Ramipril and amlodipine?

[Ecki]

My BP has been high since an episode of fast AF in August 2019. I had a cardioversion in Sept 2019 and PVI ablation Jan 2020. I was originally on losartan but got horrendous side effects so GP changed me to Ramipril 2.5 mg. BP remained high so dose increased to 5mg about 2 months ago. BP still high. Saw my cardiologist yesterday, who has advised adding amlodipine 5mg, so when I got home I googled it. One of the listed side effects is that it may cause arythmias. Haven't started it yet, waiting for letter from cardiologist to GP. Has anyone else been on this combo and subsequently developed an arythmia? I've emailed the cardiologist's secretary but no reply yet. Also, anyone got any advice on what else I can do to reduce BP, as I know high BP is a cause of AF. Over the last year I've lost 4 stone in weight, don't eat salty or processed foods, walk about 3 miles each day with the dogs, about to start cycling again, don't know what else to try. Maybe it's because I'm old, 66?

[BobD Volunteer]

amlodopine is a calciu chanel blocker which do not suigte everybody. I can't take them as my ankles and feet swell badly but they work for many people. To be honest most anti-arrhythmic drugs can also be pro-arrhythmic so it realy doen't matter what you take so long is it works for you.

[tunybgur]

Ramipril is not normally the first choice for reducing hypertension in over 55's as it is less effective in older people. This is part of the NHS guidelines if you look them up.

I was taking Ramipril (7.5mg) and Amlodipine (5mg), but stopped the Ramipril as a precaution when I read about ACE inhibitors possibly being implicated with more serious covid19 infections, I'm 73 by the way.

Stopping Ramipril had little of no effect on my BP so I'm not taking them any more although I haven't told my GP as I know he wouldn't agree. My BP is about 125/65.

[SST1981]

I did fine on amlodipine for about a year recently stopped taking it ( with dr permission) due to massive hair shedding. Just saying.....

[cuore]

Since you have had only a PVI ablation, it sounds as if you are not taking an antiarrhythmic drug.

After my second ablation, I was on the antiarrhythmic drug Amiodarone plus 5mg. Amlodipine, a calcium channel blocker. At 5mg. I was fine. Because my blood pressure was still high, my GP doubled the Amlodipine dose to 10 mg. so that I would not go back into arrhythmia. The opposite happened, I went into 6 days of constant arrhythmia immediately upon taking it. I actually stopped taking it after two days, but it took another 4 days to get back to sinus.

The drug you were taking, Losartan, is an ARB (angiotensin receptor blocker). For my blood pressure, I am taking one in the same class Olmesartan 20 mg. And, it did not do the trick plus I did not want the dose increased which would be monotherapy. So, Amlodipine 5 mg. was added. With two drugs the treatment is combo therapy. From what I have read, low doses of drugs combined have less side effects than increasing doses of a single drug.

Ramipril is an angiotensin-converting-enzyme inhibitors ( ACE inhibitor). Adding Amlodipine , a dihydropyridine CCB, makes the treatment combo therapy. When my GP looked in his computer when I requested a CCB, he said that cardiologists are prescribing Amlodipine.

As you do Google, you might want to place in the address bar: combo therapy - Rampril and Amlodipine. Personally, I think that you will be fine because you are not adding Amlodipine to an antiarrhythmic potent drug like Amiodarone. I say that with a disclaimer because I am not an MD.

[Ecki in reply to cuore]

Sorry, I didn't mention I am also on sotalol, but very low dose 20mg twice daily. Was on 40mg twice daily but it was triggering my asthma so the EP suggested reducing it, which has improved the asthma and no AF so far. Reducing the sotaolo made no difference to my BP.

[cuore in reply to Ecki]

Sotalol is both an antiarrhythmic drug and a beta blocker. So, for you, reducing the dose also helped your asthma which is in keeping with how monotherapy works. I did check with Dr. Google about interaction between Sotalol and asthma. You might benefit from doing some research on it and discussing it with your EP because asthma is highlighted.

When a new drug is added it might be wise to check how it interacts with drugs you are already taking. There are two efficient sites: rxlist.com and especially drugs.com such as this information for sotatol and amlodipine interaction:

drugs.com/drug-interactions...

I am also on the antiarrhythmic drug Propafenone which is in the same class as Amiodarone. I was fine with Amiodarone and 5mg. Amlodipine, and I am fine with Propafenone and 5mg. Amlodipine. It was the doubling of the dose of Amlodipine that affected me.