Blood Pressure Medication

[kennkate]

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

Splorff Why don't you get a pre paid cert £104 for 12 months to cover presciption charges tel 0845 850 0030.

That would save you a lot of cash and it could work out cheaoer than trying to buy them in Thailand

[Wrong Turn]

Thank you for the responses, I'll consult a cardio specialist and get comprehensive testing, first (as I'm due for it).

[ProThaiExpat]

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.

Wrongturn: I would consult a cardiologist in Thailand before starting medication for a new medical problem as Sheryl said or when changing countries. There are some excellent cardiologist in Thailand who have not been bought or influenced by major drug companies in the west. There are so many different blood pressure medicines and "approaches" to controlling blood pressure, that seeking another opinion about what is best for you is in your best interest. A visit to a cardiologist in Thailand can cost as little as 300 Baht. No mater what you do, buy a cuff blood pressure measuring machine for home use and check your own pressure regularly so you can monitor the effectiveness of whatever blood pressure meds you are taking. It is a good idea to take your blood pressure machine into the examining room when you see the doctor and take your pressure along with the doctor so you can check the accuracy of you machine and learn the proper way to take it.

I had been on a common diuretic along with a beta blocker for a few years from the US and a routine health checkup showed I had stage three kidney disease. Looking back three years to previous lab tests showed the same level of kidney failure. I was referred to a kidney specialist who took me off the diuretic immediately and put me on a vasodilator, which has much less kidney involvement according to the kidney doctor. He actually wanted my pressure below the standard 140/80. I have now achieved levels below the standard but it takes a low dosage of Madiplot three times a day to accomplish that. Having lived with high blood pressure for fifty years, I participate actively in my health care and hourly blood pressure readings markedly helped the doctor and me determine the three times daily regime was needed to offset the usual "upon arising" pressure spike.

As I approach the winter of my years, the kidney doctor wants to see me every few months and wants me to have a battery of tests to watch the progress or lack thereof of my kidney status as well as other old age abnormalities. With the lab tests he orders and his fee, my quarterly cost for feeling well taken care of is about 2000 Baht. Cardiologist and Nephrologists are internists first, so I feel comfortable allowing either of these specialists to monitor my general health. In my view, it is all about preventative medicine as I am self insured for health care in Thailand.

[jsflynn603]

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?

A general rule is that higher doses lead to more common adverse effects but in reality every person is different. Their liver enzymatic systems may be more active (or seriously less so) than others, other medications may or may not interfere indicating one med over another, the cause of the initiation of antilipid meds may be different, as it is in your case, versus let's say an obese person with metabolic syndrome and full blown diabetes. I don't mean to be evasive but there is no easy answer to your question.

Twenty milligrams of simvastatin is close to the "middle," usual doses generally are 10, 20 or 40mg. If you develop symptoms of malaise, muscle tenderness, muscle soreness, changes in mood, or other odd symptoms, that "might" indicate adverse effects that "might" go away if you drop to 10mgs.

I'm more familiar with the pharmakodynamic curve for rosuvastatin than the others but with rosuvastatin one might expect that a 40 milligram dose is eight times more effective than a 5 milligram dose. In reality nothing could be farther from the truth.

I take rosuvastatin and chose to do so because my HDL's were marginal (39; in a male they should be >40) but my LDL's and Triglycerides were normal. But I know my body and my genetics and I'm at risk for Metabolic Syndrome and thus for eventual diabetes and my father died of a heart attack. (But consider he smoked for decades, and had probably many years of unidentified diabetes—neither current risk factors for me) My Doc agreed with my request and wrote a script for 20 milligram rosuvastatin. But all I cared to get was a 15-20% reduction in LDL's and a 3-4point increase in HDL's so I used the dose/response curve from the manufacturer of Crestor. Dose response curves are available but it can take some work to find them.

It was an eye opener to see that 2.5mgs would give me that expected response, and I take my 20mg tablet, cut it in half, and cut each half into thirds giving me about 3.3mgs per dose. I monitor my lipid profile two or three times a year and I got just about a 20% reduction in LDL and a bump from 39 to 44 on the HDL.

But let's say I took 10mgs, we'd expect a 60% reduction in LDL, but this is not the case, in reality tripling my dosage would give me only another 10% reduction. And going to 20mg (a 12 fold increase) would only decrease my LDL's by another 8 points or so. In short many lipid meds are powerful even at low doses but their response curve is far from linear.

Statin works by affecting the Malevonate pathway. You cannot affect one thing in the body without affecting other processes and if you research you will find plenty of frustrated and angry posters who have had moderate to severe adverse effects with statins. So, in short, the lower the dose to achieve the desired result is the answer.

In your case, you say you had good HDL/LDL numbers, though I would not be as interested in the numbers as I would be interested in the ratio of HDL/LDL. Very high HDL and coincident high LDL would not worry me as much as "Ok" LDL and low HDL (my case).

If your numbers were good one has to ask "why" was atherosclerotic plaque being formed? High LDL causes deposition along the lumen of an artery, and high HDL should be "scavenging" the deposited cholesterol before the body "encapsulates" it (calcification) creating a reduced lumen.

If you asked your Doc "why," she'd probably say: "we don't know," a good answer. So the simvastatin therapy is a hopeful "insurance policy," or perhaps "pre-emptive maintenance," an attempt to move your body away from either depositing the cholesterol in the first place, or via an increase in HDL (or bettering the HDL/LDL ratio) offering the body a better "get rid of the trash before someone trips up on it again." Seems appropriate to me.

Yes to me it seems reasonable because it is a "mid-line dose." She doesn't want to err on the conservative side; after all, your life is at stake here. She also knows that if you call and say: "dam_n, my legs are killing me," that she can lower the dosage then. If you have no muscle aches and if nobody around you is complaining that you have turned into an Orgre after starting the simvastatin, then it would seem to be working quite well for you and I'd only suggest that you read up on the HDL/LDL "ratio" and compare the old bloodwork with the new.

Yes, you are correct, Simvastatin, Atorvastation, all of them increase HDL to some extent—I've read 3-15% and cannot find a chart (which I have back on my home computer in the States) which tells the approximate bump for the different statins. I remember that rosuvastatin gave the biggest bump, but consider, if your HDL (male) is a borderline 39, a 5% percent bump is two points to 41, and at best, a 20% bump brings you to 48. Is this difference important? Well, if your starting HDL is 33, I think so—but if your starting HDL is 45, probably not. So again, one must look at the whole picture, not just parts of it.

Consider too that moderate consumption of alcohol and aerobic exercise can increase HDL levels. To me it's all part of a puzzle, but I prefer it to fit together the best it can.

Caveats: This is my opinion and a sharing of my views only. I am not a medical practitioner and you should rely on your medical practitioner for advice. I'm just a very curious RN who reads a lot and likes to write, I'm not an expert. Also there is some risk in advising "moderate alcohol consumption" as related to HDL's, since it "could" lead some along a dangerous path since alcohol can be addictive.

The American Heart Association gives this warning:

"The best-known effect of alcohol is a small increase in HDL cholesterol. However, regular physical activity is another effective way to raise HDL cholesterol, and niacin can be prescribed to raise it to a greater degree. Alcohol or some substances such as resveratrol (res-VAIR'ah-trol) found in alcoholic beverages may prevent platelets in the blood from sticking together. That may reduce clot formation and reduce the risk of heart attack or stroke. (Aspirin may help reduce blood clotting in a similar way.) How alcohol or wine affects cardiovascular risk merits further research, but right now the American Heart Association does not recommend drinking wine or any other form of alcohol to gain these potential benefits. The AHA does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and blood pressure, controlling your weight, getting enough physical activity and following a healthy diet. There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures."

Note: I agree wholeheartedly in their words: "can replace these conventional measures."

[Phil Conners]

^

Thanks for your reply!

I did ask the doctor "why" and his answer was "about 30% of the patients with this problem have no obvious reason for it, including good cholesterol. "

My HDL/LDL/Totals were 43/101/163 at last test about a month ago, just before starting Bestatin (Simvastatin), should all be well within the "ok" range.

Well no bad side effects yet, but the warning about possible liver failure worried me a little.

I'll have another lipid test in another month or two, then see how things go.

The one thing I do realize is a possible reason is lack of exercise. I've been kinda lazy the last 10 years living in Thailand. The climate is too hot to enjoy most sports I used to enjoy in Europe before, but I've started going to the gym for an hour every day, hopefully that will have a positive effect.

Edited February 11, 2011 by Phil Conners

[jsflynn603]

Liver failure is very rare and often caused by a mixture of other meds that compete with the same enzymatic system, and/or, liver disease (such as hepatitis) and/or excessive alcohol and or alcoholic liver damage that already exists.

Your Doc will look at liver enzymes, I imagine within three months, if they are not elevated, then the liver is handling the simvastatin just fine. Even if some liver enzymes were elevated the doc might consider that ok, depending upon the level, adjust dosage, adjust medication, etc. It is unlikely that you would even notice symptoms, the elevated liver enzymes would tell the story first (usually). Still, weakness, fatigue, jaundice (yellowing of the eyes) etc. would be a "call the doc" ASAP symptom. Less than 1% of statin users experience liver issues and many of those are in the high dose range (40 and 80mg dose range for simvastatin).

A little, well known to some, but not spoken often enough, secret about beneficial aerobices is this:

Appropriately (don't rush things and check with the doc first) work up to the point where you are doing at least 30 minutes, continuous, in your "target heart rate" range. It does not need to be at the top of the range, it can be at the bottom, but there is plenty of evidence that the body responds well to 25-30 minutes of continuous aerobic exercise. That is not, ten minutes now, and twenty minutes in an hour--it's continuous. It's good if it takes you a month, or even two to get to that point--and 90% of people will know exactly when they reach that "magic point."

It goes like this: You're working on the elliptical, the treadmill, or bicycle (or jogging, etc.) and thinking "Oh, this is soooooooo boring, or tiring...or..." and then *poof* all of a sudden (usually between 25 and 35 minutes of continuous aerobic activity in your target heart range, a change occurs--and you feel that you could do what you're doing for another hour. At that point, you can stop--probably endorphins are the cause of the change, but I suspect that coincident with the endorphin release other cardiopositive actions occur.

Search "target heart range" for your age and you will find it. American Heart Association has a good chart. But always remember, better to ramp up very slowly, working with your doc's permission in the case of a prior cardiac issue. I can't count the number of times I've told 40 and 50 year old guys to "take it very easy," but ellipticals, rowers and other devices sometimes make it "feel easy," and the fella remembers how easy it was when he was 20 and goes for it--only to get off, walk down the hall, then into the bathroom to vomit. You're not out to prove anything to anyone, slow and easy is the only way to approach aerobics.

Walking is good, working is good, but ONLY by getting your heartbeat into the target range and keeping it there will you reap significant benefits. We like to be lazy, but the body truly likes to be kept active, one of the little paradoxes of life.

[Phil Conners]

^

Do you know what that liver test is called - "liver enzymes" or is there a better term for it?

I do 30 min on the bicycle and 30 min of pushing irons, in this order and in one go. I can't push my pulse over about 110 bpm due to the betablocker I take for high blood pressure, one of the ways it works is by reducing the pulse. The doctor didn't seem to think that was a problem though.

[jsflynn603]

It's usually called a "Liver Function Test," also "Liver Profile," it's a test that looks at several "markers" and compares them to normal. Ask your Doc for a copy of your raw results and then, if you care to, you can look up each one to see what each one "means." Though the quick and dirty is that as long as it's within normal, your liver's livin'.

If you're over 36 then 30 minutes at 110 BPM is in the "target zone."

See:

http://www.americanheart.org/presenter.jhtml?identifier=3030999

[Phil Conners]

^

Yes I know I keep being reminded to see a doctor, but unfortunately, after having tried a lot of doctors in the Pattaya area, private practitioners as well as hospitals, the only doctor I feel reasonable confident about is in Bangkok and can only be consulted after several hours wait, so I take my chances.

Blood tests I get done in a lab in Naklua, which is where most of the private practitioners in Pattaya send their blood work anyway. They charge 300 baht per test, including a written report with all the findings and all the recommended values. Bangkok Hospital charge 3,000 baht per test for comparison.

I'm 49 so I guess 110 BPM is fine then.

Edited February 12, 2011 by Phil Conners