at 10 and during those 2 hours it will sometimes go as high as 160 or 170 I have tried taking meds at different times of the day, altering my diet, nothing seems to work Anyway, my wonderful GP has agreed to let me try diltiazem (which I am a great fan of) again. His only request is that I get off the clonidine first. So I will began by cutting my 1/2 in 1/2. That's not an easy chore since tha pills are sooooo tiny.
Thanks for the info,
Cass

 
Old 07-13-2005, 09:13 AM   #13
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Re: Messing with my hbp meds

If you only take clonidine sometimes, I don't think you would have a problem getting off it. I took it irregularly at first and didn't have any problems.

I take tiazac which is a form of diltiazem and it is my major bp med.

 
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