Discussions that mention lotrel

High & Low Blood Pressure board


dmer,

I wonder if your persisting fatigue can in any way be linked to your diet? I am sure your diet is a very healthy one. Does it contain carbohydrates (sugar, pasta, starches and rice)? Changes in our blood sugar levels can make us feel tired and very sleepy even hours after eating a meal or a snack or drinking juice or a soda. Some people are very sensitive to carbohydrates without realizing it. I am reading a book about this sort of stuff.

You are on an excellent combination of medication. As you know, this drug combination is NOT indicated as an initial therapy for hypertension. It is only prescribed after either or both of these drugs have been tried and proven ineffective, and the person has demonstrated the ability to tolerate amlodipine without edema. This way the dose-dependent hazards have been minimized.
CCB/ACE combination is sometimes prescribed to people who get excellent results with amlodipine alone (and do not need further blood pressure lowering), but cannot tolerate the drug because of the edema. The ACE inhibitor counteracts those amlodipine effects that cause the edema to develop.

Your twice daily dosing should be OK (and safe) though this drug combo is usually taken once a day. It would be interesting to see your blood pressure response. You might find you'll feel less tired, sleep better and even get more of a blood pressure reduction with twice daily dosing. Lotrel lowers blood pressure within 1 hour after dosing with a peak reduction in 2-8 hours. Keeping that in mind, the antihypertensive effects most likely start diminishing after that time, though they persist for up to 24 hours. The blood pressure reductions that can be expected on a 10/20 once daily dose are about 10-25mmHg, on a 2.5/10mg, once daily dose there should be a 6-13mmHg blood pressure reduction. I wonder what level of a reduction you'll achieve with the twice daily dosing. The elimination half life of benazepril is 11 hours, of amlodipine 2 days. Maximum blood pressure reduction on any dose of Lotrel is seen within 1-2 weeks.

There shouldn't be a problem with a divided dose. The one adverse effect to watch for is the edema (including angioedema -face, hands, throat, intestines), which can show up at any time. I am sure this is mentioned on your package insert that comes with the medication. The side effects of benazepril are independent of dose. Since you have already tried this medication in a higher dose, I think you'll be fine.

An ACE inhibitor and a CCB could turn out to be the best drug combination yet from a cardiovascular point of view, as the ACCOMPLISH trial has shown (and ASCOT trial before that). They say that the ACCOMPLISH study was designed to challenge the existing guidelines for blood pressure control and cardiovascular event prevention. According to many, it has succeeded. Both of these trials were stopped EARLY. Amazingly, the trial arms using the CCB/ACE combination were shown to be superior to the other drugs or drug combination used (such as an ACE inhibitor and a diuretic) in preventing CV events, while achieving the same degree of a blood pressure control. It will be interesting to see how well this drug combination does in the future. :)

flowergirl