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Suggest Treatment For Severe Fatigue While On Methyldopa, Minoxidil And Valsartan
Question: attention dr xxxxxxxxx, back again, thank u for your last response and recommendation, to your question about methyldopa, I am on 250 mg, 2 times per day,4 mg doxazosine at night and 2,5 minoxidil,and 160/12.5 mg valsartan morning and night. since taking the new meds my energy level has crashed, before it was always awesome. I have been on this regiman for 10 or more days yet at 7:00 am my systolic was 185,diastolic 63 and my heart rate 99.............help, if possible could you make a dosage protocol for the meds I am now taking and advise me if another med should be added or some of the ones I am now taking should be changed or if the strength of some of the ones now taking should be increased, look forward to your good council.......... XXXXXXX Ward
Brief Answer:
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
Let me explain you that some fatigue and probably energy loss feeling may be present while potentiating anti-hypertensive therapy.
A systolic blood pressure of 185 mmHg is quite high and it is necessary to make some modifications of your therapeutic scheme in order to achieve a systolic BP around 150 mmHg, which would be suitable for your age:
1) I suggest increasing the daily dosage of Methyldopa to 4 tablets/day.
That's you need to add two other tablets (so one Methyldopa tablet four times daily: 7:00-12:00-17:00-22:00).
2) If after a couple of days the blood pressure is not yet controlled, we can increase Doxazosine daily dose up to 8 mg once at night.
But, first assure that Doxazosine form you are using to be immediate release and not extended release (this latter form is not suitable for hypertension).
3) Another point to consider in your therapy is the opportunity to add low doses of a beta-blocker.
As I have mentioned you before Carvedilol 3.125 mg twice daily could be a suitable option.
All the above mentioned steps, should be added one each time, once the preceding step has not yielded a good result after using it for a week.
And don't remember to be well hydrated all the time, as otherwise all the antihypertensive drugs may be associated with more expressed adverse effects, like tiredness or the risk of hypotension.
Hope you will find my answer helpful!
In case of further uncertainties, feel free to ask me at any time.
Best wishes,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
Let me explain you that some fatigue and probably energy loss feeling may be present while potentiating anti-hypertensive therapy.
A systolic blood pressure of 185 mmHg is quite high and it is necessary to make some modifications of your therapeutic scheme in order to achieve a systolic BP around 150 mmHg, which would be suitable for your age:
1) I suggest increasing the daily dosage of Methyldopa to 4 tablets/day.
That's you need to add two other tablets (so one Methyldopa tablet four times daily: 7:00-12:00-17:00-22:00).
2) If after a couple of days the blood pressure is not yet controlled, we can increase Doxazosine daily dose up to 8 mg once at night.
But, first assure that Doxazosine form you are using to be immediate release and not extended release (this latter form is not suitable for hypertension).
3) Another point to consider in your therapy is the opportunity to add low doses of a beta-blocker.
As I have mentioned you before Carvedilol 3.125 mg twice daily could be a suitable option.
All the above mentioned steps, should be added one each time, once the preceding step has not yielded a good result after using it for a week.
And don't remember to be well hydrated all the time, as otherwise all the antihypertensive drugs may be associated with more expressed adverse effects, like tiredness or the risk of hypotension.
Hope you will find my answer helpful!
In case of further uncertainties, feel free to ask me at any time.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks for responding so quickly and thanks for your answers, I would prefer to take medications 2 times daily if possible, also my pressures are somewhat decent during the day, its the early a-m that they are crazy, what would you think about taking 500 mg of methyldopa morning and night and then up to 8 mg mg doxazosine at night. by the way I just completed a thorough blood testing and will provide you a copy of the results when I get them from the lab, cheers and have a great day...... XXXXXXX Ward
Brief Answer:
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
I understand your concern and would explain that you can take Methyldopa twice a day. I would recommend increasing the dose to two tablets at night initially and then tow tablets in the morning after a week, to a desired dose of four tablets per day divided in two meals (morning and evenings).
If after these changes your blood pressure is still high, the next step would be increase the dose of doxasosine to 8mg, which you can take in the evening.
Let me know about everything.
I remain at your disposal whenever you need me.
Regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
I understand your concern and would explain that you can take Methyldopa twice a day. I would recommend increasing the dose to two tablets at night initially and then tow tablets in the morning after a week, to a desired dose of four tablets per day divided in two meals (morning and evenings).
If after these changes your blood pressure is still high, the next step would be increase the dose of doxasosine to 8mg, which you can take in the evening.
Let me know about everything.
I remain at your disposal whenever you need me.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank u for that quick response, I started the 500 mg methyldopa last night following your reccomendations, thank heaven, a little progress........this morning my systolic pressure was 168.........however my heart rate was 96.....ultimately I think it will be necessary to add the low dose beta blocker you recommended, but I will wait a week before getting to that stage..........thanks for your help...... XXXXXXX Ward
Brief Answer:
My answer:
Detailed Answer:
Dear XXXXXXX
I am glad that the new changes in your therapy are showing good results on your blood pressure.
The increased heart rate may be a response of your heart to the decrease in blood pressure values.
I agree with you that waiting a week before starting carvedilol would be the best thing to do.
If you have any other questions, please don't hesitate to ask me!
Wishing all the best,
Dr. Iliri
My answer:
Detailed Answer:
Dear XXXXXXX
I am glad that the new changes in your therapy are showing good results on your blood pressure.
The increased heart rate may be a response of your heart to the decrease in blood pressure values.
I agree with you that waiting a week before starting carvedilol would be the best thing to do.
If you have any other questions, please don't hesitate to ask me!
Wishing all the best,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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