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Old 02-02-2009, 12:36 PM   #1
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Enalapril (vasotec) Nightmare

Thought I'd drop in with an update...my old cpap machine, the one I use to keep down my blood pressure "failed" on me...I went in to get a prescription for an antihyperintensive to tide me over until I could get my cpap repaired or replaced.

Given my horrible experience with hctz, benicar, lisinopril, atenolol, and amlodipine, my doctor wrote a prescription for enalapril--5 mg. I took it and within 24 hours my left arm was sore which was understandable since I've been shoveling snow day and night (what can I say---we've set 100 year old records for snow fall). My arm and shoulder got progressively worse over the next two days to the point I couldn't raise my arm. Again, I attributed it to shoveling...but 8 days later I knew better. In addition to the excruciating back and shoulder pain I had felt while on hctz, and my entire body was stiff and in pain. On the 11th day, I was unable to straighten my body, walk, or sit in a chair! At that I knew it was the enalapril, disco'd it immediately and my body returned to its normally agile and active state....but it took 2 weeks.

Got my machine up and running so I haven't returned to the doctor but will do so in the next month or so...this was the 6th med that I've tried that has been intolerable (understatement) and I must have a back up plan in case I NEED to take medication.

Famnd, will check out the pharmacology and compare it to the other meds I've been on...haven't seen any patterns yet.

Any thoughts/advice welcome.

Bethsheba

Last edited by bethsheba; 02-02-2009 at 12:38 PM.

 
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Old 02-02-2009, 07:42 PM   #2
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Re: Enalapril (vasotec) Nightmare

Hi Beth,

Welcome back!!! So sorry to hear about your experience with Enalapril. Sounds similar to mine with Cozaar but yours started earlier. Apparently your drug has a quick onset of 1 hr & can be used in HBP emergenicies. Luckily, you didn't have any of the allergic reactions. Sounds like it attacked your muscles. It is strange that a med can cause pain or other symptom in one arm etc. That's what threw me off at first with Cozaar. I just re-read my notes & saw that my right hand swelled first. It wasn't long though until both were swollen plus my knees & ankles.

You should always have benadryl on hand when you first take a ACE inhibitor because of the rare side effect of Angioedema (swelling of the face etc.)

I know how worried you are about not having a back up plan. I have a similar dilemma because of my dye allergy. I went to see a new Dr. for a pap smear because my regular Dr. didn't have time. Of course my b/p went through the roof. He wanted to give me Clonidine but his supply consisted of blue pills. Of course, I couldn't take that. He wanted me to take the pills & go to the ER. I said I didn't think I should be driving myself if I have to go to the ER. I called my husband & went home. Apparently, the Dr. doesn't realize the effective that Clonidine has on a patient's thinking abilities plus the stress involved puts everyone on the road at risk. And he was giving me twice the dose that I had taken before when my hypertension first started.

From what I read in the Nurse's drug book (08'), muscle issues are one of the potenial side effects of your drug. I had that awful pain in my upper arms too from Cozaar & had thought I had been stressing them. Also, in my reaction to HCTZ (with the red dye) I had muscle issues & strange pain in my legs. My Dr. apparently had seen that before because she immediately said it was an allergic reaction which surprised me. She said don't take that again!!! She is not one to panic so I was completely taken aback by her response. I figure she may have lost a patient with that same reaction. The pain was a stinging type pain when walking up stairs or even a small incline. It started the 2nd day.

I don't know what you can do for a back up plan except to drink plenty of fluids so you can do a natural diuretic (remember drink slowly throughout the day.) No caffeine.

This past weekend I had left my HCTZ at home by mistake as I was hurrying to get the RV packed. Luckily, I packed my beta blocked & synthyroid. So I didn't get to take it until 9pm instead of in the am. We had to come home a day early. Scary with my high b/p. Think my husband learned a lesson that I just can't get things together fast between my damaged hands & knees plus the fatigue that goes along with the meds. I need more time to get ready than I used to.

There was a silver lining though, I found the best book on Heirloom tomatoes-tells about the tomato festival in CA.

Let me know if you have questions about the drug that I can look up. So glad that your C-Pap is working again. Fam

 
Old 02-02-2009, 10:32 PM   #3
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Re: Enalapril (vasotec) Nightmare

Hi Beth,

thank you for the update. It's good to hear you've been fine except for the unfortunate drug reaction. As you have indicated, you are very sensitive to all medications. For this reason, I hope you will continue to be able to manage your blood pressure through other means.

When I read your post I wondered about your blood pressure levels prior to the problems with the CPAP device. I remember you saying you had gone off the antihypertensive medication. Have your blood pressure readings changed? Do you normally experience blood pressure elevations only when you sleep? I guess what I am asking is whether the CPAP mask helps maintain 24 hour blood pressure control. Or is it for regulating only short-term nightime blood pressure spikes? I know the mask is only used during the night when people sleep. It would be great to learn more about how the use of CPAP mask contributes to blood pressure control.

Having a backup plan in case your CPAP mask breaks down again is definitely a good idea. How about trying an ARB? The consensus is that this antihypertensive medication has the fewest side effects, which are (supposedly) minor and tolerable when compared to all others. Unfortunately, I can't speak from personal experience as I have tried two different ARBs and found I am allergic to this drug class. Because of your sensitivity to drugs, you should look for a blood pressure medication that will work for you in a small dose. As you know, using the smallest dose of drug possible also minimizes the chance of developing adverse reactions and side effects.

Please keep us posted.
flowergirl

 
Old 02-03-2009, 05:42 PM   #4
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Re: Enalapril (vasotec) Nightmare

Hello Famnd,

So good (in the good sense) to see you are still here!!

Yup, I thought of your experience when I was dealing with mine...I just wish your body would bounce back like mine has done thus far, knock on wood!

Must review your recent posts to see how you've been doing...have thought of you lots and have questions but maybe another time.

I didn't take the time to research enalapril before I took it so the info about quick onset was news to me but it makes sense. Yes it attacked my muscles, but I also believe it attacked my nerves. I say this because only a day or two ago I read in the Pain Management?? boards that someones doctor told her that pain meds would help with muscle pain but not with nerve pain. That little statement leaped out at me because if you remember, pain medication did nothing for me when I had problems with shoulder/side/back pain while taking hctz.

Yes, it is strange how it affects one side more than the other. TIme and time again I read about people who discount their side effects because they think if the meds were causing the problem, it would be on both sides, in both ears, in both feet, etc. Not so, not so. Aside from my back, I don't know if I've ever had side effects on both sides of whatever!

You were so very smart to right down your notes with Cozar...except for the pain (which I don't think any of us will ever forget), it's difficult to remember the details when it comes to our problems with meds. Did you have pain with the swelling of your hands and feet? Or did that come later?

Benadryl is an excellent suggestion and I will try to get some tomorrow. Although ace inhibitors can cause problems with allergies, I think most other meds can as well. Funny, although I've experienced most of the side effects of all of the meds I've been on (except for jaundice and headaches), I've never had the "traditional" allergic reactions.

Quote:
... He wanted me to take the pills & go to the ER. I said I didn't think I should be driving myself if I have to go to the ER....
How did these guys get through med school?

Quote:
.. My Dr. apparently had seen that before because she immediately said it was an allergic reaction which surprised me. She said don't take that again!!! She is not one to panic so I was completely taken aback by her response. I figure she may have lost a patient with that same reaction.
Well, at least she learned from the experience...how many don't??

Quote:
...I don't know what you can do for a back up plan except to drink plenty of fluids so you can do a natural diuretic (remember drink slowly throughout the day.) No caffeine.
Funny you mention this...I got up one morning and my numbers were similar to those that I had last summer...goooood. I hadn't been "Dashing" and I was getting up 2-4 times a night due to sleeping without my maching. I couldn't understand why my numbers were so good until I remembered that I was very, very thirsty the evening before and drank 3-4 glasses of water, which I never do. I should really try to consitantly drink water and see how much it impacts my pressures.

Why the caffiene? Because it elevates pressures temporarily? Or is there another reason. I refuse to give up my coffee in the am, .

Quote:
Think my husband learned a lesson that I just can't get things together fast between my damaged hands & knees plus the fatigue that goes along with the meds. I need more time to get ready than I used to.
I hope he's learned...much better to delay a trip due to a med prescription than due to a hospitalization or worse!

Quote:
There was a silver lining though, I found the best book on Heirloom tomatoes-tells about the tomato festival in CA.
Do tell, as I need something to look forward to until garden season....and no, it's not off topic, . Tomatoes contain alot of potassium which is critical for the control of hypertension...so Famnd, the details please.

Thanks for the offer to research the enalapril for me...should have done it myself but didn't and have paid the price. Off the top of your head, are there any obvious similarities between it and the hctz?? I swear the pain was the same but came on faster.

The cpap, is another story...those interested can peruse it on the sleep disorders board under equipment failure.

Sooo glad to see you're still reading the boards!

Bethsheba

 
Old 02-03-2009, 06:04 PM   #5
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Re: Enalapril (vasotec) Nightmare

Oh flowergirl, so good to have you here, ...It's good to know that you and famnd are keeping up with your reading as I have not and may need to rely on you both for the latest.

My pressures have been bad to worse...when I stopped sleeping, I fell off the DASH wagon and started eating junk, gained weight, and of course am homebound in this winter "ice palace" so I'm not doing well at all.

After trying drug number 6 I've come to the realization that I MUST lose weight because aside from my cpap machine, I may not have other options.

As to your question regarding cpap...CPAP helps maintain 24 hour blood pressure control, at least for me. My pressuress didn't start climbing until I had been off cpap for weeks (I wish I would have documented...alas, I am more talk than action in that area). I don't think this is surprising...breathing exercises are proven to work also (and probably for the same reasons)...but if I recall, it took about 6-8 weeks to get the full effect and I would suspect the reverse was true...must do some research.

But yes, the effects of cpap are relatively long lasting...again, from what I understand, having adequate oxygen levels in the blood makes it possible for the nitric oxide levels to be at the proper levels and it is the nitric oxide (I hope I"m using the right gas here, there is another one with a similar name that I confuse it with)gasses that help regulate blood pressure. So I suspect those nitric oxide levels stay in the blood for a while despite not sleeping with the cpap. In other words, if I miss a day or two without my machine, my pressures are usually about the same...but I haven't slept with my cpap since October 31st and I have gotten readings as high, if not higher than 160/96...not good, I know.

Interestingly enough, despite being on the enalapril for almost 2 weeks (which was how long the pharmacist told me it would take to "work"), my pressures didn't come down one iota....hmmm. I was on a different ace, lisinopril, and that one I od'd on.

I was on benicar once...I forget, isn't that an arb? I had problems on that one but it may have been because it was a benicar/hct combo and there is no doubt I can't tolerate the hctz. Perhaps I should try the benicar solo? Thanks for the suggestion...will do some reading as I am not current with the latest...

Flowergirl, I do hope you're doing well!!! So good to know you're able to share your vast experience with these meds with others.

Take care and stay in touch!

Bethsheba

PS My computer has risen again (for the third time) after sudden death---it hasn't worked since Oct/Nov??? So if I suddenly disappear again, don't worry. Tried doing the computer at the library but can't compete with the kids, .

 
Old 02-04-2009, 12:01 PM   #6
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Re: Enalapril (vasotec) Nightmare

Beth,

thank you very much for that information. Most people, including myself, know very little about sleep apnea and its effect on blood pressure. I remember reading that this condition is much more common than people think. Unfortunately, it often goes undiagnosed.
I hope your computer continues to work because it's so nice to have you back!

flowergirl

Last edited by flowergirl2day; 02-04-2009 at 12:01 PM. Reason: spelling

 
Old 02-04-2009, 03:25 PM   #7
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Re: Enalapril (vasotec) Nightmare

Flowergirl, It's good to be back. I often think of you, famnd, and our other friends on this board. Suspect we're here for the long haul.

Can't count on the computer. It died for about 3 months...I was going to junk it when it came alive. Gave the insides a thorough cleaning and the color returned to my monitor, .

In a week I will attempt to install a new hard disk. Have never taken a "real" computer class in my life but I have nothing to lose.

Must do that blip about oxygen, nitric oxide, and sleep apnea....

Take care, Flowergirl!

Bethsheba

Last edited by bethsheba; 02-04-2009 at 03:30 PM.

 
Old 02-06-2009, 08:56 PM   #8
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Re: Enalapril (vasotec) Nightmare

Beth, I don't remember any pain with the swelling other than having some pain when I tried to walk or do things with my hands. I'm sure I took aspirin for the arm pain but it didn't really help. What did help was hot compresses ( a warm washcloth) which is my answer to any pain . Maybe tomorrow I can address the similarities between HCTZ & your drug.

BTW you can get benedryl without dye now. I just found out that there are groups trying to get the FDA to require drug manufacturers to do something about the dyes in drugs. This reaction was because the new info about red dye. Apparently it comes from beetles & the package info always says artificial ingredients as in chemicals. I just wonder what he real source of yellow dye is? Fam

 
Old 02-09-2009, 11:10 AM   #9
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Re: Enalapril (vasotec) Nightmare

Quote:
I just wonder what he real source of yellow dye is? Fam
Because it is a component of so many of the drugs we take daily, others might also be curious. I was!
D&C yellow #10 dye and lake (that's a tint) specs are listed in 21 CFR (Code of Federal Regulations), section (74.1710).
The requirements are that the dye contain not less than 75% of the monosulfonated component and not more than 15% of the disulfonated component. Basically, it is a mixture of the sodium salts of the mono- and disulfonic acids with a few other things thrown in for good measure, including lead, arsenic and mercury, with no more than 20, 3 and 1 part per million, respectively. It is not approved for use in food and not approved for use in some countries.
The good news is that a sample from each batch has to be submitted to FDA for testing and certification to ensure it meets all criteria before it can be used in manufacturing.

FG

 
Old 02-09-2009, 06:58 PM   #10
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Re: Enalapril (vasotec) Nightmare

Thanks so much, FG. Where did you find that info? I had the problem with yellow dye # 6 AL not # 10. I imagine there isn't much difference.

If the dye isn't allowed in food why would it be allowed in medication? Fam

 
Old 02-09-2009, 10:38 PM   #11
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Re: Enalapril (vasotec) Nightmare

Quote:
I had the problem with yellow dye # 6 AL not # 10. I imagine there isn't much difference. If the dye isn't allowed in food why would it be allowed in medication?
There are differences in chemical composition and use. The specs are in CFR 21 74.706. This dye has more additives than #10, which also include lead, arsenic and mercury (10/3/1 ppm), amounts somewhat smaller than #10. The #6 yellow Al is an aluminium lake, a pigment. It is classified as FD&C - meaning it is approved for use in food, drugs and cosmetics.
All aluminium lakes must be made from previously certified batches of straight dyes. I am not surprised that some people cannot tolerate them.
I don't know the answer to your question - it is a good one! I guess some additives are deemed safe for human consumption only in minute amounts. I don't think one pill contains a lot of dye. Perhaps large quantities of dyes are needed to color food products, which would make some dyes unsafe. I am not sure what's involved in safety testing.

flowergirl

 
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