blood pressure medication

[KatyB]

Can anyone throw any light as to why, after 15 years being on the same amount of medication for high blood pressure, I've just had a letter from the doctor as follows - Have adjusted your indapamide 1.5mg to 2.5mg once a day to try and reduce the overspend on medication that the CCG and the practice is experiencing. The medication is equivalent and there are no additional blood pressure lowering effects from the new dose or additional side effect profile.

Have just had my yearly BP check up - 136/80 which is not bad as I suffer stress going to the surgery. Usually around 125/75. Cholesterol over a year ago 7.8 but I was told no action needed when I phoned up! Saw the doctor last week and had a cholesterol test done but no mention about altering my medication until the letter arrived a few days later. Has anyone else experienced this?

[kasibarndoor]

Here are the NICE guidlines, nice.org.uk/guidance/cg127/... you will see number 1 on the list (1.6) is to prescribe 1 dose a day. The practice is probable overspending, and some junior or maybe even "a computer" is going through the regular medication of all patients and ensuring that they meet the guidelines in all respects. Maybe there is also some saving by having a consistent dose over all patients, increasing purchasing power.

[KatyB in reply to kasibarndoor]

Thank you for the NICE guidelines, they make interesting reading and I see they mention the once a day dosage. I shall however, check with my doctor as I only take medication once a day.

[Andyman in reply to KatyB]

Yes you should go and see him/her. Get it clear in your mind. I hate it when I get impersonal letters like this. Especially as I have only just seen them a week before and no mention.

[Gardengnome1942 in reply to kasibarndoor]

Raising a dose in order to have consistent medication for all hypertensive patients, thereby reducing costs, is frankly outrageous

If I was Katy I would be making an appointment with the GP for some answers! It could of course just be an error ?

[KatyB]

Thank you for your reply. I think you could be right re buying the higher dosage at a special price.

[SilverDreamMachine]

Hi Katy,

Whilst there may be economies for the practice, for me the priority is YOU! Unless your Dr. convinces you the increase is for medical reasons (and maybe your own research confirms this), then I'd stick to the original dose. If your Dr. Still insists on the 2.5mg then if it were me I'd shave approx 60% off the tablet.

Best of luck

Peter

[rocheen in reply to SilverDreamMachine]

I was told if you cut the tablets they are not as effective

[SilverDreamMachine in reply to rocheen]

Hi rocheen, As far as I am aware the problem with halving tabs is that the inside is exposed to oxygen and this reduces the potency of the medication. If the precede due is done just before taking the tab I understand this overcomes the problem.

[rocheen in reply to SilverDreamMachine]

Thanks. will trying cutting them and taking them straight away and chucking half a way. I was keeping the other half until the next day.

[PeterWh in reply to rocheen]

I was told a simple rule.

If there is a split line on a tablet then it is always OK to split.

If there isn't a split line then check with pharmacist first then possibly GP because many tablets actually have a coating which controls the release rate of its contents and therefore if it is a tablet like this the release will be faster where the tablet is split and therefore you can get too much too quickly and therefore the effect may not be as long.

[rocheen in reply to PeterWh]

You recommend shaving above. Isn't that the same as cutting in half

[PeterWh in reply to rocheen]

I can't see where I said shaving.

I looked this morning at tablets. The 5mg Bisoprolol had two split lines so you could split into 4 x 1.25mg pieces. The 125mcg digoxin didn't have a split line. Warfarin no split lines.

[rocheen in reply to PeterWh]

Sorry someone else said that

[PeterWh in reply to SilverDreamMachine]

True for some drugs but not true for many. Most are in blister pack these days for health reasons as not picking up germs, contamination, etc.

See reply my reply above to Rocheen.

[foxglove]

I am hypothyroid, some time ago doc. wanted to increase my levothyroxine although lower dose suited . I later found that the higher dose was cheaper - no consideration for patient !!!

[Gardengnome1942 in reply to foxglove]

As ever it's all about the money - sod the patient!

[foxglove in reply to Gardengnome1942]

Entirely agree!!!

[kasibarndoor]

Lets get this into perspective, if the doctor increases the dose and there are no side effects, and possibly some benefits then I am sure Katy would not complain. If the end result is a saving of 5 pence per patient per pescription and there are 10,000 patients in the same position, then that is a fair bit of money which is saved that can be used elsewhere to better effect. Yes it is about cost, but the NHS does not have a limitless budget, a small saving on a "lifetime" medication can save a lot of pounds per person per year.

[KatyB in reply to kasibarndoor]

The tablet I am referring to is a diuretic that in time, can cause kidney problems, dizziness and also deplete the body of essential minerals, this is why I am concerned that my dosage has been increased to the maximum amount with no real explanation except to save money. Too high a medication has on more than one occasion, caused more problems than it has solved.

[PeterWh in reply to kasibarndoor]

I actually believe that with all medications you should only take the minimum amount that you have to take. This is because of reducing foreign things into the body, reduces possible side effects and effectiveness and also for many allows a leeway to increase in the future if necessary. The GP I had 30 years ago was a medicine minimalist and even hated prescribing pain killers (if he did it was minimalistic as he said the big trouble was that they masked injuries and people did to much too soon.

[foxglove]

Matter of opinion. Maybe you don't mind taking higher dose of med..- I do, you may be fortunate not to be on a "lifetime" medication. And very noble of you to think you might be saving the NHS some money

[Gardengnome1942]

There are other ways of saving money - how about not prescribing statins for everyone with a Qrisk of over 10%?

[PeterWh in reply to Gardengnome1942]

I believe the cost to the NHS for most of the statins is actually very small. Also the break even point whereby the cost of statins is less than other treatments if people didn't take statins is also low. Hence statistically a really good idea!!!!

[Gardengnome1942 in reply to PeterWh]

Not a good idea if you are among the many who get muscle pain due to statins. They cost about 5p I believe - enough to add up to a worth while saving for the NHS.

I refused them as I didn't want side effects, even if the incidence is relatively small. I asked my GP if she would take them in my place and she said NO - good enough for me!

[PeterWh in reply to Gardengnome1942]

Thanks for clarifying. It would obviously have been better to have said "Hence statistically a really good idea for the medics and the accountants. However often for many it is not our may not be a good idea, but recognising that statins can be beneficial for some, providing they have no reactions.".

After my problems with simavastatin I asked my GP should I try another statin and she said NO!!

[Gardengnome1942]

It beats me how 2.5mg can be equivalent to 1.5mg and yet have no additional BP lowering effects. If that is really so then it jolly well should have !!

[Lisahelen]

If it comes to it and you really dont feel comfortable with the higher dose you could always cut the tablet in half and carry on as normal, just tell your gp you have done this for their records.

[KatyB in reply to Lisahelen]

Thanks for all your replies. I did think of cutting a tablet in half if there is no alternative but on checking the tablets I have now, they are so small, cutting them in half would be impossible so I would have to do what SilverDream Machine above suggests, shave a piece off!! Hopefully I shall get it sorted before it comes to that. Shall definitely NOT be taking statins after reading Daily Mail today and the report from Japan.

[Lisahelen in reply to KatyB]

I use a pill cutter i got from the chemist to cut pills for my cat, it works a treat even to tiny pieces.

[KatyB in reply to Lisahelen]

That's a brilliant idea. Thanks for suggesting it.