The Importance of reading Patient Information Leaflets.

I saw my GP yesterday re issues I'm having with a slipped disc, as a result of that visit here's an email I've just sent to the surgery.

Hi, I saw Dr xxxxx yesterday morning, he prescribed me some Amitriptyline 10mg.

I read the patient information in the medication and it states Do not take Amitriptyline and tell your doctor: if you have recently had a heart attack, if you have heart problems such as disturbances in heart rhythm which are seen on an ECG, heart block or coronary heart disease..

As someone who had a heart attack in June 2021, has a left bundle branch block and has angina I was very worried about taking this medication.

I phoned the surgery to seek advice yesterday afternoon, I was asked to call back later, when I did they had not managed to speak to Dr xxxxxx and the lady I spoke to recommended that I speak to a pharmacist.

I spoke to two pharmacists.

The first said; In my opinion you should avoid this medication. It should not be taken in the following people, recent myocardial infarction. Any degree of heart block or disorder of cardiac rhythm. There are alternatives like gabapentin.

The second said; In patients with preexisting bundle block disease there is a risk of heart block with this medication. So even in low doses I'd say you shouldn't be taking this medication.

Obviously in light of the opinion of these two pharmacists, one of whom is Superintendent Pharmacist I do not feel that I want to take this medication and would seek to take a safer alternative.

Could I ask that you draw Dr xxxxxx attention to the content of this email.

Thanks

[Walkytalky]

Hi John, I agree on checking our meds ourselves. I have same health issue as you, with dilated cardiomyopathy, and my Consultant and GP expect me to take aspirin and Spironolactone with Losartan/ Ramipril - but these are listed as warnings/ precautions. Also expected me to take Dapagliflozin when I'm not a diabetic, and these made me collapse from low blood sugar! Ditto Statins until I insisted on blood test to prove I have high good fat and low bad, hence clear blood vessels. I guess there is a standard parcel of meds which should work, but one size doesn't fit all does it?Keep up the good work John and I hope your back improves ( I used a tip up table to stretch my spine out until the disc popped back in).

[Hidden in reply to Walkytalky]

Thanks, good to hear that I'm not alone in checking these things.It doesn't feel quite right checking and doubting the GP, my priority however is doing whatever I can to improve my health, there's no way I want to take backward steps.

[Hidden]

Thanks for that HappyJo.

[Mountwood]

Good Morning John. In 2002 I had a major op to correct a faulty diaphragm which involved moving my heart. As a complication of this I had 2 episodes of atrial fibrillation. Some years later my GP prescribed Amitriptyline for nerve pain and it sparked another episode of AF. I now avoid it like the plague and always read the info leaflets. I hope your slipped disc improves. I found a chiropractor more help than my GP.

[Hidden in reply to Mountwood]

Thanks Mountwood, our GP phoned me yesterday afternoon and he assured me that at the dosage he had prescribed and with my heart condition I had nothing to be worried about. He is very good GP and he is very caring. He won a national health care leader award a few years ago.I'm taking my first tonight.

I'm in the surgery on Monday for blood tests and he said he'll come and have a chat to me whilst I'm there.

He's ordered an MRI scan for my back, our surgery does have its own physiotherapist.... unfortunately there's a three weeks wait to see her so I've done a lot of research into local physiotherapists and have an appointment for next week.

I've had success with physiotherapy many years ago so it's fingers crossed.

[Mountwood in reply to Hidden]

Your GP sounds wonderful. I wish I could say the same for mine. Good luck.

[Hidden in reply to Mountwood]

We realise how lucky we are to have him, under his leadership our surgery has been transformed.

[Qualipop]

Unfortunately he standard treatment for pain is amitrip and gabapentin . They simply don't know what else to give now they've been told not to prescribe opiates so most GPs don't even check whether there are interactions. I'm glad he's reassured you and will check with you. Don't be surprised if they make you very very tired . I'm like a zombie.

[Hidden in reply to Qualipop]

Hi Qualipop, over the last few weeks I've been on Co-codamol (didn't reduce the pain at all), Morphine (worked fairly well but gave me terrible constipation) and Tramadol (quite effective), the Dr feels that the Amitriptyline is the right medication at the moment.When my sciatica first started I asked for Naproxen as in the past I've found it very very effective, he said that unfortunately following my HA last year that he couldn't prescribe it to me any more.

Are you currently taking Amitriptyline?

[Qualipop in reply to Hidden]

No I can't function at all when taking it. I've had spinal problems for over 30 years and have been given Amitrip at least 10 times. I manage about a week then can't stand it. It's never helped me but maybe I haven't taken it for long enough. Gabapentin made me seriously suicidal and didn't touch the pain. Also tried Nortriptylene which is the older version. That also knocks me out. During along stay in hospital I was finally given morphine ( Oramorph) but was very allergic to it so it was changed to oxynorm which I've been on ever since. It's the only thing that has ever touched the pain and I've been through the lot. The trouble with opiates is that your body gets used to hem,they become less effective and the dose has to be increased. I'm now at the limit. If they decide not to operate in May I don't know what I can do. GP just asked me to try duloxetime which is also an anti depressant and also says in the leaflet not to be taken if you have heart disease. It's a very low dose but I'm still too scared to try it. I react really badly to an awful lot of medications. We think it's a preservative or a colouring but can't pin it down. The best for me when I've had sciatica has always been an osteopath but not one who does hard manipulation.

[Hidden]

Bloody hell Qualipop, you've really been through it, my heart goes out to you.It's interesting that of two neighbours who have been to see me today one had severe issues with Tramadol and the other had severe issues with Amitriptyline.....

I've taken my Amitriptyline so fingers tightly crossed.

[Hidden]

Took the amitriptyline last night.....no side effects at all I'm pleased to say, zero impact on my sciatica, I had a dreadful nights sleep due to the pain.

[Squeaker12]

Hi JohnMy husband got prescribed tablets,antibiotics,by the consultant urologist.He was to take them for 6 weeks due to an ongoing urine infection.When I read the patient information leaflet it said don’t take if you are elderly,have an aneurysm,are on omeprazole,or have kidney disease which my husband has all of those.We rang the pharmacy and she said they’ll be ok as the company has to state every eventuality,just in case!My husband decided to take some over the weekend to see if they would help with the infection,and 3 days later could hardly walk due to bad tendinitis in his calves! We rang the consultant on Monday n he said to stop taking them immediately.We saw our gp. about it and she said yes it will be the tablets that’s done it and”hopefully “his leg pain will pass.Cant imagine what he would’ve been like on them for 6 weeks.So you are correct always read the paperwork.If my husband had been on his own and I hadn’t noticed the effects he could’ve been still taking them!

[Hidden in reply to Squeaker12]

It's frightening isn't it.....with the computer systems that GP's and pharmacies have, assuming that they have records of your ailments and conditions, you would think that any significant interaction between what is being prescribed would immediately be flagged up.Maybe I expect too much!!

I hope that your husband is ok now

[Squeaker12 in reply to Hidden]

Yes it is scary .I know a lot of older people who have taken medication and it’s had awful side effects.I said to my husband,as soon as they make the prescription on the computer it should come up in red as a warning not to prescribe it!Hopefully now my husband is on another antibiotic he will improve.Take care of yourself,no one else will it seems !! 😩😩