Blood pressure treatment - Irbesartan

[Jelbea]

Hi all, Its me again with yet another problem. I have Jak 2 positive ET controlled on hydroxycarbamide, aspirin and rivaroxaban.

I went to GP to-day to get sun spots on my face treated with liquid nitrogen and whilst there he discussed with me my borderline/raised blood pressure. He decided to start me on a low dose of irbesartan 75 mg once daily. I duly collected the tablets and on reading the patient information I was a bit alarmed.

These tablets can cause "decreased levels of a protein found in red blood cells (haemoglobin)." This is noted as a common side effect - up to 1 in 10 people.

These tablets can cause "reduced number of platelets". This is described as an undesirable effect and other undesirable effects are "increased blood potassium, impaired renal function and abnormal liver function". Also described as an undesirable effect is inflammation of small blood vessels mainly affecting the skin (a condition known as leukocytoclastic vasculitis).

Should I be worried about these? Is anyone else on site taking this particular treatment and could perhaps tell me of their experience. The "inflammation of small blood vessels" one bothers me as I have just recently had a slight petechial rash.

Maybe I am fussing too much but as my ET has been well controlled I do not want to upset things. By the way I am 81 years old, have slight type 2 diabetes diagnosed six months ago (no treatment) and I take buprenorphine sublingual tablets for severe life-long restless legs syndrome.

I would be grateful of your thoughts.

[Cat1001954]

Iv been on higher dose for years no bad effects I have ET

[Jelbea in reply to Cat1001954]

Hi Cat, Thank you so much for replying so quickly. I am probably being too fussy but recently I have just had one thing after another. The recent petechial type rash sounds a bit like the vasculitis thing described which is why I was worried. Good Wishes

[Cat1001954 in reply to Jelbea]

your welcome try not to worry x

[hunter5582]

I have taken a low dose of losartan, which is another angiostatin receptor blocker. It never was an issue and effectively managed low-grade hypertension with no adverse effects. Suggest you discuss your concerns about irbesartan and ET with your MPN Specialist for an informed case specific answer. Raised BP is a risk factor with ET so best not to ignore it.

You may wish to review drug interactions with your GP.

Monitor/Modify Tx. buprenorphine + irbesartan. monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Monitor/Modify Tx. irbesartan + aspirin. monitor renal fxn, BP w/ high-dose aspirin: combo may incr. risk of renal impairment; may decr. antihypertensive efficacy (additive effects; antagonistic effects)

Monitor/Modify Tx. rivaroxaban + aspirin. monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, incl. life-threatening (additive effects)

Additional Considerations. buprenorphine. consider prescribing naloxone, esp. w/ concomitant CNS depressant use

online.epocrates.com/intera...

Note that none of these potential interactions means you should not take the medications. Each of these choices requires a case-specific risk/benefit analysis. It does mean that you need to be aware of the potential issues and know what to monitor for. This is a conversation that you would need to have with your GP or another provider familiar with your case.

Wishing you all the best as you move forward.

[Jelbea in reply to hunter5582]

Thank you so much Hunter for all the information you have provided. I got speaking to my GP this afternoon and he was of the opinion that I really needed to get the BP under control, particularly as I was diagnosed with mild type 2 diabetes six months ago. He assures me he will keep a close eye on my progress. I have reacted badly to many antihypertensives so we are running short of ideas. I seem to be the sort of patient who is sensitive to very many drugs. I shall be discussing the subject with Prof. McMullin (MPN) and see what she suggests and in the meantime I shall try the very low dose for two weeks as suggested by GP. He is going to assess the situation then.

Thank you for your help and good wishes

[hunter5582 in reply to Jelbea]

That sounds like a very good plan. The BP is a significant concern in the context of a MPN and diabetes. Hope you find the current plan works for you.