Amlodipine for angina

[lizzieloo2]

My husband, who is nearly 72, had a heart attack in April last year caused by high cholesterol. He had a stent fitted, told that his heart had no damage and was put on Bisoprolol 2.5mg twice a day, ramipril 2.5mg twice a day (now changed to Losartan 50mg once a day), ticagrelor for a year and aspirin. He was also referred to lipid specialist and in September last year, started fortnightly injections of Evolocumab for cholesterol (intolerant of statins). After a few months, started getting chest pain while out walking which GTN spray wasn't dealing with. After several trips to A&E, told that about 15% of people who have a stent end up with angina. He was then given Amlodipine 5mg and this seemed to work, chest discomfort stopped and he didn't need the GTN. This went on OK until a couple of months ago, when he started getting the chest discomfort and breathlessness again whilst out walking the dog. Went to A&E and they said was breakthrough angina and needed another 2.5mg of Amlodipine. Couldn't get it though as hospital pharmacy didn't do it and told him to cut a 5mg in half to make 7.5mg dose. Rang GP who didn't want to get involved with hospital prescribing but made an appt for him in 2 weeks. Started taking the 7.5mg first thing in the morning before his walk rather than waiting until about 10.30am when he normally took his tablets. This seemed to work without any bad effects. Then when he saw the GP and mentioned that it was a pain cutting the 5mg tablets in half every day, she upped the dose to 10mg once a day. He queried this as before she increased his ramipril to 5mg once a day from 2.5mg twice a day and it floored him and had to be reinstated to twice a day. His GP insisted it wouldn't be a problem and told him to start taking it at night before he went to bed. The first day he did this, he had an awful night, couldn't sleep, stomach pain, diarrhoea and generally felt ill. He spoke to the chemist who told him to stop the 10mg dose but to go back to the GP for advice from now on. Finally got a message to the GP and she sent a message back to say she thought that would happen! and to go back to the 7.5mg. He has done this and taking it in the morning again but although it seems to be stopping the angina, he is still getting the stomach cramps and diarrhoea several times a day. He is also getting muscle weakness in his arms and various other muscle and joint pains and exhaustion. We have looked this up and it seems that Amlodipine can cause all these pains and weakness too and are classed are uncommon side effects. Unfortunately, the Evolocumab also causes muscle and joint pain but this has settled somewhat after time and now seems to be something new. My question is, has anyone else experienced anything similar with Amlodipine because he can't put up with the way it's making him feel and is loathe to ask the GP as she doesn't seem to be very helpful. He doesn't have a cardiologist as was never given a follow-up appt following his stent.

[Tos92]

I am sorry to hear what your husband is going through. I too have found that my GP does not like to ‘interfere’ with what my cardiologists say, and vice versa which can be a real pain when trying to sort out which medications we should change, stop and continue with. There are alternatives to Amlodipine, have these been considered by your GP? I noticed you mentioned one that he has tried, but there are other calcium channel blockers which could possibly be explored under the supervision of the GP or a cardiologist.

Might be a good idea to push for a referral for your husband to be seen by a cardiologist. If you’re not successful and he has private healthcare which covers his heart condition, it might be worth booking a private appointment to see one.

Let us know how you get on.

Tos

[lizzieloo2 in reply to Tos92]

Thanks Tos. I agree that we should ask the GP to refer him to a cardiologist. No private healthcare but willing to pay just to get this sorted

[Fourwhitesheps]

Hi I had 3 stents fitted in March. I was put on Ticagrelor for a year. A month to 6 weeks after extreme breathlessness to the point I felt worse than the unstable angina I had suffered since my heart attack in September. Chest pain also intensified. I was changed from Ticagrelor to Prasugrel as breathlessness is quite common with Ticagrelor. Maybe worth your husband getting a review about his blood thinners. I too was put on Amlodipine it did nothing for me apart from swollen ankles and swollen throat. I too have been on every statin and have suffered extreme muscles in arms hips and groin and I am waiting to see what doctor says as the last one ezetimibe has made me extremely ill. It is a nightmare trying to get the medications right and you just want to be normal. Good luck to your husband I hope he gets sorted.

[Wingnutty]

I was on Amlodipine and at a diabetic review, I told the nurse that I had some ankle swelling which I think is the beginning of heart failure. The nurse suggesting switching from Amlodipine to Lercanidipine Hydrochloride, because ankle swelling can be a side effect of Amlodipine. So I switched and it made no difference to the ankle swelling, but it is possible that if this drug has fewer side effects, it might be more beneficial for your husband. Could be worth asking about if you get another appointment with your GP.

[lizzieloo2 in reply to Wingnutty]

Thanks will enquire about this

[10gingercats in reply to Wingnutty]

I am not a diabetic but started to take Amlopodine for sudden unexlained high blood pressure.Took it with very small dose of Furosimide once daily..... 5mg made my ankles swell but 2.5mg(rec. by the pharmacist) did the trick. Losartin was not rec. for me although my GP wanted to me to try it. Cardiologist said quite firmly.NO!My Gp s do not like, generally, to mess with my medication for heart so, as said here, get yourself refered to a cardiologist and let them prescribe for your heart and blood pressure issues....much safer than most GPs in my opinion.

[Tiggs876]

Both Losartan and Amlodipine do the same thing (lower blood pressure). One is a calcium channel blocker (Amlodipine) the Losartan is an angiotensin blocker & involves potassium.

Amlodipine didn’t agree with me (diarrhoea & persistent cough) so I now take Losartan for my mild high BP & get on fine with it. I can’t take statins & my lipid clinic has put me on Bempedoic acid (Nilemdo). Again I’m fine on it.

Has your GP told you why 2 lots of BP drugs have been prescribed? I’ve not heard of both being prescribed together.

[lizzieloo2 in reply to Tiggs876]

He's on 3 blood pressure tablets - bisoprolol and losartan (replaced ramipril as it made him cough. The amlodipine is a blood pressure tablet but was given to him specifically for angina. All prescribed by the hospital following admission for a heart attack but because there was no heart damage, no follow-up was considered necessary apart from with GP and so far she's just made things worse whenever we've asked her for help

[Tiggs876]

oh dear, it’s awful when your gp is no help. Amlodipine definitely upset my stomach badly. There must be another drug for your husband’s angina. I think a cardiologist referral might get the drug situation sorted. My late ex husband had heart trouble - long-standing high BP & eventually a double by pass, as well as lifelong asthma. His cardiologist was excellent at getting his many meds right. I wish you all the best in getting this sorted out and I hope it’s not before too long.

[Drummer20]

Hi Lizzie,What springs to mind and I’m sorry if I’m breaking the rules here,is that your Dad is on a lot of heart medicines he probably doesn’t need and he hasn’t got a cardiology review coming up.If his heart hasn’t been damaged why does he need all these medicines?The pain could be alleviated by good diet,magnesium supplement,increased gentle exercise,reduced caffeine.

I think I f the heart pain is new the doctor should be getting to the bottom of the new problem and he would benefit from a cardiologist looking into it.I look into every medicine they prescribe and lots of times I’ve argued I didn’t want something and have been proved right when they removed it.

[lizzieloo2 in reply to Drummer20]

Yes, we can't understand why he only took one BP tablet (atenolol) before the heart attack and this was sufficient. Now, he needs 3 tablets. He already has a good diet and walks 2-3 miles a day at present (4-5 before the heart attack) and trying to gradually increase this but has COPD and reluctant to go too far with the angina now. He only drinks decaf coffee but maybe a magnesium supplement could help. I eat lots of nuts because of the magnesium content although my cardiologist says nothing is proven about these helping. As you and others say, we will have to get the GP to refer him to a cardiologist. It seems strange that there is no cardiac follow-up, say a year after a heart attack and stent fitting even if just to check all is OK and discharge.