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AF Association
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Medication change and arrhythmia

Has anyone on this forum triggered an arrhythmia episode via a change in blood pressure medication?

After my 2nd ablation for atrial tachycardia two weeks ago, my GP, doubled my blood pressure medication from 5 mg amlodipine daily to 5 mg twice daily for a total 10 mg daily.

Reluctant to start immediately on a double dose, I took 7.5 mg at once three days ago. Several hours later, I experienced extreme sleepiness ( I had a 16 hour sleep) plus my arrhythmia returned upon awaking after a 4 hour nap.

On the second dayof the 7.5 dose, my blood pressure reached a low of 94 systolic.

This is my third day continuous arrhythmia. Was this a coincidence or a trigger? Thoughts?

( I have sent an email to my EP for direction)

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Perhaps the sequence was low BP following increase in dose, with low BP triggering the AT. There seem to be quite a few reports of amlodipine induced AF but I don't know if that is proven.

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The sequence was arrhythmia first and then the low blood pressure on the second day. Yes, I have read that side effects of amlodipine can be extreme sleepiness, irregular heartbeat and heart palpitations. I was just wondering if anyone had had a similar experience.

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No idea about the drug but a BP that low could trigger AF in itself. Go back to 5mg until you've talked to your EP. Why did he double the dose - that's a huge jump ?

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Thank you Mike 11. It was not my EP that doubled the dose; it was my GP. I was just wondering if that was a correct move barely two weeks post ablation when the heart is just beginning to heal. As my procedure was in Bordeaux, France, I have emailed my EP there and am awaiting a respose since it is now my fifth say in arrhythmia.

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What was your BP before your GP doubled it ?

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With my Omeron machine my systolic blood pressure vacillated from low 130's to high 140's as I was taking it four times a day. These readings are without counting a low of 105 when I walked 21,000 paces in one day or a high of 167 when I had jet lag on flying back across the ocean.

Somehow, when I went to see my GP, his reading was in the high 150's although my reading that day ranged from 137 to 149. Today, I have ranged from a low of 110 to a high of 137, in arrhythmia and quite a long time from having taken amlodipine.

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Well obviously the dosage needed increasing, but it's just a case of playing with the increase to get your BP in the correct range

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The 10mg dose was meant to be spread over the day, so no more than 5mgs was taken at one time. This suggests to me that a whopping 7.5mgs in one dose is too much, and not what the doctor intended. If you want to start slowly, then take 5mgs at the usual time, and then 2.5mgs twelve hours later.

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Very good point Polski. I have wondered if I would have had the same reaction if I would have done it the way you have suggested, but I have also wondered it I would have had the same reaction if I had taken the total of 10 mg for the day, albeit in two doses. In any case, I have placed myself back on 5 mg. with my systolic BP on my Omeron being 110 this morning. Unfortunately, I am in day 5 of arrhythmia.

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Why did you not follow the instructions? 5mg every 12 hours is a lot different to 7.5mg in one hit. NOT what the doctor ordered at all.

Low BP may well trigger AF so what is your target BP?

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I did not follow my GP's prescription because my GP is not knowledgeable in arrhythmias and because I thought doubling the dose was excessive all at one shot, barely two weeks post my second ablation when my heart is healing.

Also when I was first diagnosed with atrial flutter this GP prescribed 25 mg Metotropol immediately thinking it would stop my flutter. I took it when I had reverted to sinus rhythm, but the Metotropol had made the condition worse and I had huge palpitations that I had not had before. There were other debilitating side effects. I later read that a beta bocker is contraindicated with vegal AF. This GP commented that the Metrotopol had stopped my flutter, but as you know, beta blockers are rate control, not rhythm control. In fact, he didn't ask me if I wanted to live in arrhythmia, he just put me on rate. Later when I asked about rhythm control drugs, he admitted he could not prescribe those.

Furthermore, this GP delayed one year until I went into persistent AF before he sent me to a cardiologist, not an EP, so I lost another several months while persistent AF to get to an EP. In addition, at the 11 month mark when I complained that I was 3 days in persistent and 3 days sinus while on Verapamil, he did not become alarmed but merely stated that it was the drug working. Three weeks later I was in persistent.

The bottom line is that I questioned his judgement to give me such a high dose especially since when he first put me on amlodipine 5 mg, he said to start with 2.5 mg for one week before the full 5 mg. as I can be somewhat sensitive to drugs and from my BP readings, I did not think that they were that high that the dose should have been doubled.

You have a point that you should follow instructions, but that is applicable only if the instructions are correct. This GP even admitted to me that he had to do homework on my case.

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I have been taking 5mg of Amlodipine daily for quite a few years, together with another BP medication. I used to have only 2.5mg which involved splitting a small tablet in half, as at that time you couldn't get it in 2.5mg doses. I did say to the doctor that I may as well have the 5mg tablet and reduce my other BP medication, but he was adamant that even a small increase in my Amlodipine could " upset my system". He said it was known that some people only had a certain tolerance to Amlodipine so your dosage increase could well have upset your balance and possibly induced the AF ( not a side effect I recall to be honest). There are many different BP meds, so if you did warrant an increase then ask your doctor to give you some alternatives, or at least do some control testing to see if the current combination isn't suiting you. Good luck

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Thank you Bob56, your explanation is most insightful, especially the part where even a small increase could upset my system. Your GP appears more knowledgeable about drugs.

In terms of blood pressure, I have tried other drug classes, alone or in combination. The first was the diuretic with an ACE inhibitor later added. When I was diagnosed with atrial flutter, I was immediately taken off the "water pill' as they can cause arrhythmia if there is an electrolyte imbalance. There were some times when I had an electrolyte imbalance.

The ACE inhibitors can do damage to your kidneys, and my reading has gone down to 49 from 75 pre-arrhythmia. The rate control Verapamil, which I was put on for AF, does have some blood pressure lowering properties. So when my rate dropped to the low forties, I questioned why I still needed Verapamil. Verapamil was stopped and the calcium channel blocker amlodipine was added to the ACE lisinopril.

The calcium channel blocker, I felt, was working way better than the ACE inhibitor, and the GP and I had talked about whether I could be only on one or combination. During my ablation on November 20th Lisinopril was not readily available and my blood pressure was fine just with the amlodipine although there were a few spikes about two weeks later which may have had a lot to do with what was going on in my life. So, I was amazed that my GP decided to double the amlodipine dosage probably because , at his office, I registered, I believe 158 systolic that day. In any case, I have weaned myself back on the 5 mg of amlodipine with readings from my Omeron being all right. Right now I have averaged 125 systolic with my Omeron and that is about 20 hours from having taken amlodipine.

I am now going to look into supplements and life style rather than an increase in amlodipine. Yes, irregular heartbeat, and heart palpitations as well as extreme sleepiness are side effects of amlodipine.

Again, thank you for your post as I may be one of those that has only a certain tolerance to amlodipine. I will certainly keep a surveillance on this drug. You have been most helpful.

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Hi again, I should perhaps add that the advice given to me by my doctor was from a cardiologist, not my regular GP. In fact, all my BP prescriptions have been driven by the specialist. Obviously, if you see a cardiologist infrequently then that might not be an ideal regime, but I pay for the advice and feel comfortable that I have someone who really understands the interplay between my different heart medications. One more thing to add is that it is still only a couple of weeks or so after your ablation, and this is firmly within the blanking period. As I know only too well, anything can happen while the heart is recovering, and whilst I'm sure your GP has the best of intentions I wouldn't think it was a great time to be playing with either new medications or big changes in dosage. Just an opinion and no substitute for expert advice, I should add!

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The points you make are exactly what I was thinking. It also makes sense that the fine-tuning information about amlodipine came from a cardiologist as I have concluded that GP's have limited knowledge about heart drugs.

I am from Vancouver, Canada. I got fed up with the slow and inadequate system here who were just allowing me to get worse in persistent AF, so I went to Bordeaux, France for both my ablations at a cost of 16,555 Euros each for a total of 33, 110 Euros and that's not counting airfare and hotel. They are tops in the world, so I even had alcohol injected into the Vein of Marshall for my perimitral flutter, a technique they had been using for just four months. I am more than angry if this good work was undone by an increased dosage prescription at an inappropriate time. I have an email to my EP in Bordeaux for direction to get me back into sinus. In the meantime, I have reverted to 5 mg of amlodipine without any drastic spike in BP.

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Amlodipine is a calcium channel blocker and although one targeted more at the peripheral blood vessels will nevertheless have an effect on the heart, as diltiazem does (which is more targeted at the heart but has a BP effect). I found both diltiazem and amlodipine gave me ectopics (after / ever since my ablation). Much better off them. I'd suggest you request a change in BP meds, at least as a trial to see the effect on your arrhythmia

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Cuore, just noticed you went to Bordeaux. I did the same, many years ago. I would strongly agree that you get advice from H&J there, asap - they really know their stuff. I had years of being prescribed things without them really understanding it all - including good specialists, but not at the level of H&J.

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My first ablation was done by both H&J as it was quite extensive, six or seven hours, I think. My second for atrial tachycardia not quite a month ago was for only an hour. Both times the latest technology was used and I had no complications.

After 5 days in arrhythmia, having cut myself back to the 5 mg of amlodipine on the third day , and tweaking supplements, I am in my second day of sinus with my blood pressure just fine.

Obviously, I cannot say for sure if the increased amlodipine taken by me at a 7.5 mg shot rather than 5 mg taken twice daily triggered the arrhythmia, but I can say that I am fine on 5mg.

I definitely recommend Bordeaux, France. I have nothing but praise, especially since I was in persistent.

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