What Medication Next?

Vanessa74

Beth,

Thank you SO SO much - I was sitting here crying and feeling like I was going a little 'crazy' - because for the first week of taking the PPI's I felt GREAT - and then the new breathing problems started. I was beginning to think it was all in my head....

When I mentioned the PPI's and Toprol to my Dr. and what I felt were 'side effects' - he bascially told me I am anxious and gave me anxiety medicine... DOES NOT HELP ME BREATH ANY BETTER????

I am terrified that if I stay on the Toprol my breathing problems will become irreversible but my Dr. (my third one in 1 year) - is not taking me seriously and does not want to stop the Toprol -- my B/P is REALLY high so I can't just wean myself off without something to replace it.

I stopped the PPI today - I want to try and deal with one thing at a time.

You are RIGHT - no matter WHAT is causing our breathing problems - BREATHING BETTER is what I live for right now. It was actually my New Year's Resolution

You saved me from a long crying jag tonight - THANK YOU!

flowergirl2day

I think it would be interesting to find out about the regulation of generic drugs. What does it take for the generic drug makers to apply for and obtain a FDA approval? I don't think they are required to conduct costly and lengthy clinical trials, nor do they have to incur any R & D expenditures. What is involved in the process of getting their products to market? I think it should be illegal for the pharmacies to substitute a cheaper drug for a brand name medication without obtaining a written permission to do so and INFORMING the patient beforehand!

Vanessa, after I had started taking the PPIs my severe breathing difficulties went away COMPLETELY, which is another reason I believe they were stomach and medication related and not from ashtma. Unfortunately, the PPIs have brought on ALL of the symptoms of GERD, making my life pretty miserable. I had no symptoms of GERD, other than nausea, prior to the PPI therapy. (I still have the nausea ). The reason my SOB has not returned is, I believe, my lower dose of a different, cardioselective beta blocker, started at about the same time as the PPI. This one agrees with me, unlike the non-selective beta2 blocker I took previously. I think the PPIs are responsible for most of my GI problems. Well, at least the symptoms I now have are not as bad as not being able to breathe (except for the coughing and choking) - that's how I look at it. As you know and my doctor reminded me (twice already) when I demanded to stop the PPI therapy, the GERD gets worse with the discontinuation of the drug. I wonder if Prevacid is the same as Nexium in that regard.

I just read your latest post - please be careful!!!! You should not stop taking the medication without your doctor's knowledge! If your symptoms get much worse, take the darn pills! It seems that we are stuck between a rock and a hard place.

These two medications should be fine taken concurrently.
Good luck with your breathing.
flowergirl

bethsheba

Vanessa, thank you. Sometimes I think I talk too much and people think I'm a nut case, and not credible. I appreciate your feedback and would hope you would feel free to tell me when I'm out of line and/or off the wall. Feedback is critical to the well being of this board...because as we like to say here, "everyone is different". And for the record, at one time or other, most of us have been told by our doctors that it's all in our head.....

Well, I'm relieved to know I mentioned the anxiety side effect given your symptoms and your doctor's comments. Both the toprol (beta blocker) and/or the ppi could give you breathing problems. I know they say on the package inserts/pharmacy sheets that some of these side effects go away, but in three years, I've never found that to be the case...they only got worse for me.

Some side effects are irreversible, some go away within hours after discontinuing the med, and some take several months to disappear...I had horrible breathing problems on my beta blocker (atenolol), but I think they went away within the month...I'm not sure as I disco'd due to multiple falls and suicidal tendencies, but I was breathing ok within a short period of time.

Why does your doctor want you on a beta blocker? Do you have heart problems? Other health conditions? I had problems with intolerable side effects with 4 families of meds, but the family I had the least severe problems was with amlodipine....mind you some find this med HORRIBLE but if I would choose, to go on a med again, it would be a VERY small dose of this calcium channel blocker.

Given the multiple side effects of both meds, I think that is a good idea...it's what I would do. I don't know what your history with gastrointestinal problems is/was but I do know that my acid reflux disappeared for three years when I started using my cpap, only to reappear again when I started taking norvasc. One of the posters on this board recognized the source of my problem right away. Stopped the norvasc, and the acid reflux disappeared.

Vanessa, you will breath better. The fact that you've identified a breathing problem is a good start! And you've got a wealth of people with personal experience on these boards!

And thanks for the thanks...it means alot! Many of us post to find our own solutions, and many of us post because we don't want others to go through the hell we have been through. When we're able to share info that may help others, we help ourselves.

Take care and best of luck. Do let us know what you learn as we can all benefit.

Bethsheba

bethsheba

Vanessa,

I reread your posts with this thread looking for your experience with the ppi's...did you know that side effects of toprol include upset stomach, gas or bloating, and heartburn? Is this why your doctor prescribed the ppi? Or was it due to your breathing problems?

Other side effects of toprol include dyspnea which is difficult or labored breathing and/or shortness of breath. In the clinical studies of over 3000 people, one in a hundred experienced this side effect. From what I've read, it is my understanding that people experiencing this side effect shouldn't be taking toprol...

Bethsheba

Vanessa74

Thanks Beth

I was put on Toprol 4 years for HBP - started at 25 mg and then increased to 50mg 1 & 1/2 years ago. He had originally started me on Verapamil (a CCB) - but I had an 'adverse reaction' to that after being on it for 2 weeks - severe upper chest tightness that landed me in the ER - so that is when I was switched to Toprol.

I do understand from research that Toprol can be hard on the stomach - and I begin having some 'heartburn, etc.' about 4 or so months ago. The significant breathing problems started in late October 2007. I did some research and found Toprol can cause breathing problems so brought this up to my Dr. right away.

He sent me to a pulmonologist for a second PFT in 4 years - and all was normal -- BUT the pulmonologist increased my asthma meds anyway and told me OFF TOPROL now..... Told me I did not need to wean????

So back to my regular Dr. and even though he said my PFT looked normal and like I do not have asthma??? He took me off Toprol over only a 4 day period of time (worse withdrawl I have ever had - horrific) - then tried on Diovan 80 mg (could not tolerate, cough and chest tightness), then on to Diazide HCT (made me feel awful). When I went back to try something ELSE - he put me back on a low does of Toprol after being completely off it for a couple of weeks because he felt that if it was the Toprol causing the breathing problems I would be breathing better after two weeks (I wasn't really breathing too much better). So he put me back on 25 mg and had me try it with 80 mg Diovan -- COULD NOT. So is leaving me on 25 mg Toprol for now until he can decide what to do next????

At the same visit (all this in early Dec) he started me on the Prilosec OTC.

I have since heard that Beta Blockers can take up to (2) months to completely get out of your system. What are your feelings on this?

Also, what medication should I try next for the HBP??? I am so scared

famnd

BTW, my 2nd b/p expert told me he had one patient develop an allergic reaction to HCTZ after being on it 15 yrs. That's when I told him, I want a EPI-Pen (an adrenalin syringe ).

PPI's can cause a fungal pneumonia especially in the elderly because the ph of the stomach juices
is increased (less acidic.) So when the stomach fluid backs up into the lungs, it causes a problem. There is a reason our stomach juices are acidic-to kill the germs that come down the track with food etc.

There is also the problem of B12 absorption went one has less acidic stomach.


Some of the drugs we take are supposed to have an acidic environment to dissolve properly. So when the stomach is changed to a less acidic environment the drugs don't get absorbed & we don't get the benefit.

PPI's have a place in healing the stomach which is why most are only supposed to be given a short time-I think it is 8-12 wks.

I think it is much better to concentrate on lifestyle changes even if they are difficult to accomplish to decrease the acid reflux.

Fam

bethsheba

Vanessa, you are so very welcome!

Well, I'd definitely stay away from amlodipine/norvasc, which is a ccb, unless you id exactly what's causing the problem...famnd may be able to give you more info on that.

Good! We need to do a better job of educating our doctors.

I've been seeing a pulmonolgist, too, since he is my sleep medicine specialist. He told me I didn't have asthma and said my lungs were fine. Duh??? Then why couldn't I breath??? I went back and forth between my primary and my specialist only to find the answers on my own. As far as weaning off of a beta blocker, from what I've read, it's dangerous not to do so....one reason is that not all heart problems are identified by doctors and if there is an underlying heart problem, it could be fatal. I think you've learned about the other reasons why one should wean...and personally, I think the dosage, whether small or large, is irrelevant.

Both diovan (valsartan) and hct list breathing problems as side effects, by the way.

It takes at least a week for toprol to lower pressures...I doubt very much that 4 days after disco'ing toprol you'd be breathing better. From personal experience with a variety of side effects, after discoing a drug, some side effects would start to diminish within hours...but some took longer. When I disco'd my ccb, due to sleep problems, I slept all the night the first few nights (probably because I was so sleep deprived)...but it took over 6 weeks before I started sleeping though the night EVERY night. Another example I can offer is a friend, a nurse actually, who developed a terrible rash on her face. It took several months for her and her doctor to figure out the rash was due to the diuretic, hydrochlorothaizde (hct)....and it took several MONTHS after discontinuing the medication before her rash went away...now breathing problems and rashes are not the same thing...but I think you get my point.

I strongly agree!!!! I discontinued my beta blocker, atenolol, abruptly due to suicidal tendencies and falls...I lost 10 pounds the first week simply because I could move again, but it took a number of weeks for all of me (mind, body, and spirit) to return to normal. Oh, and I do believe I experienced rebound hypertension (hypertension that was higher than it was before I took medication) when I discontinued my bb. Although I do not know how toprol is broken down in the body, I do know that a number of factors impact the way we process/eliminate drugs--water composition, fat composition, muscle composition, liver function, kidney function, age, etc...and everyone is different!! So it may take some people longer to "get back to normal" than it would take other people. And just for your info, they used to test meds on young white men which means the reactions/experiences in women will quite likely be very different due to differences in fat and muscle composition. Doctors aren't always aware of this and overmedicate women (and older people) as a result.

I don't know what med to suggest...I suppose it would depend on what kind of reactions you had to your previous medications. I know your experiences were terrible but it may help others to know exactly what kinds of reactions you've had...that way people who have had experienced similar bad reactions could offer ideas as to what has worked for them.

Have any of your doctors ever given you a reason for your hypertension at such a young age (28)? I would think that there may be an underlying condition that may be complicating things a bit, but I don't know.

It's understandable to be scared...but that fear is protecting you! You're becoming actively involved in your care which in the long run will keep you safer and healthier than if you believed everything you were told. The answers are out there and I think you'll find them...just keep your old detective hat on and keep an open mind and question EVERYTHING and EVERY SOURCE because no one is right all the time.

Take care, Vanessa. Do stay in touch.

Bethsheba

bethsheba

I've always said that side effects/allergic reactions can happen hours, day, or years after taking a medication. Thanks for the perfect example and preventative measure, Famnd.

Thanks so much for this info, famnd. After being on ppi's off and on for years, I knew they were not the answer. Thanks for reminding me "why"!

Bethsheba

Vanessa74

Hi Beth and Fam,

Thank you for the information.

Not sure what medication to go to next - feel sort of out of options and scared. I was diagnosed at 28 with HBP, I am now 34. I have a 'family history' for HBP so that is what my Dr. is attributing it to. Tested my thyroid and it was fine?? What other reasons could there be behind the High B/P???? Any other tests that I should ask for to rule out other things?

Though to my credit - I do not smoke or drink, I watch my diet strictly and I am not overweight. NOW - I need to add exercise!!!!

Beth,

When your pulmonologist said you didn't have asthma but you still could not breath - what answers did you find? Did any asthma meds help you? What were your medication side effects?

With the CCB (Verapamil) -- I had EXTREME upper chest tightness, felt like an elephant was sitting on my chest 24/7 -- only took the Verapamil for (2) weeks and this side effect took almost (2) weeks of being off the medication to go away.

With the Diovan -- I was on it about (7) days when I began to get a tickle in my throat and a cough - then it started to feel like someone was grabbing the muscles in my upper chest and pulling them tighter and tighter.

With the Diazide HCT - I would get similar chest tightness to the Verapamil - but it would come and go sometimes lasting for up to an hour at a time - then I would get bad headaches on it.

The Toprol was GREAT GREAT GREAT for 4 year - NO PROBLEMS except making me tired so I would just take it before I went to bed - it was GREAT. Then got switched to the generic without my knowledge (10/07) - and HORRIBLE BREATHING PROBLEMS - chest tightness, inability to get a breath all the way down into my lungs, the feeling that all of sudden I just could not breath, feeling like someone had a belt around my chest and was PULLING and PULLING... I switched back to the regular Toprol 20 days later - but TOO LATE, the side effects persist....

On the PPI Prilosec OTC -- the same chest tightness and pulling that I had on the Diovan -- I wonder if it is because they are both 'inhibitor' drugs?????

I also take Flovent HFA (2) puffs twice a day and Ventolin as needed for the asthma -- not sure if I have it or not but with the horrid breathing problems scared to give it up

famnd

Vanessa,

You've got to find out what other ingredients (besides the drug itself) are in the meds that you've had breathing problems with.

The best way to find this info is to ask your pharmacist for the package insert-go to several pharmacies if needed. Fam

bethsheba

I always cringe when I hear that heredity/family history feedback. This is going to be difficult for me to explain in an understandable way so if anyone else can say it better, please do so:

Yes, there may be a family history of hypertension and yes, some hypertension due to stiffening of the artories may be caused by heriditary conditions that scientists can't explain at this point in time...BUT some hypertension (secondary hypertension) can be a symptom that may be caused by a condition that runs in the family or is inherited...and sometimes treating the condition can reduce or "cure" the hypertension. Example: Sleep apnea runs in families and some charactoristics that put one at risk for apnea(allergies, thick neck, large tonsils, small jaw, etc) can be inherited. Sleep apnea can elevate blood pressure. Treat the apnea, reduce or eliminate the hypertension. Was the hypertension inherited? Not directly....the family history or the inheritance was due to factors that caused sleep apnea...the hypertension resulted because the apnea wasn't treated. This is only one example...there are other underlying conditions that can run in families or be inherited that cause hypertension. I think, too often, the docs don't take these into account. It's too easy to say hypertension is inherited and prescribe a pill.

One thing that should be ruled out is sleep apnea...it's something you can read about on your own and there are some free written tests you can take to see if apnea (or another sleeping disorder) may apply to you. This condition is very common (but often undiagnosed) so it's the first place I would start. Then I would do as much reading as I could about secondary hypertension, the causes and the treatments. A good source of info can be found in the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JCN7) [url]www.nhlbi.nih.gov/guidelines/hypertension[/url] . These are the guidelines that our government recommends health care workers use.

My primary had already prescribed advair and my pulmonologist didn't adjust the rx so that's what I used (as needed). I don't recall any side effects but I was in such a brain fog (sleeping up to 16 hours/day at that time) I doubt I would have noticed any if I had them. I only filled the one prescription. I had no insurance at the time and couldn't afford to refill the rx for advair ($300). The answers I found by accident...disco/switch the med, eliminate the breathing problems.

Sounds like my side effect to a "t".

It's important to remember that these things do come and go. Some people think that because they don't experience the side effects all the time, or every day, every week it's not a side effect. Not so.

If there was something in the generic medication that caused your problems it may take some time for your body to eliminate it and for the symptoms to go away (remember my friend with the rash?)...your problems may not be due to the toprol at all. Again, famnd's posts would be of help here as she has some experience narrowing down the "villain". Another possibility is that you may need a smaller dose of toprol (even though your pressures remain high) due to changes in your body.

Just remember that some inhalers can cause thrush so it's important to rinse out your mouth after using them. You don't need another med to treat the side effect of the med treating the side effect.

Bethsheba

PS Thanks for the info on the meds and side effects. When I have some time I will compare and contrast as it may help me id my problems, too.

Vanessa74

Thank you so much for your great ideas.

I will start to investigate other causes for my 'hereditary HBP' - if that is what it is!

Fam,

What types of things should I be looking for in the package inserts? How will I know if they are bothering me?

THANK YOU AGAIN!!!!!

famnd

There will be a section called: Inactive ingredients. This is a list of the other stuff in the capsule or pill. For example, cornstarch is sometimes in pills to bind the actual medicine & keep it together. The amount of actual drug in a pill or capsule is usually very, very tiny.


Do you know which generic drug you took instead of the brand name Toprol? Fam

famnd

I think it is interesting that you were able to take Toprol for 4 yrs without a problem until you took the generic.

This maybe similar to food allergies. Someone maybe able to tolerate a small amount of a certain food but when a larger amount of that food is ingested, he or she may have an allergic reaction. Or if he or she has a cold at the same time, when the food is eaten he can't tolerate the food. Fam