Messing with my hbp meds

mgraylorn · 06-07-2005, 01:03 PM

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?

CASSIEBEL · 06-07-2005, 06:48 PM

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

pal7778 · 06-07-2005, 11:47 PM

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.

junior26 · 06-08-2005, 03:45 PM

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

mgraylorn · 06-14-2005, 02:17 PM

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.