Detailed query on high BP and rapid pulse issues, and some medicines

This was my Flowmax experience. You will find others with similar problems if you do a Google search
on Flowmax or look at the Flowmax thread on sci.med.prostate.bph Sorry I originally posted the reply
to the next thread. Derek.

"Derek F" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I am about to start Proscar and Flomax. As I already take two BP meds I voiced my concern to the
doc about the additional effect on my BP. He suggested that I take them at bed time to begin with,
as Flowmax is slow release I doubt if it will make much difference when taken. Derek.

After starting Flowmax and Proscar last Tuesday my BP was lower than usual the next morning and
eventually went as low as 106/58 but my normally drug induced pulse rate of under 50 was up to 61.
By evening the headache began and by Sunday my BP was much higher than normal all day. I woke up
early Monday morning with my heart pounding and checked my BP and pulse getting a reading of 214/85
and a pulse of 112. Alarmed my wife phoned the doctor who came round to check me out. He said that
my BP was still as high but heart sounded all right and that my pulse had gone to 90. He had never
heard of such a reaction before but to stop taking the medication.

I did a Google search and found others who had a similar problem with Alpha Blockers:-

"I have had bph problems for quite a while now. I have tried Cordura and it really made me dizzy. I
have tried Hytrin which I may have to go back too. I was only taking 2 mgs a day, but it was helping
a little. The problem was it was making my heart beat pretty rapidlyt at times and I decided to
discontinue it".

Also:- "A few days ago, I read an article in "Worst Pills, Best Pills" newsletter

warning of the dangers of alpha-blocker drugs. The article, by Sidney Wolfe,

M.D., cautioned that these drugs can significantly increase the chance of

heart attack or stroke. The article specifically named Cardura, Hytrin and

Flomax, all of which belong to the alpha-blocker family. Although, I had

been taking Flomax for the last two years and Proscar for more than five

years, I reluctantly decided to discontinue the Flomax out of concern that I

might increase my risk of stroke"

Also:-----

" I was having dizzy spells, weakness and after very little exertion, my pulse rate would go sky

high. I normally have low blood pressure and that might have been some of

the problem. The fact that there are increased cases of congestive heart

failure and stroke are enough to make you think twice or more about taking

it".

When I posted my problem on a cardiac NG I got this reply from a Doctor:-

" I would wonder about the Flomax interacting with the verapamil by

lowering levels of the latter. This would raise both your heart rate

and your BP"

Derek.

"Charles" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I am 44 years old. After many years of normal blood pressure and pulse, I am suddenly experiencing
both high blood pressure (130/90 and higher) and rapid pulse (90 to 100). I am speaking with my
physician, and with several other doctors I see, but they are very busy and I'm not always sure
they are on top of things. So I want to use this space to discuss some medication changes, and see
if anyone can tell me if the meds may be related to the problems I'm having.

First, I've been on a lot of psychotropic meds over the years. I also take Melatonin, 1 Mg, to
help me get to sleep, and Zantac (150 mg, twice daily) for stomach acid.

About 1.5 years ago, following surgery for a benign tumor, I had a bad depressive episode. I was
switched from:

Serzone (can't recall the dose) Zyprexa (1.25 mg, once per day, at night) Depakote (250 mg
twice daily)

To:

Remeron (also called Mirtazapine) (15 mg x 3 pills, once a day, at night) Desipramine (50 mg once
daily, in morning) Zyprexa (1.25 mg, once per day, at night) Depakote (250 mg twice daily)

Now, sometime after this change was made -- and I'm not sure exactly when -- my doctor started to
observe the high blood pressure during office visits.

The psychiatrist thinks the Remeron is unlikely to cause high blood pressure or fast pulse, but
the Desipramine could be the culprit. So recently he switched me from the Desipramine to
Nortriptyline (50 mg at night), since he thought the latter drug was less likely to cause fast
pulse or high blood pressure. However, the change made no difference in my symptoms. We have
lowered the dose of Nortriptyline to 25 mg, still with no noticeable difference in symptoms. One
option is to stop taking the Nortriptyline for a few weeks, and see what the effects are, if any.
However, before doing that, there is another medical factor involved.

I need a lot of sleep. I saw a sleep doctor, and they did two overnight sleep studies. They
noticed a urinate a lot at night, and suggested that might be the cause of needing a lot of sleep,
so they sent me to a urologist. (It's like, trying to solve one problem just leads to another.)
The urologist put me on Flomax (0.4 mg), and more recently switched me to Uroxatral (10 mg). Now,
the thing is, I'm not sure exactly when this rapid pulse problem showed up, but I think, maybe, it
roughly coincides with when I started on these medicines that are supposed to address my urinary
frequency. So the next question is: Can Flomax or Uroxatral cause rapid pulse problems? (The high
blood pressure definitely preceded both the Flomax and Uroxatral, so the latter two medicines are
not under suspicion there.)

Next medicine: The doctor put me on HCTZ for the high blood pressure. It does not seem to have
helped much, if at all, with the high blood pressure; and I'm wondering if that medicine itself
could have caused the rapid pulse problems I'm having.

Finally, the doctor put me on Toprol-XL, last week, for both the high blood pressure and pulse
problems. So far, based on my home monitoring device, it seems to be lower my blood pressure
somewhat. But my pulse remains stubbornly rapid, and it's scaring me a bit.

In case you've lost count, I'm currently on:

Toprol-XL (50 mg in the a.m.) HCTZ (12.5 Mg in a.m.) (both meant to address the high blood
pressure, and I think the rapid pulse)

Remeron (also called Mirtazapine) (15 mg x 3 pills, once a day, at night) Nortriptyline (50 mg, at
night) Zyprexa (1.25 mg, once per day, at night) Depakote (250 mg at night, 125 mg in the a.m.)
(all to relieve depression and anxiety)

Uroxatral 10 mg at night (Flomax, until very recently) (for urinary frequency)

Melatonin, 1 Mg Zantac (150 mg, twice daily) for stomach acid (been on both for ages, can't
imagine they are causing the problem)

Does anyone out there in medical land have enough experience with these medicines to know which,
if any, might be causing the problem? Of course, it could also be that the blood pressure and
rapid pulse problems are unrelated to my meds, and are happening for other reasons. But I'm not
that old. I don't smoke, don't drink, don't use drugs. I've put on a little weight since starting
the Remeron (it does induce hunger), going from 160 lbs to 175 lbs, but I'm hardly obese. I don't
exercise as much as I should, but I'm not short on breath, either.

So, supposing it is the medicines, can anyone pinpoint which ones it might be. I'm reluctant to
get off the Nortriptyline (and actually, would prefer to get back on the Desipramine, since I was
getting real good benefits from that). On the other hand, I lived with the urinary frequency for
years, and the Flomax (and then the Uroxatral) have not provided terribly much improvement anyway,
so I'm perfectly prepared to ditch that, if that might be causing the problems (at least with the
rapid pulse). Any suggestions or insights?

Finally, let me add, I won't make any changes without consulting with my physicians. I just want
whatever added information people can provide.

Thanks, CJ

In article<[email hidden]>, Charles

Quoted message said:

I am 44 years old. After many years of normal blood pressure and pulse, I am suddenly experiencing
both high blood pressure (130/90 and higher) and rapid pulse (90 to 100). I am speaking with my
physician, and with several other doctors I see, but they are very busy and I'm not always sure
they are on top of things. So I want to use this space to discuss some medication changes, and see
if anyone can tell me if the meds may be related to the problems I'm having.

First, I've been on a lot of psychotropic meds over the years. I also take Melatonin, 1 Mg, to help
me get to sleep, and Zantac (150 mg, twice daily) for stomach acid.

About 1.5 years ago, following surgery for a benign tumor, I had a bad depressive episode. I was
switched from:

Serzone (can't recall the dose) Zyprexa (1.25 mg, once per day, at night) Depakote (250 mg
twice daily)

To:

Remeron (also called Mirtazapine) (15 mg x 3 pills, once a day, at night) Desipramine (50 mg once
daily, in morning) Zyprexa (1.25 mg, once per day, at night) Depakote (250 mg twice daily)

So, we have the atypical anti-psychotic drug Olanzapine (ZYPREXA) and the anti-manic drug
Semisodium Valproate (DEPAKOTE) given for bipolar schizophrenia.

The change is from Nefadozone(SERZONE), an atypical antidepressant which raises serotonin (5HT) but
blocks the 5HT2 receptors... into Mirtazapine (REMERON), an atypical anti-depressant which raises
noradrenaline in an unusual way by blocking Alpha2 negative feedback receptors so that physical
arousal is prolonged once started... plus desipramine, a conventional tricyclic noradrenaline-
raising drug.

Quoted message said:

Now, sometime after this change was made -- and I'm not sure exactly when -- my doctor started to
observe the high blood pressure during office visits. The psychiatrist thinks the Remeron is
unlikely to cause high blood pressure or fast pulse, but the Desipramine could be the culprit. So

The switch from serotonin to noradrenaline anti-depressants is very likely behind it. Tricyclics
can mess with blood pressure, usually negatively, and they certainly can cause irregular or racing
heartbeat especially in very high dose (or if you are unfortunate enough to be very sensitive to
them). In my mind combining Remeron with other noradrenaline drugs is looking for trouble, given
its particular mode of action. It may not be remeron on its own which does this, but remeron which
potentiates effects of the other drug. Beyond that I don't know.

Do you have lack of response, or bad effects, with SSRIs? This would probably go away if you used
SSRIs instead.

Generally I would advise against swallowing a spider to catch the fly
i.e. taking a new medication to remove side effects of the old EXCEPT where it would be fatal to
cease the first such as cancer chemotherapy. Much better to change to something which does
not give the side-effect. (NB I am not medically qualified, my advice is worth what you paid
for it and is not covered by medical insurance).

Quoted message said:

recently he switched me from the Desipramine to Nortriptyline (50 mg at night), since he thought
the latter drug was less likely to cause fast pulse or high blood pressure. However, the change
made no difference in my symptoms. We have lowered the dose of Nortriptyline to 25 mg, still with
no noticeable difference in symptoms. One option is to stop taking the Nortriptyline for a few
weeks, and see what the effects are, if any. However, before doing that, there is another medical
factor involved.

I need a lot of sleep. I saw a sleep doctor, and they did two overnight sleep studies. They noticed
a urinate a lot at night, and suggested that might be the cause of needing a lot of sleep, so they
sent me to a urologist. (It's like, trying to solve one problem just leads to another.) The
urologist put me on Flomax (0.4 mg), and more recently switched me to Uroxatral (10 mg). Now, the
thing is, I'm not sure exactly when this rapid pulse problem showed up, but I think, maybe, it
roughly coincides with when I started on these medicines that are supposed to address my urinary
frequency. So the next question is: Can Flomax or Uroxatral cause rapid pulse problems? (The high
blood pressure definitely preceded both the Flomax and Uroxatral, so the latter two medicines are
not under suspicion there.)

Next medicine: The doctor put me on HCTZ for the high blood pressure. It does not seem to have
helped much, if at all, with the high blood pressure; and I'm wondering if that medicine itself
could have caused the rapid pulse problems I'm having.

Finally, the doctor put me on Toprol-XL, last week, for both the high blood pressure and pulse
problems. So far, based on my home monitoring device, it seems to be lower my blood pressure
somewhat. But my pulse remains stubbornly rapid, and it's scaring me a bit.

In case you've lost count, I'm currently on:

Toprol-XL (50 mg in the a.m.) HCTZ (12.5 Mg in a.m.) (both meant to address the high blood
pressure, and I think the rapid pulse)

Remeron (also called Mirtazapine) (15 mg x 3 pills, once a day, at night) Nortriptyline (50 mg, at
night) Zyprexa (1.25 mg, once per day, at night) Depakote (250 mg at night, 125 mg in the a.m.)
(all to relieve depression and anxiety)

Uroxatral 10 mg at night (Flomax, until very recently) (for urinary frequency)

Melatonin, 1 Mg Zantac (150 mg, twice daily) for stomach acid (been on both for ages, can't imagine
they are causing the problem)

Does anyone out there in medical land have enough experience with these medicines to know which, if
any, might be causing the problem? Of course, it could also be that the blood pressure and rapid
pulse problems are unrelated to my meds, and are happening for other reasons. But I'm not that old.
I don't smoke, don't drink, don't use drugs.

Quoted message said:

I've put on a little weight since starting the Remeron (it does induce hunger), going from 160 lbs
to 175 lbs, but I'm hardly obese. I don't exercise as much as I should, but I'm not short on
breath, either.

That's from the "atypical" effect. Olanzapine/ZYPREXA is noorious for weight gain. Perhaps by using
TWO atypicals together you have multiplied the effect?

Quoted message said:

So, supposing it is the medicines, can anyone pinpoint which ones it might be. I'm reluctant to get
off the Nortriptyline (and actually, would prefer to get back on the Desipramine, since I was
getting real good benefits from that). On the other hand, I lived with the urinary frequency for
years, and the Flomax (and then the Uroxatral) have not provided terribly much improvement anyway,
so I'm perfectly prepared to ditch that, if that might be causing the problems (at least with the
rapid pulse). Any suggestions or insights?

Finally, let me add, I won't make any changes without consulting with my physicians. I just want
whatever added information people can provide.

Thanks, CJ

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`. | | | ;-'' `. \___ / /-._;,' ;,-' , / [email hidden] / ,-'_ / _' | ,'
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