Discussions that mention cozaar

Heart Disorders board


Hi Everyone,

I have a question about heart failure and if anybody could help me I'd appreciate any advice.

I am 48 yr old woman,and about 40 lbs overweight with a history of high blood pressure that was uncontrolled for a few years now finally with the right medication it seems to be more controlled. In July I started filling up with fluid in my lower legs and feet so in August I went to the doctor and he put me on Lasix 20 mg in addition to Hyzaar 100/25mg. To make a long story short I ended up in the hospital the beginning of September due to being dehydrated and my potassium and magnesium levels were very low.

He changed the medication and had me on Cozaar, Lasix, Clonidine and Norvasc. MY BP dropped too low so the Norvasc and Clonidine were discontinued. I now take potassium 10 meq twice a day and magnesium supp. three times a day.

My problem is that I'm still filling up with fluid, I'm tired and weak, I have shortness of breath upon exertion but not at night, I feel nausea at times and I'm up a lot during the night going to the bathroom. I have noticed for the past few days that after being on my feet the swelling subsides but comes back at night despite elevating the foot of my bed. My sneakers don't fit me in the morning.

I went to the cardiologist on Monday for a follow-up and described my symptoms but all he said was "we need to keep an eye on your kidney function." I went back Thursday evening because I felt tired and weak so they weighed me and I had gained almost 6 lbs since Monday. I asked him if it was odd that I gained so much weight in 3 days and he asked "are you wearing different clothes?" The he told me my cholesterol was a little high.

I researched heart failure on the internet and out of 10 symptoms I have 7. I had an Echocardiogram done 2 yrs ago but it was normal and he says my EKG's have been the same. I'd like to know if it's possible to have normal results but still be in heart failure and how do I get him to listen to how I feel? I'm thinking of trying a new doctor.

Thanks so much for any advice on this problem.
Dianne
[INDENT]Hi Dianne :) If I were you, I would get another echocardiogram and a stress test with nuclear imaging. If I understand you correctly, you are taking Cozaar and Lasix, along with potassium and magnesium.[/INDENT][INDENT]I did some reading about Cozaar, and found that it is one of the newer treatments for hypertension. Cozaar is a brand name for Losartan potassium, the first of a new class of antihypertensives, and is an angiotensin II receptor (type AT1) antagonist.
Losartan and its principal active metabolite block the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor found in many tissues.[/INDENT][INDENT]PRECAUTIONS for Losartan potassium
General
Impaired Renal Function
As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. In patients whose renal function may depend on the activity of the renin-angiotensin-aldosterone system (e.g., patients with severe congestive heart failure), treatment with angiotensin converting enzyme inhibitors has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. Losartan potassium would be expected to behave similarly. In studies of ACE inhibitors in patients with unilateral or bilateral renal artery stenosis, increases in serum creatinine or BUN have been reported. There has been no known use of losartan potassium in patients with unilateral or bilateral renal artery stenosis, but a similar effect should be anticipated.[/INDENT][INDENT]Ok Dianne, enough gaboldygook. Look at what you are taking: potassium 10 meq twice a day, Losartan potassium, and Lasix. You are taking a drug that is inhibiting your renin-angiotensin-aldosterone system.The hormone aldosterone regulates kidney excretion of sodium and potassium. Lack of aldosterone can result in hyperkalemia (too much potassium) with an increase in total body potassium. Yes, Lasix makes us lose potassium, but I don't think that you are losing enough! You have went from one extreme to another.[/INDENT[INDENT]]Hyperkalemia is often asymptomatic. Occasionally, the following signs or symptoms may be seen:
Nausea
Irregular heartbeat (this may be an emergency symptom if prolonged or severe)
Slow, weak, or absent pulse (emergency symptom)

The kidneys normally excrete excess potassium from the body. Therefore, most cases of hyperkalemia are caused by disorders that reduce the kidneys' ability to excrete potassium.[/INDENT][INDENT]Dianne, I have got some info from the following 2 websites to help put this together. One has info on hyperkalemia, the other has info on Cozzar. Remember that 98% of potassium is within our body's cells. Blood tests reflect only the extracellular potassium levels, and do not indicate the amount of potassium within the cells!
http://www.rxlist.com/cgi/generic/losar.htm
http://health.allrefer.com/health/hyperkalemia-info.html[/INDENT][INDENT]Do you have flank pain or kidney pain? Lasix and Cozaar, can each be tough on kidneys, especially in someone with impaired kidney function. Do some reading here and talk with your doc soon. Signing off for now, but will get back with you :)[/INDENT]
[INDENT]Dianne, what I was trying to say in my previous post is that you could have the condition of Hyperkalemia, due to the Cozaar and potassium supplements. Your doctor may think that the Lasix takes care of (or removes), the excess potassium. The Cozaar can prevent your kidneys from removing potassium. It could be something easily overlooked, because of a lack of general info on this new medicine, Cozaar, and the widely known affect that Lasix has to deplete potassium, coupled with your heavy (I think) supplementation of potassium.[/INDENT][INDENT]Are you restricting your salt intake? Salt or sodium causes fluid retention. I'm sure that you are aware of this, but just wanted to mention. Watch your BP! Elevating your legs often is good for your blood circulation (prevents blood from pooling in your legs) and improving your circulation will help remove the excess fluid.[/INDENT][INDENT]I am sure that you are aware that the heart and kidneys remove excess fluid from our bodies. Circulating blood picks up excess fluid from our cells. ~30% of the output of our heart, is pumped through our kidneys, where the excess fluid is removed and sent to our bladder.[/INDENT][INDENT] If you have excess fluid retention (edema), it is probably associated with the function of your kidneys or your heart, or both. I am not saying that you may have heart or kidney disease, because there are more than a few medicines, and conditions, that effect the heart and kidneys, and will indirectly cause extreme edema.[/INDENT]
Hi Jack,

Thank you so much for all the information in your posts. I'm going to another Cardiologist next Wednesday 11/3.

Before I was put on the Cozaar I was on Hyzaar 100/25mg for about 2 years. I never had a problem while I was on it but it wasn't controlling my BP that good so that's when the doctor added Norvasc 10 mg. A few months after adding Norvasc he added the Clonidine and it seemed that combination was working. In July I started noticing the swelling of my feet and legs but thought it was just because I was aheavy salt user so I took some water pills that my mother had when she was alive.

They seemed to do the trick for a few weeks but then in August the swelling was back so I went back to the doctor and that's when he added the Lasix. As of September 3rd my medications were Hyzaar 100/25mg OD, Norvasc 10mg OD, Clonidine 1mg OD, Lasix 20mg OD, ASA 81mg OD, Protonix 40mg OD, Compazine 5mg PRN, Tylenol #3 PRN.

On 9/9 I drove myself to the ER because I didn't feel right. I was weak, tired, short of breath and felt like I was going to pass out. After doing all the necessary lab work and cardiac enzymes it was determined that I was dehydrated. I was kept overnight on a heart monitor and discharged the next day with a medication change. That's when I was put on the Cozaar.

I was going to have blood work done every week and the only thing that kept coming back low was my magnesium and potassium levels. I was put on Slo-Mag Tablets and Potassium 10 meg OD. I still had swollen legs and feet and was gaining weight everytime I went to the doctor. The only thing the doctor did for me these past few weeks was an EKG, listened to my heart and went over the medication. He could never tell me why my feet and legs were swollen.

I did get copies of all the blood work he did and the last potassium level was still a little low and that was being on the Potassium twice a day. The last level was done on 10/18 and it came back normal so I stopped taking the potassium twice a day. That was done on my orders. My magnesium level is still very low so he increased the amount of Slo Mag I take. I now take 3 tabs twice a day.

I had gone to the dr and saw his PA on the 18th of Oct. and I felt pretty good this day and my BP was low but I was still swollen and gaining weight. He wasn't concerned because my lungs were clear. By Thursday I was feeling very bloated, couldn't wear my jeans and couldn't get my sneakers on so I called the office and went in that evening. I was shocked but not surprised that I had gained almost 6 lbs in 3 days but he didn't seem to be the least concerned about that. I know I'm a big woman and I like to eat but I've never gained that much weight in 3 days.

He just told me to increase the Lasix to 40 mgand he would see me again in 3 months. I left that office that night feeling very frustrated because I wanted to know what was wrong with me and no one was telling me. I finally decided to go back to my Internist who knows me very well and by the time I saw him Sunday evening I had gained another 2 lbs. I had taken all the copies of my blood work from the time I went into the hospital plus I wrote down all my symptoms and after examining me he told me it was CongestiveHeart failure. My kidney function tests have all been normal except for the magnesium and potassium levels. My BP was very high also. It was 140/100.

He didn't seem to think it was from the potassium but said I was on a lot of it but I told him I was only taking it once a day so he has me alternating the days I take it so I'm taking it every other day once a day. I never read up on the Cozaar but I will later when I come home from work.

I have been restricting my salt use for over a month now and I also cut down on my soda but I have not seen any improvement in the swelling of my legs and feet. I keep them up when ever I can and I elevated the foot of my bed. My feet still swell at night in spite of being in bed. The swelling goes down during the day but I think it's becasue the sneakers are restricting them from swelling therefore increasing the swelling in my legs and ankles. After the shot of Lasix on Sunday evening and the 40mg of Lasix the last two days I'm almost able to get my jeans on. My sneakers are a little easier but I can't tie them yet.

I'm not sure if it's my heart, kidneys or the medication making me fill up with fluid but I'm sure there must be a reason for it. I'm just disappointed that the dr I was going to since 1999 didn't really seem to want to find out which it is. Hopefully the dr I go to next week will take me a little more seriously than this one did. This one made me feel like a hypochondriac.

I appreciate all the advice and the information you provided. It helped me a lot. I will write down a few of the important parts like the meds, etc and will mention it to the dr when I go next week. In the meantime I will appreciate any more advice or information you might have and I will check out the web sites after I get out of work tonight.

Thanks so much. You helped me more than you'll ever know.
Dianne
Dianne,
Here is an excellent link for info on the diagnosis of heart failure from the American Association of Family Physicians:
[url]http://www.aafp.org/afp/20000301/1319.html[/url]

Absent the cough, I think heart failure is not your problem.
BUT persistent edema IS. There are a multitude of causes and if you search out "edema causes" you will find a week's reading.

Personally I think that Cozaar and a diuretetic work well together. I find the slightly hyperkalemic tendencies of losartan are more than balanced balanced by the stronger HYPOkalemic tendencies of most diuretics. I take Cozaar and HCTZ and ALWAYS have a slightly low, though symptomless, K+ (and low Na+.)

Make sure you ask your cardiologist to SPECIFICALLY rule out CHF for your mental well being:D!
Thank you for your explanation. I'm quite sure you're right that I don't have CHF although I have all the other symptoms except for the cough. As for the edema, well I guess I will just live with it then as well as the shortness of breath on exertion and feeling tired and weak.

Cozaar and a diuretic may work on some people but not everyone, Before I was put on Cozaar I was on Hyzaar 100/25 but it did nothing to lower my BP so Norvasc 10mg was added. My BP was still high so then Clonidine 1mg was added. In July of this year my feet and ankles started swelling up so every once in awhile I would take one of my mother's diuretics and the swelling seemed to go down.

However in August my feet and ankles swelled up and would not go down in spite of elevating my feet and taking the diuretics. On September 3 I went to my Cardiologist because of the swollen feet and ankles plus I was gaining weight. He discontinued the Hyzaar and put me on Cozaar plus Lasix 20 mg and that's when I ended up in the hospital with dehydration, low BP and an electolyte imbalance. They also found out that magnesium level was very low.

All of my blood levels are now normal. Norvasc was discontinued at the end of the September because one of the side effects was swelling of the lower legs. Lasix was increased to 40mg a day and I still gained almost 6lbs between Monday and Thursday. On Sunday evening when I went to my Internist because I didn't feel good and my feet hurt I had gained another 3 lbs. Since I left the hospital on 9/10 I have gained almost 15 pounds. It may be more now. I won't get on the scale anymore and I know it's not from what I'm eating.

I'm almost sure my symptoms are all in my head so therefore I'm not going to worry about anything anymore. I will just continue to go to work and push myself for as long as I can and ignore anything that is bothering me.

Thanks for your input.