is anyone else on a large cocktail of meds like me?
I’m thinking I might be on too many and I am going to have a chat to my GP next week as Cardiology have discharged me
I currently take
nicirandil 20mgx2
Ramipril 5mg x2
Ranolazine 750mg x2
Isosorbide 60mg x2
Amlodipine 10mg
Bisoprolol 10mg
Avorstatin 80mg
Aspirin 75mg
Prasugrel 10mg
Spironolactone 25mg
Lansoprolol 30mg
Then I have my GTN spray and morphine 10mgx2 but I’m hoping to come off that with the GP supervision.
Without knowing what your medical conditions and history are, it is difficult to say whether you are taking too many or just enough, although it certainly looks a lot. And most people on here are not medically qualified to comment, including me. All you can do, as you intend, is to consult with your GP, and hope the outcome works best for you, assuming that your medical conditions remain under control, side effects are tolerable, and issues like liver function are kept in check.
I have had a stroke, a bypass, 2 stents and am diabetic and take 12 tablets a day (9 different ones)
As pointed out earlier it depends on what your medical condition is but that said it never hurts to have a review with either your GP or surgery Pharmacist.
if you can get an appointment with your surgery pharmacist that might be good too. speak to the receptionist st the surgery
Hi .It's strange that you have been discharged from Cardiology .
my advice would be to talk it all through with the GP who should be able to tell you what each tablet is for so you can decide together whether or not you need to keep taking them all or not. I suppose it depends what conditions you have what your symptoms are if taking the medication is keeping you well, definitely something to discuss with the GP who should know also why you’ve been discharged from cardiology.
I’ve been discharged by my cardiologist 3 years ago as my symptoms were under control and have been in the care of myGP and feeling well until recently When my symptoms have come back and I’ve now been referred back to cardiology.
That certainly is a Mouthful 🙃. Definitely deserves a review. I’ve recently cut out/ down on mine. ( my choice) and monitor. Side effects decreased 👍👍
Hi , that seems a lot ,but iv no medical training, I'm on alot too, I went to boots and spoke to pharmacy manager, but, he wouldn't decrease any said to speak to doc or cardi. Iv got to the stage now after years of taking them, they make me feel sick just thinking about taking them, I look at them all and have to force myself to swallow them all every day, some twice a day.I have stomach pain and nausea alot, as well as cad and angina and take an assortment of drugs , some the same if yours, I had to come off the amlopidine made me so ill and cardi put me on ranolazine, I see you take both, I take citalopram 40mg too as well as heart meds and my gtn spray , o yes also co codamol 30mg/500mg for pain, hope you get sorted out
Arty, I'm guessing you live in the UK as you've spoken to Boots.
IN the UK, I think most GP surgeries have got together in groups and employ one or two pharmacists between them.
If your meds are causing difficulties, and I see you are on citalopram, I think an appointment with the pharmacist at your surgery (over the phone possibly) will be useful to you.
I’ve had AVR, PCI and CABG, I’m taking 9 tablets a day (8 different drugs) so this doesn’t seem shockingly high.
As others have said we are not medical experts on here so we cannot really comment or make suggestions other than talk to you GP if you have any concerns.
I have go with consensus here and say the GP and cardio are best placed but trust me I know how difficult it is to get a decision, just keep at them and please let us know how you get on, medication is personally a big thing for me, I threatened to stop taking any until they explained and removed the ones no longer required, I would t advocate that tack as I was in hospital at the time so felt a bit safer.
I found before my diagnosis was confirmed I was prescribed medication in a scatter gun approach. I have been on most of the medications you have been prescribed. My symptoms actually became worse. I later discovered that beta blockers can make coronary vasospasms worse. Ranolazine is more suitable for patients living with microvascular dysfunction.
Ramipril dropped my blood pressure way too much.
Morphine can mask angina pain. I only take morphine for a few days after I have been in hospital with unstable angina.
If my chestpain is so bad that I need to take morphine my Cardiologist's instructions are that I must go to hospital to be checked out. I am always admitted.
As others have suggested you need to discuss your medication with a sympathetic Cardiologist who has reviewed all your test results and listens with open ears.
I’m just mindful because I’ve had 3 Angiograms and a Cardiac MRI scan in the last month and I’m starting to doubt myself.i have been looking into one of the Cardiologists you kindly provided me information about Milkfairy.
Ive applied for my medical records and when I receive them I’m going to make an appointment to see him.
I can ask for a referral to Manchester but that could take months
Thank you everyone for your replies
After a quad by pass in May 22 I now take 5 different tablets including Aspirin which now seems quite modest compared to your list!
It is difficult to believe that a large cocktail of so many pills doesn't interact to some extent, as many will individually have some sort of side effect described on the leaflet.
I think stomach upsets or discomfort are fairly common which has a big impact on general well being.
I think a chat with the GP or GP pharmacist would be a good idea especially if you have kept a health diary and are able to identify which of the tablets might be causing problems.
Only an angiogram using acetylcholine will confirm coronary vasospasms.
I have had 3 cardiac MRIs, several stress echoes, holter tests and angiograms all normal.
I was even told by a specialist listed on the website that Tos posted that I had a pain problem not a heart problem. It took some doing to look an eminent Professor of Cardiology at The Royal Brompton Hospital in the eye and say I didn't agree with his opinion and asked for a second opinion.
I too doubted my sanity. I was beginning to think maybe they are right and I must be wrong.
I was then offered an angiogram with acetylcholine which confirmed my diagnosis of vasospastic angina.
I carry a copy of this angiogram report along with my admission plan with me at all times.
I ask any doctor who tries to dispute my diagnosis to read these documents.
I’m pretty sure I’ve had one is that the pressure wire one. And well done you for advocating for yourself!! I did the same at my “bedside” meeting the other day through tears to a very arrogant and quite nasty cardiologist.I told him I didn’t agree and the latest research on the bhf showed that MVD can be missed on a cardiac MRI.he actually agreed and said that’s one prognosis but I’m not diagnosing you with that as you don’t have chest pain.
Vasospastic Angina has never been mentioned to me it will be interesting to see what my Tests show with regards to that
The pressure wire test with adenosine is used to diagnose microvascular dysfunction. It cannot detect coronary vasospasms.
I look forward to the day when we are not reduced to tears by the sheer effort of advocating for ourselves 😊
Milkfairy like most people with similar diagnoses to us, it is not uncommon to encounter negative experiences with cardiologists early on, as it is hard to diagnose our symptoms without the proper specialised testing which you have spoken about multiple times due to the nature of how our symptoms present.
Our symptoms can be intermittent and unless a spasm is being caught at the time of us being in a clinical setting, it is not often diagnosed or further investigations actioned. I know this as I have been in this position many times. Sometimes it takes multiple trips to A&E or even a cardiologist before a spasm is caught. I have found that tests have previously been conducted on me after the spasm has resolved due to ambulance or A&E waiting times. By then, there is nothing of particular significance that can be found.
I believe you had this encounter 10 years ago, from a previous response with this particular cardiologist. It was very much under recognised and under diagnosed 10 years ago, and it still is to some degree today which is why we have members enquiring about how to go about getting a diagnosis and which specialists would be ideal.
Cardiologists continue to still remain uniformed on the proper diagnostic tests for VSA and MVA however, research has improved over the years and since then, this particular cardiologist continues to be recognised for setting up one of the first INOCA clinics at The Royal Brompton and still treats patients with INOCA.
I appreciate we do not all have the same experiences with cardiologists and I am sorry this one encounter with this particular cardiologist continues to upset you. I have been in this position with other cardiologists before. However, the same leading INOCA specialist that diagnosed yourself, also diagnosed me who is also on the site that I mentioned. Therefore, experiences with cardiologists will vary on an individual basis.
I would prefer if you would PM next time if you are unhappy regarding something that I have posted. INOCA International is a highly regarded site, with over 30 specialists and can be a great resource for people struggling with the same conditions, and aid in getting a diagnosis like myself, similar to the Heart Spasms Alliance which I believe you have also provided information for before.
I hope you have a good weekend.
Thanks for adding that insightful point , Tos.It's worth us remembering, that sometimes , especially with conditions that may not be symptomatic at the time we see a Cardiologist that they may not be able to confirm a condition or diagnosis , especially if it's the first time it's happened , no matter how many tests they do , or how bad the symptoms were when we first visited AandE before we see them.
It's even more likely with less common and intermittent cardiac or Neurological problems that don't necessarily leave lasting markers in our blood or in electrical testing , x-ray or scans.
At the time of the Consultation, after the fact , we appear Normal , its a big frustration, and one I've sadly experienced many times with various conditions , but with even the most thorough knowledgeable doctors sometimes this happens and can't be helped .
Obviously , the negative appointment is distressing and disappointing to us , especially if we don't get any answers first time around or get discharged, but it doesn't necessarily mean the doctor involved was not skilled or experienced. Even the best Cardiologist with Specialist knowledge can't confirm a condition until they can see it in your test results or during examination.
So , unless we can be sure that the whole appointment was negative or we feel we were too quickly dismissed or gaslighted ( and believe me even without experience you know when this is happening the red flags of language , and lack of testing makes it obvious) it isn't always fair to a dismiss a Cardiologist or Doctor as being bad at their job or to be avoided if they cant diagnose on the evidence they have.
Some of the most prestigious Consultants in every field of medicine , and experts in the rarest conditions will have been unable to diagnose someone at least some of the time in their careers. Which is partly why they work so hard in finding ways to improve diagnostics as they move on through their careers.
Take care , and thanks again , Bee
The Cardiologist whom I made reference to is still telling patients the same thing today. It's not just my personal experience.
We are fortunate that there are several groups providing support to patients living with microvascular dysfunction and coronary-vasospasm
There are also patient advocates quietly advocating for us all as patient representative in places of influence including:
British Cardiovascular Society
The European Society of Cardiology
BHF
Biomedical Research Council
National Institute of Healthcare Research
National Cardiac Audit Programme
Speaking at professional conferences.
Coronary vasospasms and microvascular dysfunction is now included in the training curriculum of UK Cardiologists.
Participating as research advisors to leading researchers and co authors of various academic articles.
Working with the BHF to produce information about microvascular and vasospastic angina on the website.
Perhaps there are others - as I said, we will not all have the same experiences, however, despite this, there is still a wealth of information on there outside of this particular cardiologist which may benefit someone.
I would hate to think that responses of this nature may completely deter others away from potentially obtaining another resource on the site that could be helpful in their unique circumstances.
I am in fact, in contact with two of the organisations you have listed and it is fantastic that we have organisations advocating for us. Some of them have also previously worked with INOCA International.
Definetely you have many pills to take, but I think that it is the doctor who has to say what is recommended to you. My concern would be whether or not you can take the pills as prescribed. For example, I never had problems in take medications prescribed twice a day, but often I had difficult to take regularly when medications were prescribed 3 or 4 times, I usually forgot the 2nd or 3rd time because it is during my work, walking, etc.
You could speak to your pharmacist, your surgery will probably have one. I would keep a diary of how you feel from now up to when you see your Dr. it may help him asses whether you are on the right meds and the right number and dose.
Are you feeling better , or at least feel your heart events are being managed at the moment whilst on this group of medications? That's the important question.
If you feel you are improved then it isn't too many medications for you at the moment.
If you are still struggling or getting regular symptoms despite changes to your Self Care then your medications may still require tinkering with or the amount of different medications may need a review.
Even if you have been discharged from active Care by your Cardiologist you can still contact them to request a reminder or explanation of what each medication is for and to double check that you are on the right doses.
Getting copies of your previous hospital letters and test results can also help you to understand what's being used and why , and it's good to have hard copies of these anyway in case you want to share information in them at future appointments with new doctors.
You can request copies from your GP surgery or the records section of your hospital.
Whether you need a medical review yet would depend on the last time you saw a Cardiologist and medications were changed , and if the symptoms are not improving.
If you were only discharged recently from Cardiology, or have only tried this combination of medications for a short time , unless there were any obvious drug interactions the GP would be more likely to suggest that you remain on the treatment suggested for a few months before assessing how well they are working and if changes should be made.
You can speak to your GP and ask for a drug review , which is better than a pharmacy review initially because your combination may have specific medical reasons which your GP will have more information about than the surgery pharmacist or nurse will.
I have various illnesses, and although I don't take every drug , every day , there are 26 medications on my total prescription list. My monthly repeat comes in two pharmacy brown paper carrier bags. If you add in the daily oxygen , that comes twice a month on a van and other machines it could be quite startling . My daily used medications total 16.
So , you can see that sometimes it isn't always the amount of different medications on your prescription list that counts as how you use them and how well they help your symptoms.
Take care and let us know an update when you get some answers , Bee
I started on Nicorandil 2 weeks ago and I do feel that is helping.As I’ve had 3x hospital stays in the last month where I was given morphine I wasn’t sure if it was Nicorandil but I’ve weaned myself off the oral morphine and have cut down on the extended release.I’m keeping a diary and I’m still getting pains but they are not as severe.
I have also requested my medical records and I understand what TOS is saying but my particular Cardiologist is an extremely arrogant and quite nasty man.
He performed a stress angiogram on me 3 weeks ago after just telling me he didn’t believe I had chest pain and would remove my meds if it showed that I didn’t.I was extremely upset and in tears throughout the procedure.he discharged me last Tuesday in the most upsetting way and I’m still not over it, so I understand where Milkfairy is coming from as these type of situations leave deep scars mentally and emotionally.
Thankfully all are not like him and I’ve started a complaint against him .I have an appointment with my GP next week and il keep u updated xx
Your Cardiologist definitely sounds like a handful, and when you get treated like that it is hard to get over and it stresses you out seeing the next doctor or going to an appointment.
I've had some arrogant Cardiologists, My current Cardiologist was sceptical about my self reported symptoms because I'd had tests at times when symptoms weren't occurring, because of appointment delays , which seemed to prove the opposite.
Luckily , by the time I'd got to this Cardio I'd got used to dealing with doctors and how to talk to them , so he tested again , and reluctantly did less common tests, and realised I was right .
He didn't know a lot about my condition so initially just rattled off basic self care suggestions. Experience as a patient meant I could prove with my diaries and bloods done by the GP that those things were not working for me alone at the return appointment, so he actually looked something up that I asked about recommended by the charity for my problem and he chose to prescribe it.
Three months on aFib was occurring too , so that was dealt with by him as well, but he also put me on another medication used for my cardiac issue in combination with what I was already taking and that condition improved , and so periods of arrhythmia and aFib did too.
He has learnt a lot more about orthostatic conditions and is actually prescribing the drugs I am on more widely now too.
In the past I'd have probably just crumbled at the initial appointment.
Now I go prepared and despite being nervous I hold my own , politely but firmly.
So , my experience over the years , although I wish I hadn't had it , or had delays in my diagnosis , helps me to understand that both the situation TOS discusses and Milk fairy talks about can happen with the same doctor in different circumstances.
If I do see an upsetting or arrogant doctor whom doesn't actually appear to understand my issue , or just spouts nonsense to bully me , I ring the Department and request a second opinion because I am unsatisfied with the way I was treated and believe some of the information was incorrect. If you feel that the Cardio you have seen hasn't treated you appropriately or fairly you can request to get a second opinion , even if the Cardiologist has already discharged you.
Because it is a second opinion and a patient query the wait can be very short.
Put in a complaint with the Chief Executives Office if you feel that you were unprofessionally treated , it's the only way the learn.
My daughter has been swapped to my Cardiologist after prejudiced and factually inaccurate treatment at an initial consultation with an outdated , sexist, ageist , senior consultant whom didn't even have all of her cardiac paperwork to hand which I witnessed as her advocate.
Her new appointment , after request, will be 6 weeks after the initial one , and the my Cardiologist contacted her two weeks ago , has begun the treatment based on reassessing the tests she has already, all done before the appointment to see if things have begun working to speed up the process. Yet , a few years ago he may not have treated the same information in such a confident way.
I've seen some very considerate doctors in the past whom seemed very knowledgeable and they missed things or stopped searching for a diagnosis after ruling out the most obvious causes with a pat on the hand , a standard medication , and the comment ,"we've done everything it's sadly one of those things", Nonsense they'd checked the common issues and wanted to move on !!!! I've seen some doctors with a horrible bedside manner as well whom did extra checks and hit the nail on the head , they didn't give up , even though they weren't sure what was going on.
I've begun to feel that if you have a chronic health issue you need as much experience as a patient dealing with doctors ( and being able to recognise the duds from the ones that are just confused by your symptoms ) as doctors need in recognising the illnesses to get the most successful treatment.
The last time I saw my Cardio ( a couple of weeks ago) my BP was very high 175/117, its never high , in fact its usually low , even at appointments. My issues are heart rate based.
He questioned if it could be a blip!
"Do you mean you think it's White Coat Syndrome?" ,I asked .
"Possibly?", He said
To which I answered , " I doubt it , you aren't that scary!"
To which he laughed, he rechecked , checked my previous BP record, and monitoring is ongoing until we know the cause.
Take care and I hope you get there in the end , Bee
Thank for your reply you have been through a lot and it’s so good that you advocate for yourself.
The consultant said he couldn’t refer me for a 2nd opinion that I’d have to go back to my GP XX
That's incorrect. You have the right to ask for a second opinion if you feel that your treatment was unsatisfactory, the initial Consultant you saw can't refuse you one.You can request one via your GP or speak to the manager of the Cardiology Department, pointing out that you would prefer not to make a complaint but will need to if you can't organise a second consultation which you have the right to request based on NHS guidelines. To be honest, if you do put in a request in this way they are usually very eager to sort this out for you and prevent an escalation of the situation.
If you still receive a refusal with no appropriate medical reason for their decision you can complain to the Chief Executives Office or the Local Trust.
You will still eventually get Primary Care via your GP surgery and depending on your condition may still see a Cardiologist once a year for a follow up , but sometimes that is unnecessary, although you still have the right to contact the local Cardiac Team or Nurse with any questions .
I’ve complained because a “bedside” meeting was held when I was emotionally distressed and the registrar was taking notes.I wasn’t told there would be a meeting or given the minutes.so I’m going to wait for their reply then ask for the 2nd opinion that’s really interesting as he definitely said he wasn’t going to refer me that I had to go via my gp.there have been so many things gone on with my treatment.could you point me in the direction of where it says about a 2nd opinion as I will include it in my email.thank you so much for all your help and advice xx
It's in the NHS Constitution, only applies for those living in England.
gov.uk/government/publicati...
The GMC says this
"The General Medical Council, which regulates doctors, state that all doctors must 'respect the patient's right to seek a second opinion'. The Department of Health accepts that if a doctor thinks that it is in the best interest of the patient to refer for a second opinion, they should do so."
Thank you Milkfairy.it’s strange that he refused to do so xx
A doctor has to have a very good reason to refuse a patient's request for a second opinion.
I suggest you ask in your complaint for the doctor's reason for doing so.
Thanks I will do xx
Hi, I thought I was on a lot! Ihaveto agree with many comments here, that only your doctor can decide togeather with you, I dont no your age or condition, but do know there is a reluctance for doctors to reduce ones medication with any condition and some of us will definately be on too much,
All the best, (ex nurse)
BP Still too high. Meds include, Ramapril. Bisoprolol. Sertraline. Omeprazole.
Meds 
Meds 
Meds 
weight loss and heart meds
