Coming off Beta Blockers and Eplerenone?

[STEMI_Dave]

My HA was over a year ago and I am reasonably pleased with my recovery, as measured by physical activity levels with no discomfort during exertion.

I have a GP meds review coming up, and I would like to know if suggesting a plan to eventually come off Bisoprolol (1.25mg/day) and Eplerenone (25mg/day) might be feasible. I would want to stay on Lansoprazole, Aspirin, and Candesartan.

I suspect that most of my twinges and niggles are due to those two culprits. I think Bisoprolol is making me too sluggish (i.e. while inactive). Eplerenone seems to be a secret diuretic, at least according to the BNF (bnf.nice.org.uk/drugs/epler... which does not mention that side effect, whereas other website sources do.

So what might be the things a GP might suggest for onward tests and success criteria, and for anyone who has been down the same route, how might I sensibly pitch that proposal?

As GPs are generally not cardiac specialists, what other services need to be involved?

[Happyrosie]

you might want to start by having a word with a pharmacist. If you are in the UK your doctor’s group of surgeries probably employed one or two.

Before you do, take your blood pressure at the same time each day for a week ensuring you have a ten minute rest before each reading. Take three readings each time and if the first is too high discard it and take the average of the next two (or three if you prefer).

Other posters might suggest a different approach.

[abc1_2-3]

Hi Dave. I'm on a similar cocktail to you. I'm just coming up to my 4 year anniversary of MI, 7 stents and some permanent damage to the left side of my heart. I have had (partially due to the virus we can't mention) virtually no follow up, I didn't get a blood test for 2 years. Anyway out of the blue before Christmas the pharmacist from my surgery arranged a phone consultation. She asked me loads of questions & as a result the drug she is dropping over a 3 week period is Lansaprozol. All the others she seemed happy with & I'm lucky I don't seem to have any side effects apart from the cold feet, nose & fingers which as an outside worker all my life I'm used to it.As often gets mentioned on here I do not research anything anymore, you will probably find someone supposedly an expert that will put forward a case for not drinking water & breathing air. The BHF is the only site I would trust for information.

My GP is not the most sympathetic person I've met in the medical profession, apart from that I would never start suggesting to him what my meds should be.

I would try & have a chat with the pharmacist first, hope they sort you out.

[STEMI_Dave in reply to abc1_2-3]

Thanks for that Mr 3,

"... I would never start suggesting ..."

Can I clarify if you mean that's because you make your own decisions and act on those; or the GP is such a klutz you wouldn't bother negotiating your preferences; or despite him being a klutz you would still do it his way?

I assume a practice pharmacist would have access to your medical records and give informed advice, whereas a dispensing 'high street' pharmacist (where I get my gear) does not? Does that sound right?

Ta,

Dave

[abc1_2-3 in reply to STEMI_Dave]

I did try making a suggestion once & got told quite firmly, he was the one that had done the training!!. I'm must admit I'm not sure how much of my records the pharmacist can see, but she is attached to the practice

[MountainGoat52]

Hi Dave,

I went through a similar process with my GP practice pharmacist. After a run-in with my GP over my medication, he passed me on to the practice pharmacist so I could benefit from her expertise. Over a period of time I managed to work with the pharmacist to get my medication right for me.

I can see why you think the two medications you would like to drop are causing the symptoms you have. 1.25mg of Bisoprolol is a low dose, the same that I'm on. I had serious issues with higher doses and found my GP to be totally unsympathetic, but the pharmacist understood what I was experiencing. I had other issues with Eplerenone (not related to its diuretic qualities) and that is no longer on my prescription.

The pharmacist agreed to one change in my medication at each stage so the effects of the change could be ascertained. I took regular blood pressure and heart rate readings. We would then review the results, discuss the next stage and so it went on. The pharmacist has also taken my Raynauds, a pre-existing condition, onboard and agreed to my suggestion that Nifedipine be added to my prescription. Again there was a period of monitoring in case my main blood pressure medication needed adjusting. I also got my statin dose increased after an annual blood test revealed its effectiveness had reduced. My GP hadn't noticed the change and it was not the remit of the pharmacist to undertake a review. I have found that I need to be proactive as far as my health and medication is concerned.

I think your first approach might be to contact your GP about the symptoms you have rather than tackling it from the other direction requesting the Bisoprolol and Eplerenone are stopped. As I said, I did have a run-in with my GP which had the positive result of me being passed on to the pharmacist, so you might have to face a similar scenario. My GP had already declared me to be a nightmare to medicate, so passing the "problem" on was the best for all concerned.

I hope that you are able to get the issues you are experiencing resolved soon.

Regards,

Gerald

[STEMI_Dave in reply to MountainGoat52]

Thanks Mr G,

That's a good point about being symptom rather than outcome driven, though a previous experience mentioning diuretic properties and symptoms just started the PSA/DRE process cogs whirring (re-assuring as those results were!), rather than actually thinking more broadly and doing any follow-up.

As the diuretic properties are not mentioned in the NICE rule book (the BNF), independent thinking and initiative seems to be moderated.

Regards,

Dave