This is what I was saying about ACE inhibitors (ACEI here) like Coversyl versus Maxide (HCT in this monograph) diuretics.
However in your regime, it should be noted that neither Norvasc nor Metoprolol are indicated due to potentiation. However Inositol Hexanicotinate (no flush niacin) and Lovastatin due to their CYP involvement (liver enzymes) are not indicated either!!
The best balace would appear to be to cut back on the Carbatrol, substitute Gabapentin, and use IH with Lovastatin = 1 gram IH to <5 mgs Lovastatin, and eventually wean yourself from the Maxide.
This study seems to contradict the earlier post. It shows that medical information is all over the map.
At all times Liver and Kidney deterioration should be watched for by frequent tests. At least every month for a while.
Even the drug with the best life expectancy outlook of any BP and cholestrol drug, no-flush niacin, has problems with the liver potentially. No flush niacin is available in prescription as Niaspan. It may also be bought over the counter as
It will as noted above potentiate Carbatrol. The solution is to cut back on the Carbatrol. This requires careful monitoring and MD advice. It is possible to increase the gamma aminobutyric acid in the brain by simply taking L-taurine, GABA, manganese and B6. Gabapentin is widely prescribed in Canada to fight alcoholic addictionm, reduce seizures when combined with other medications, and reduce shooting pains associated with physical injury. It is useful for promoting sedation and sleep, reducing the level of 'fight or flight' norepinephrine in the brain.
Too little GABA can cause adverse reactions.
* Palpitations, pounding heart or rapid heart rate
* Sweating and body temperature changes
* Trembling or shaking
* Shortness of breath of smothering sensations
* Choking sensations
* Chest pain and discomfort
* Nausea or stomach distress
* Dizziness, lightheadedness, or feeling faint
* Sense of unreality, as though you are outside yourself
* Fear of losing control or going crazy
* Fear of dying
* Numbness and tingling throughout the body
* Chills and hot flushes
GABA is available over the counter. Doctors prefer using drugs because GABA is not supposed to cross the blood brain barrier. However oral GABA does result in sedation and sleep improvement. So something is happening. L-taurine increases GABA absorption and is include in several naturopathic over the counter sleep aids and sedatives. Manganes and B6 increase brain GABA synthethis. There has been some clinical experimentation since the 1980's with these substances to reduce seizures and control alchohol addiction.
GABA is taken in dosages of about 1 gram. 3 gram dosages can be taken, but it can cause some side effects that are ephemeral.
With high dosages of Carbatrol and potentiating drugs like Lovastatin, and Norvasc, GABA is probably not advisable.
With the reduction of Carbatrol and no Lovastatin or Norvasc, the potentiating effects of no flush niacin for instance would have to be measured. Then if Carbatrol in the blood is fairy low, GABA could be substituted in the form or prescroiption Gabapentin and the desirable reduction in symptoms obtained perhaps without the attendant risk of kidney damage. As long as Carbatrol is taken, the risk to the kidneys is every present. This is also there for Valproate and other anti-seizure drugs. It is a bit of a whip saw unfortunately.
If Gabapentin and L-taurine, Manganese and B6 worked alone then I would say an ideal solution could be reached. I would not know if this is possible. There are a few new drugs out there. Vanishingly small risk to kidney damage cannot be predicted.
Most medications in this class have what they call ADR's. adverse drug reactions. Many are serious. Multiple organ failure is one class of ADR in some drugs.
Gabapentin is not without side effects. It can even cause aggravation of seizure. However I have knowledge that is fairly effective in certain cases.
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The Second Australian National Blood Pressure (ANBP2) study demonstrated that, particularly in men, there were fewer cardiovascular events and fewer deaths from any cause in the group treated with ACEIs than in the group treated with hydrochlorothiazide (HCT Z).7
The favorable results for the ACEI in ANBP2 may reflect, in part, the predominance of white persons in the study population.
Several studies have documented that the nondihydropyridine CCBs diltiazem and verapamil are equivalent to, and in some instances better than, diuretics and ß-blockers in preventing some cardiovascular diseases.8–10 The second Swedish Trial in Old Patients with Hypertension (STOP-Hypertension-2) trial found no difference in long-term cardiovascular outcomes between subjects taking diuretics and ß-blockers and subjects taking ACEIs and CCBs.11 The Captopril Prevention Project (CAPPP) compared captopril with diuretics and ß-blockers and found that subjects treated with captopril were less likely to die from cardiovascular causes, but subjects in the captopril group were more likely to develop strokes.12
One might argue that ß-blockers potentially diluted the benefit of the diuretics in the STOP-Hypertension-2 and CAPPP trials, but in the Metoprolol Atherosclerosis Prevention in Hypertension (MAPHY) study, metoprolol was found to be superior to diuretics in terms of preventing sudden cardiovascular deaths.13
jabfm.org |
