Blood Pressure Medication

[bprinceuk]

I have just moved to Thailand and I take medication for high blood pressure. In the UK this is prescribed by the local GP. Is this type of medication available over the counter in Thailand or does it have to be a prescription issue by a GP the same as in the UK. I am presently taking Amias (Candesartan Cilextil) does any one know if this medication is available in Thailand.

Brian

[PMNL]

Almost every single medication are available OTC in Thailand including blood pressure medication.(except sleeping pill and chemo tablet!)

Candesartan is available OTC here ( Blopress) but it is very expensive as an imported medication.

You may use other ARB alternative as they have them in generic here ( Loranta, Tanzaril).

If your blood pressure is under control and you have no other problem and you wish to continue your prescribed medication, you can buy it at any chemist.

If you are not sure about other problems( Heart/kidney/Dyslipidemia), you may consider seeing the doctor fisrt and follow his/her instruction and treatment.

Once on ARB in long term, kidney function and potassium level should be tested occasinally.

[Sheryl]

As above. Since you are still in the UK I suggest you ask your doctor if there is any reason why you could not switch to losarten (the generic name for the Thai made brands Loranta and Tanzaril). Explain to him that you will have to pay out of pocket for meds once in Thailand and that losarten is available in a local generic forum whereas Candesarten is not.

[rak sa_ngop]

Beetroot juice (usually mixed with other juices) and fresh beetroots (at certain times) are available in Thailand:

Benefits of beetroot juice, BBC News:

http://news.bbc.co.uk/2/hi/health/10433877.stm

[gotlost]

Not quite true on the OTC. Some cities in Thailand yes and some cities no. I live in Chiang Mai which is yes but when I go to Surin its NO.

[PMNL]

You may order them online from trusted Chemist eventhough you are in Surin or Sisaket then.

[gotlost]

You may order them online from trusted Chemist eventhough you are in Surin or Sisaket then.

Thanks for the info on that. I just go to the main farang hospital in Surin see a doctor and get my medication they do have it and even with seeing the doctor its the same price as if i had gone to a chemist.

[Farma]

Amlor and Atacand is hard to find.

[bprinceuk]

Thanks everyone for the info

Brian

[Rahimseven]

While we are on the subject. Does anyone know the generic or what Prinivil (lisinopril) is called in Thailand? Looked everywhere for this today in the Bangna area but to no avail...

[PMNL]

Lispril by Siam Pharmaceutical.

Lispril

[Route21]

Similar situation.

Planning on retiring, with Thai wife, some time soon, to Petchabun area.

Does anyone know whether the following medications are available in Thailand, whether there are any generic equivalents, or where I can order them (Bangkok?):

1. Ivabradine - (Trade name: Procoralan)

2. Valsartan - (Trade name: Diovan)

3. Rosuvastatin - (Trade name: Crestor)

Many thanks

[Sheryl]

Similar situation.

Planning on retiring, with Thai wife, some time soon, to Petchabun area.

Does anyone know whether the following medications are available in Thailand, whether there are any generic equivalents, or where I can order them (Bangkok?):

1. Ivabradine - (Trade name: Procoralan)

2. Valsartan - (Trade name: Diovan)

3. Rosuvastatin - (Trade name: Crestor)

Many thanks

Ivabradine is a very new drug and new class of drugs, there are no other forms of it available. It is available as brand name Coralan but will be expensive. May also be hard to find in small pharmacies or in rural areas but can certainly be obtained in Bangkok or other large city.

Valsartan is available in a local generic brand called Valatan, made by Silom medical.

Rosuvastatin is only available as brand name import but simvastatin, which is in the same family of drugs and has same action, is widely available under many local brand names, suggest you ask your doctor if there is any reason why you cannot switch to it instead.

You need to think carefully about how you will finance health care once here as with a pre-existing heart condition it will be difficult to get local insurance and as a foreigner you will not be eligible for free health care. You can go to government hospitals, but you'll have to pay and while costs are lower than in private hospitals they can still add up to a considerable amount in cases of serious illness or major surgery. Stent placements are especially costly due to the cost of the devices themselves.

I'd also be a bit concerned about being all the way out in Petchabun as it will be a long trip to the nearest decent hospital. Govt hospitals below provincial level are not worth going to and even at provincial level specialty care is limited. In that general region, Khon Kaen is probably the best served as it has a regional government hospital (provincial hospital that also offers specialty services in a tertiary care capacity) affiliated with a medical school. There is also a private hospital in Khon Kaen (Ram) which is affiliated with the medical school as well but of course more expensive. I'd suggest considering the distance to Khon Kaen in selecting where you live.

[PMNL]

Similar situation.

Planning on retiring, with Thai wife, some time soon, to Petchabun area.

Does anyone know whether the following medications are available in Thailand, whether there are any generic equivalents, or where I can order them (Bangkok?):

1. Ivabradine - (Trade name: Procoralan)

2. Valsartan - (Trade name: Diovan)

3. Rosuvastatin - (Trade name: Crestor)

Many thanks

Neillythere,

As sheryl said, Ivabradine is only available as expensive orginal made (Coralan).

Can you not take Beta- blocker instead?? You may want to discuss with your cardiologist if procoralan can be replaced with beta-blocker(such as carvedilol,nebivolol).

Generic Carvedilol and Nebivolol are available at a very reasonable price.

Coralan will cost you a fortune unless you do not mind to spend ~5000-6000/month for the three medication.

Good Luck.

[splorff]

You may order them online from trusted Chemist eventhough you are in Surin or Sisaket then.

Can I order the medications I need from the UK ?

Could you please provide a web link to a Thai pharmacy that would do this.

[splorff]

Hi

I live in the UK. I am really tired of paying heavily for my medication, it's another form of tax here. I am thinking of travelling to LOS for a holiday and while there buying enough medication for several years.

I am asthmatic and take Ventolin [salbutamol], and [Clenil Modulite] I also have hypertension, and for this take [Losartan], I also need to take Prosac.

Is it possible that I could buy these medications wholesale. I would like to buy enough to last for a good few years.I suppose the place to try is BKK.

The meds in brackets are the generic names for them I think. I have yet to discover the generic name for Prosac.

Are these meds commonly found in LOS

Thank you

[cardholder]

Could I ask the same question about AMLODIPINE.

Is there a generic equivalent available in Thailand ?

[Sheryl]

Amlodopine is available in a number of inexpensive local generic brands. Ambes is the GPO product.

Lasartan is likewise available under many different brands.

Salbutamol is made locally, both tabs and inhaler.

I am not sure how Clenil Mudulite differs from regular Clenil, which is beclometasone. There are several local brands of beclometasone inhaler available. Better check with your doctor first before assuming they are interchangable with Clenil Modulite.

If by "Prosac" you mean "Prozac", can get generic equivalent here as well. Ditto if you meant "Prilosec".

These medications are all sold over the counter without prescription in Thailand. However, prescription is required if bringing them back to a country where they are prescription only drugs i.e. the fact that it was OTC where you bought it doesn't matter if you bring it into as country where prescription is required, to do have prescription with you to show. Splorff, you may also run afoul of customs and other regulations bringing back a large quantity, better research that first with the appropriate government agency in the UK.

I do not know of any pharmacy in Thailand that ships abroad. I imagine there would be issues around whether or not Thai-made pharmaceutical products were licensed for sale abroad which is unlikely to be the case.

[PMNL]

Could I ask the same question about AMLODIPINE.

Is there a generic equivalent available in Thailand ?

Try Amlopine by Berlin Pharmaceutical.

It is widely used and inexpensive.

Google Berlin Pharma for your information.

[splorff]

Amlodopine is available in a number of inexpensive local generic brands. Ambes is the GPO product.

Lasartan is likewise available under many different brands.

Salbutamol is made locally, both tabs and inhaler.

I am not sure how Clenil Mudulite differs from regular Clenil, which is beclometasone. There are several local brands of beclometasone inhaler available. Better check with your doctor first before assuming they are interchangable with Clenil Modulite.

If by "Prosac" you mean "Prozac", can get generic equivalent here as well. Ditto if you meant "Prilosec".

These medications are all sold over the counter without prescription in Thailand. However, prescription is required if bringing them back to a country where they are prescription only drugs i.e. the fact that it was OTC where you bought it doesn't matter if you bring it into as country where prescription is required, to do have prescription with you to show. Splorff, you may also run afoul of customs and other regulations bringing back a large quantity, better research that first with the appropriate government agency in the UK.

I do not know of any pharmacy in Thailand that ships abroad. I imagine there would be issues around whether or not Thai-made pharmaceutical products were licensed for sale abroad which is unlikely to be the case.

Hi Sheryl

Thanks for the input. Clenil Modulite may be Beclometasone dipropionate, both are written on the package. If you are an asthmatic who has been prescribed Ventolin [salbutamol], then you probably know Clenil modulate as the “brown one”.

I can easily have a prescription for these items from my UK doctor.

Five items here are very nearly £30, and that is one months supply! That is £360 per year !

I used to be able to get a three month supply for that price, but now they are becoming reluctant.

Yes, I am wondering about the UK customs people. The government of course would much prefer that I pay the extortionate UK prices.

I have found two big pharmacies in BKK,on the Sukumvit road, if anyone else is interested.

Google for “south east pharmacy Bangkok”, and “ks pharmacy”, and “pharmacy22” – all on or near Sukumvit road.

[moe666]

Hi

I live in the UK. I am really tired of paying heavily for my medication, it's another form of tax here. I am thinking of travelling to LOS for a holiday and while there buying enough medication for several years.

I am asthmatic and take Ventolin [salbutamol], and [Clenil Modulite] I also have hypertension, and for this take [Losartan], I also need to take Prosac.

Is it possible that I could buy these medications wholesale. I would like to buy enough to last for a good few years.I suppose the place to try is BKK.

The meds in brackets are the generic names for them I think. I have yet to discover the generic name for Prosac.

Are these meds commonly found in LOS

Thank you

Check experation date donot over buy

[splorff]

Hi

I live in the UK. I am really tired of paying heavily for my medication, it's another form of tax here. I am thinking of travelling to LOS for a holiday and while there buying enough medication for several years.

I am asthmatic and take Ventolin [salbutamol], and [Clenil Modulite] I also have hypertension, and for this take [Losartan], I also need to take Prosac.

Is it possible that I could buy these medications wholesale. I would like to buy enough to last for a good few years.I suppose the place to try is BKK.

The meds in brackets are the generic names for them I think. I have yet to discover the generic name for Prosac.

Are these meds commonly found in LOS

Thank you

Check experation date donot over buy

That good advice

[Wrong Turn]

These medications are all sold over the counter without prescription in Thailand. However, prescription is required if bringing them back to a country where they are prescription only druggs

I have never taken high blood pressure medication before.

I have consistently high BP. 150/100 *everytime* I have it checked (although I only check it twice per year. I am over weight.)

Should I just by a common brand OTC and take the average daily dose?

Or, should I consult a doctor first?

Thank you.

[stander]

These medications are all sold over the counter without prescription in Thailand. However, prescription is required if bringing them back to a country where they are prescription only druggs

I have never taken high blood pressure medication before.

I have consistently high BP. 150/100 *everytime* I have it checked (although I only check it twice per year. I am over weight.)

Should I just by a common brand OTC and take the average daily dose?

Or, should I consult a doctor first?

Thank you.

150/100 is not good I suggest you go and see a doctor as soon as possible, like right away!!!

[FBN]

Self medicating for undiagnosed high BP is very risky.

Please have it checked out to exclude any underlying problems (kidney function test, cardiac assessment etc) and then start on medication that will be best suited to your specific needs.

[Phil Conners]

Self medicating for undiagnosed high BP is very risky.

Please have it checked out to exclude any underlying problems (kidney function test, cardiac assessment etc) and then start on medication that will be best suited to your specific needs.

I don't agree. I've seen several doctors about my high BP and they have never done any tests or assessments, just a quick thought and then then write down "something to try". If you research the availabilities on the internet, start easy on dosing and daily checks with a tester you're doing exactly the same as the doctor, with the advantage that you can try inexpensive drugs costing you perhaps 100 baht/month instead of some new or brand name product costing you thousands per month.

Probably it's possible to find a specialist who would do all the things he should, but most general practitioners don't spend that much time, they just write up what they first think off to get you out of the consultation asap to be ready for the next patient. That has always been my experience.

At my last visit at a well known foreign doctor here in Pattaya, concerining my high BP, I mentioned several times pain in the chest. He shrugged it off. Not feeling comfortable with his answer I went off to one of the private hospitals where after several tests they found I had a myocardial ischemia with a 95% stenosis (blocking) which could easily have killed me. See for details of that story.

Only I know my body and can feel if things are right or wrong.

[Sheryl]

FBN's advice correct and Phil's account of what in fact often happens when doc consulted also, in my experience, correct. Especially (but not only) in Thailand.

This is where one needs to be an informed consumer.

In Thailand where good and thorough GPs are hard to find, I would recommend seeing a cardiologist or at least an internists with special interest in cardiovascular disease.

Insist on a full work up (if this has not been done before) which includes the diagnostic tests you'll find at this link http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

Depending on your age and other risk factors, a stress test may also be advisable.

[jsflynn603]

Hi

I live in the UK. I am really tired of paying heavily for my medication, it's another form of tax here. I am thinking of travelling to LOS for a holiday and while there buying enough medication for several years.

I am asthmatic and take Ventolin [salbutamol], and [Clenil Modulite] I also have hypertension, and for this take [Losartan], I also need to take Prosac.

Is it possible that I could buy these medications wholesale. I would like to buy enough to last for a good few years.I suppose the place to try is BKK.

The meds in brackets are the generic names for them I think. I have yet to discover the generic name for Prosac.

Are these meds commonly found in LOS

Thank you

I'm not sure about UK, but America forbids importation of medications, even with a doctor's prescription.

That being said, customs is under mandate to allow (by mail, and I presume by direct importation) up to a 90 day supply of medication as long as a valid prescription accompanies it.

This relates to non-controlled drugs, blood pressure meds, etc., not opoids, benzodiazapines or other controlled substances.

Since you are required to itemize purchases (including meds) and declare them a two year supply puts you at risk for seizure (at least in the US) if you declare said meds, and under risk of seizure and fines for non-declaration if you don't.

There are a lot of variables though, and possibly a lot of ways to work around them. Some tablets such as Crestor come in variable sizes, 5, 10, and 20mg tablets. If I get a script for a 90 day supply of 20mg tablets but only need five milligrams, then a marked pill bottle that contains 90 tablets will last me one year. So taking a pill bottle from a pharmacy (that only has enough pills for the trip) can be "refilled" (if necessary pill by pill from bubble packs) and I doubt that it would merit a glance, and if it did, the pills would be id's and found to be the same substance and voila--success.

Ask British customs about medication importation policies for personal use, and then follow that. If the meds are really cheap, (as some are) the risk of seizure may be worth it.

Also consider that UK may allow importation for personal use by mail. America does and the savings are phenomenal on many meds.

[jsflynn603]

Rosuvastatin is only available as brand name import but simvastatin, which is in the same family of drugs and has same action, is widely available under many local brand names, suggest you ask your doctor if there is any reason why you cannot switch to it instead.

As usual Cheryl has good advice and I'd only like to emphasize the latter part of this statement in agreement about asking your doctor and I'll explain why:

Rosuvastatin's brand in America is Crestor. The generic rosuvastatin is not available at American pharmacies but is available by mail order from a country where the generic rosuvastatin is allowed for sale.

The body has different methods of detoxifying substances and it looks at medications as though it was a toxic substance and will remove a certain amount over time by various means.

The statins are cleared in the liver by what is called the Cytochrome enzymatic systems. The CYP 3A4 isoenzyme is responsible for the metabolism of atorvastatin, lovastatin, and simvastatin, whereas both fluvastatin and rosuvastatin are principally metabolized by the CYP 2C9 isoenzyme.

These systems can be complex and medications can either inhibit thus increasing the length that the medication stays in the system, or in some cases it can enhance destruction causing a faster removal of the drug. The case with the first three meds, atorvastatin, lovastatin and simvastatin is that they are all strong inhibitors of the 3A4 subsystem. Consider that about 15% of people tend to have a decreased 3A4 subsystem, in this case, the "steady state" of medication will be higher in these people, since the body will remove the medication at a slower rate. These people are at risk for myopathy which can present as mild muscle aches, malaise, or muscle pain. Tests to define poor metabolizers are probably five to ten years away.

Now consider a case where a person happens to be taking a medication that is also a heavy inhibitor of the 3A4 subsystem. In this case the 3A4 system can be totally inhibited leading to a rapid build-up of one of the three statins AND a rapid buildup in the other 3A4 med, the result can be rapid onset of rhabdomyolysis, causing muscle destruction. The destroyed muscle tissue can that cause systemic issues that can be fatal. I seem to remember that the hospital stay for rhabdomyolysis is an average of about 20 days--not a good thing.

If a person is on a 3A4 utilizing med, the atorvastatin, lovastatin or simvastatin is contraindicated. In such a case rosuvastatin or fluvastatin, or a statin that clears by a non CYP method would be chosen.

I have offered to review meds for my clients that have indicated that they are going to start to take statins because I have found that MD's and pharmacists (and pharmacy computer systems that look for interactions) are sometimes not very good in picking up contraindications. I chastized Brooks Pharmacy once for not picking up an obvious contraindication for simvastatin since the client being discussed (with written permission) who suffered rapid onset rhabdomyolysis was already on a strong 3A4 inhibitor and questioned why was the prescription not flagged and denied. The pharmacist looked up the combination on their online system and found no contraindication. He then pulled out his PDA and said: "it's contraindicated here." Today Brook's Pharmacy will automatically issue a contraindication notice for that combination. Both the doctor, the pharmacist and the pharmacy system ought to have denied that prescription.

It is wise to remember that every medication can have adverse effects and the statins are one group that I universally advise caution and advise people not to try to self-medicate because of possible serious interaction problems.

All this being said, personally I consider rosuvastatin superior to simvastatin because it tends to elevate the HD lipoproteins (the good cholesteral) and also tends to reduce CRP (C-Reactive Protein) a marker for cardiac inflammation) further some research points to its "possible" positive effect at delaying the onset of dementia.

I think the statins are a great class of meds, used wisely, but they tend to be subscribed (or so it seems to me) at doses that are so high that adverse effects are often common. Use diet/lifestyle (especially aerobic exercise) as part of the bigger plan and if you use statins, use them wisely and at the lowest doses possible to achieve the results that you want.

Thailand's system makes it easy to self-treat but within that is potential for severe risk--use it wisely and do the research, or have someone knowledgeable (your trusted medical practitioner) to do it for you.

[Phil Conners]

Very interesting post! You certainly seem to know what you're talking about!

You say statins tend to be subscribed at doses that are so high that adverse effects are often common. How high doses would that be?

I recently had a stent inserted following a stenosis and the doctor among other prescribed 20mg simvastatin prophylactic. I already pointed out to the doctor that my cholesterol levels are all good (both HDL, LDL and totals) but he insisted that simvastatin still would help reduce the buildup of plague in the veins.

Does this sound like a reasonable daily dose to you? People I have spoken to who takes statins typically seem to be on just 10mg.

You say rosuvastatin is superior to simvastatin because it tends to elevate HDL. It was my impresion simvastatin does that as well, no?