Dizzy due to meds

[asiatic]

Husband's Meds (bisoprolol 1,25 mg and ramipril 10 mg ) prescribed after non stemi heart attack are causing low blood pressure and dizziness. Pulse only 48. As he didn't have high blood pressure before non stemi attack and the low BP could cause a fall should he stop them ?

[MichaelJH Heart Star]

Hello and welcome to the forum! Have you measured his BP? The Bisoprolol dose is quite low whilst the Ramipril is more on the high side. Note - this is a personal opinion as I am not medically trained.

I would suggest you ring 111, or take him to an out-of-hours drop in centre or similar. Good luck!

[asiatic in reply to MichaelJH]

Thanks for speedy reply. Heart attack 10 years ago. Always had postural h. since starting meds. Blood pressure always low about 110 over 68. Looking for advice before having conversation with GP about possibly stopping these meds as we suspect they are reducing his quality of life making him fatigued and dizzy. He is also on aspirin and statin although cholesterol always low so probably doesn't need that either. You hear so many stories of the elderly, he is 75 being overmedicated

[MichaelJH Heart Star in reply to asiatic]

I would not honestly say that 110/68 is that low just quite healthy. If you have a home monitor it might be useful to measure it on standing (maybe with him holding on to something). It is a tricky one. When mine was checked two weeks ago it was 105/51 so the diastolic is borderline. Good luck!

[ling in reply to asiatic]

It's true. 110/68 is quite an ok reading.

When u have the time, can ask what his cholesterol levels are?

Take care and best wishes.

[asiatic in reply to ling]

Cholesterol 3.6. Diastolic is often in 50,s

[ling in reply to asiatic]

Do u have the whole lipid panel?

With the ranges

50s diastolic - any symptoms?

The 48 heart rate is worrying as there are symptoms. My mom's heart rate could go to the 30s without symptoms.

[asiatic in reply to ling]

On simvastatin 40mg. Cholesterol 3.6 ,HDL 1.2, LDL 1.6 and triglycerides 1.9. No ranges given.

Beta blocker Ramipril and statin all given as secondary preventatives. But if these are causing symptoms we want to find a balance

[ling in reply to asiatic]

Thank you. Noted no ranges.

Yes, find that balance. The dizziness is a danger to him.

How is his systolic BP?

[asiatic in reply to ling]

Systolic ranges from 100 to 110. I think he should slowly titrate off Beta blocker as a first step. Not sure GP will agree

[ling in reply to asiatic]

What was the beta blocker prescribed for?

[asiatic in reply to ling]

As a secondary preventative after non stemi heart attack 10 years ago

[ling in reply to asiatic]

Beta blocker. Have you seen this piece?

How long do you need beta blockers after a heart attack?

newsnetwork.mayoclinic.org/...

Systolic 100-110 is not that low for someone 75.

Simvastatin.

Great care should be taken titrating the statin. This is an especially important medication for your husband, given he's already had a heart attack.

Please note my mother's case.

She has been on statins for the last 20 plus years. She's 84. Several years ago, a young GP decided she knew better and informed my mother that since her cholesterol levels had been under good control through the years, my mother should try stopping the Simvastatin. My mom was on a nightly 5mg dose.

The Simvastatin was stopped and the plan was to retest in 3 months. 3 months later, her cholesterol levels had spiked to stroke-causing levels. We were taken aback. Yes, we had expected an increase but not to such an extent.

Best wishes.

[asiatic in reply to ling]

Thanks ling this is exactly the type of info we need to help make the decision of staying on meds or coming off.

[ling in reply to asiatic]

asiatic, sorry to trouble again. Brain fog earlier.

1. The lipid panel results, ranges are required to interpret the results.

2. Note ranges apply to "normal" folk. For those with high cholesterol, had heart attack, elderly, on cholesterol medication, check with cardiologist how the ranges should be applied. This will guide how the Simvastatin should be titrated.

3. If you have lipid panel results from before the heart attack, these will be useful as baseline. But since it's been 10 years since the heart attack, perhaps the results in the 10 years can serve as the new baseline in guiding medication titration.

What is his heart rate range?

Work towards raising heart rate and diastolic bp. Hopefully that will get rid of the dizziness. Falls prevention is key at this age.

Sorry to be disturbing you again.

Best wishes.

[MichaelJH Heart Star]

Sometimes Bisoprolol is taken at bedtime to counter dizziness but speak to your GP first!

[Ianc2]

Rampiril has side effects, dizziness being one of them. Does he drink lots water, about 3litres of fluid per day, eat regular meals? Have a chat with your medics regarding rampiril dosage. Does he take at night to mimise side effect?

[asiatic in reply to Ianc2]

Thanks to everyone who replied. I suppose there is only one way to discover if meds are to blame. He will see GP to experiment under his guidance titrating off meds one at a time to judge if any are to blame.