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On Lanoxin, Eltroxin, calaptin, Serafo inhaler, Clopilet. Side effects?

hello doctor!
i have 3 questions regarding the patient whose history i have described below my questions.

1. Should i give clopilet 75 mg (why should it be given and what if it is not given)
2. Will there be any side-effects or problem if i follow the geriatrician and reduce the dosage or should i follow the cardiologists opinion NOT to reduce?
3.due to lanoxin 25 mg her T3 (CLIA) = 99 ng/dl, T4(FPIA) =12.09 ug/dl, TSH(CLIA) =5.53 uIU/ml
The doctor has advised ELTROXIN 50 mcg which i have not given her. Should i give it?
My mom who is (73 yrs old now in 2013) was daily taking one each of calaptin sr 120mg; ,cordarone X 200mg; storvas 10mg and ( lanoxin 0.25 mg from monday to friday ) from 2007. She han fractured her hand and had to undergo surgery but could not due to fibrilation. Recently she had to extract a tooth and we took her to a geriologist who stopped lanoxin and reduced one cardarone X 200mg to one cardarone 100mg; one ;calaptin sr 120 mg to TWO calaptin 40mg: one storvas 10mg.. Is it o.k to reduce? I took her to a cardiologist .The report of the cardio says:
1. Dilated cardiomyopathy, moderate LV dysfunction (recovered)
2. F/H/O CAD- father & brother
3.H/O atrial fibrillation one episode on T.cardarone- 200 mg
4. K/C/O Bronchial Asthma > 40 yrs on intermittent bronchodilators & homeopathic
5.H/O fracture rt. hand radius
6.Asymptomatic on restricted activities H/O dentalcarriers (+)
PR- 52/min, regular
BP- 130/80 mmHg
CNS- S1 S2 (+)
RS- B/L extensive wheezo (+)
low salt diet
1 tab. T.cardarone 200 mg
1 tab. Calaptin SR 120 mg
1 tab. Clopilet 75 mg
1 tab. storvas 10 mg
and seroflo inhaler 250 - 1(puff) twice-daily

ECHO: Dilated LA, normal, LV dimensions, no RWMA, good LV sys. function,
MR moderate, PAH mild, no clot/P.E
Asked On : Sun, 31 Mar 2013
Answers:  2 Views:  227
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Cardiologist 's  Response
Hi friend,
Welcome to Health Care Magic

1- Clopilet is anti-platelet / helps to reduce the incidence of clot formation - for which people with Atrial fibrillation are prone / and if warfarin could not be given, this is the next choice / The minimal effective dose is 75 mg. OK
2- Better not reduce Clopilet / generally, it is given in combination with a small dose of aspirin / even then, it is inferior to Warfarin, but the side effects are less. Sometimes in surgery where minor bleeding may be hazardous - like the eye or prostate - it is withheld temporarily...
Cordarone, Lanoxin, Calaptin - all can bring down the heart rate and can be reduced if the rate is 52 and regular...
3- Eltroxin should be given / the change in thyroid is from Cordarone, not Lanoxin.

In final analysis - see the Cardiologist. Your mother must be under his care / much water might have flown under the bridge, after the last cardiac assessment / need constant review..

Take care
Wishing speedy recovery
God bless
Good luck
Answered: Wed, 1 May 2013
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1 Doctor agrees with this answer

Ayurveda Specialist Dr. Munish Sood's  Response
1. As there is Dilated Cardiomyopathy, F/H/O CAD thus Clopidogrel (Clopilet) should be given to prevent blood clots, moreover she is a K/C/O Bronchial Asthma thus Aspirin is Contraindicated in such patients because of tendency to cause Bronchospasm and difficulty in breathing, thus it is an alternative to patient in whom Aspirin is needed but is CI, thus if it is not given it may result in formation of blood clots in heart and blood vessels resulting in Stroke, MI or any major obstruction.
2. decision regarding the dosage rest upon the clinical outcome i.e. if Renal Function Test are good, there is no need of Reduction, but if S. Creatinine or GFR is impaired one has to adjust the dose accordingly. regular check up and follow up with Physician is necessary.
3. Lanoxin (Digoxin): slows the ventricular rate in Atrial fibrillation, also increases the cardiac output and decreases the heart size (Dilated Cardiomyopathy is there)
4. There is Sinus Bradycardia 52/min, it can be due to Digoxin Adverse effect or due to Hypothyroidism, so before going for Eltroxin, make sure Digitalis toxicity is ruled out, and dose of digoxin has to be reduced till her hypothyroidism is cured.
5.As also taking cordarone (Amiodarone) this increases plasma digoxin concentration and amy cause AV block in some patients (probably that is why it is reduced)
6. Calaptin (Verapamil) causes increase in serum Digoxin Concentration resultin in signs and symptoms of Digitalis Toxicity, thus again dose of digoxin has to be readjusted.
7. The Attending Physician is the best Judge in this case and have full faith in him.
8. still want to continue: Go Low Go Slow.
Answered: Sun, 31 Mar 2013
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