B.S., C.N.C.

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ADVERSE REACTIONS AND INTERACTIONS OF VARIOUS HEART MEDICATIONS

There are many, many medications used for various disorders of the cardiovascular system. Their efficacy is known to vary; the benefits are questionable long-term; and their reactions are many. Following are but a few that I have information on at the present. I am always researching so that I can provide as much information as possible so people are able to make informed decisions concerning their health. I am also including a section on the combined reactions, for your information, and a section on separate reactions for each drug. Please keep in mind that this is a small sampling of drugs and their interactions. My point is to give you some small idea of the magnitude of drug:drug, drug:herb, drug:supplement, and/or drug:food interactions.

TENEX(guanfacine)
    This is known to interact with other anti-hypertensive medications which could result in hypotension. It may also interact with NSAIDs (nonsteroidal anti-inflammatories) possibly resulting in a decreased effect. Adverse reactions of Tenex include effects on the central nervous system such as anxiety, confusion, depression, dizziness, drowsiness, headache, nervousness, weakness, orthostatic hypotension (hypotension on standing up), conjunctivitis, dry mouth, constipation, nausea, decreased libido, impotence, dermatitis, purpura (hemorrhaging under the skin),and/or rash. CAUTION- Stopping this drug abruptly may cause a dangerous rise in blood pressure in addition to withdrawal symptoms; avoid alcohol which may increase central nervous system depression; take at bedtime to minimize day time sedation.

    COUMADIN
    This drug is used to treat pulmonary emboli and venous thrombosis. It is known to interact with acetaminophen, penicillan, beta blockers, miscellaneous antibiotics, vaccine, statin drugs, NSAIDS, aspirin, and vitamin E with an increased risk of bleeding. The use of alcohol may also increase the risk of bleeding. Various adverse reactions may include: intracranial hemorrhage, weakness, nose bleeds, intraocular hemorrhage, abdominal cramps and pain, diarrhea, hepatitis, nausea, vomiting, blood in urine, alopecia, jaundice, petechiae ( small purplish hemorrhagic spots on the skin), purple-toe syndrome, and/or tissue necrosis. Beware of any potentially fatal hemorrhage from any tissue or organ, observe for TIA’s ( transcient ischemic strokes – loss of feeling on one side of face, slurred speech, dragging one side or the other – all lasting for only seconds of minutes);don’t eat soy, which has been found to decrease vitamin K and could increase bleeding (eating a lot of dark green leafy vegetables would be beneficial as they are very high in vitamin K); avoid alcohol.CAUTION - Notify your doctor if you have unusual bleeding, dizziness, easy bruising, gum bleeding, headache, red, black, or tarry stools, and/or red or brown urine. Don’t take OTC drugs.

    PERCOCET
    This drug is not a heart medicine per se, however, it's use is so prevalent and it's reactions with cardiovascular medications so well known, that I mention it here. Percocet is a mixture of oxycodone and acetaminofen and is used primarily for pain. Oxycodone has the potential for abuse, often altering the perception of and emotional response to pain at the spinal cord and higher levels of the central nervous system by blocking the release of inhibitory neurotransmitters such as GABA and acetylchoine. It is known to interact with anti-hypertension drugs,possibly leading to exaggerated anti-hypertensive effects and the risk of orthostatic hypotension. Percocet reacts with coumadin, creating the risk of bleeding, and with MAO inhibitors creating the possibly fatal reactions of cardiac arrest, coma respiratory depression, seizures, coma, respiratory depression, seizures, and severe hypertension. With alcohol use there is an increased acetaminophen- induced hepatotoxicity. Some of the known adverse reactions to percocet include: confusion, dizziness, drowsiness, increased risk of falling, hallucinations, headache, restlessness,sedation, hypotension, orthostatic hypotension, palpitations, blurred vision, dry eyes, lens opacity, abdominal pain, constipation, elevated liver function tests, decreased libido, erectile dysfunction, renal tubular necrosis, urinary hesitancy, urine retention, respiratory depression, flushing, and urticaria (sudden eruptions with intense itching). It may also cause excessive bleeding, physical and psychological dependence and withdrawal symptoms. Percocet is best taken with a full glass of water or food and it is beneficial to use increased amounts of fiber. CAUTION - Notify your doctor with possible signs of toxicity such as excessive light-headedness, extreme dizziness, itching, swelling, or trouble breathing.

    NORVASC
    This drug is an anti-hypertensive; a calcium channel blocker. The most prominent interactions are known to be with beta blockers - possibly causing excessive hypotension. Some known adverse reactions are: anxiety, dizziness, fatigue, headache, lethargy, light-headedness, syncope (transcient loss of consciousness resulting from inadequate flow of blood to the brain),tremor, arrythmias, hot flashes, hypotension, palpitations, peripheral edema, dry mouth, pharyngitis, abdominal cramps, constipation, diarrhea, indigestion, nausea, decreased libido, impotence, urinary frequency, muscle pain, dermatitis, flushing, rash, and/or labored, difficult breathing. Immediately notify doctor of dizziness, arm or leg swelling, difficulty in breathing, hives or rash. It is always best to take with food. Check blood pressure often. and DO NOT take with grapefruit juice, which is known to intensify the activity.

    PROCARDIA
    This comes under the classification of a calcium channel blocker. Interactions may be with beta blockers (such as propranolol, metoprolol, timolol), which may result in an increased risk of hypotension; with calcium supplements which are known to interfere with the action of procardia; with other anti-hypertensives, which may result in an increased risk of hypotension; with grapefruit juice, which intensifies the drug's activity; with alcohol, creating an increased hypotensive effect; and, with NSAIDS, causing a possible decreased drug effect. Some known adverse reactions include: anxiety, confusion, dizziness, drowsiness, headache, nervousness, nightmares, psychiatric disturbances, tremor, weakness, arrythmias, bradycardia, tachycardia, chest pain, heart failure, hypotension, palpitations, peripheral edema, altered taste, blurred vision, dry mouth, nose bleed, nasal congestion, pharyngitis, sinusitis, tinnitus, anorexia, constipation, diarrhea, elevated liver function tests, hepatitis, nausea, vomitting, dysuria, polyuria, nocturia, sexual dysfunction, anemia, thrombocytopenia (abnormal decrease in number of platelets), leukopenia (decrease of white blood cells), joint stiffness, muscle cramps, congestion, cough, respiratory infection, wheezing, dermatitis, erythema multiforme ( small dark red papules, wheals, vesicles, or tubercles, usually on the extremeties including the palms and soles, which may appear in concentric rings, separate rings, or disc shaped patches. (This is commonly an immune reaction to drugs), flushing, photosynsitivity, rash, and/or urticaria. It is suggested that you regularly monitor your blood pressure and pulse and watch for signs of fluid retention, such as peripheral edema and weight gain. Procardia may cause enlargement of breasts and hyperglycemia ( elevated blood sugar). Other beneficial suggestions include: Do not stop taking this drug abruptly; avoid alcohol; notify doctor of chest pain, difficulty in breathing, ringing in ears, and swollen gums; take extra fiber and water; EXERCISE REGULARLY; see the dentist often; long, hot showers may cause dizziness; avoid prolonged exposure to the sun.

    TOPROL This drug comes under the classification of a beta blocker. Interactions, as mentioned above, are with calcium channel blockers, with an increased risk of heart failure and an increased therapeutic effect of both drugs; with MAO inhibitors, resulting in an increased risk of hypertension; with other anti-hypertensives, creating an additive hypotensive effect; and, with NSAIDS and aspirin, often resulting in a decreased therapeutic effect. Some of the more prominent adverse reactions are: anxiety, confusion, depression, dizziness, drowsiness, fatigue, hallucinations,headache, insomnia, weakness, arrythmia, bradycardia, chest pain, heart failure, orthostatic hypotension, nasal congestion, constipation, diarrhea, nausea, vomiting, impotence, back pain, myalgia (tenderness and pain in the muscles), bronchospasms, and rash.CAUTIONS: Toprol could put you at a risk of an AV block (atrioventricular block) – if results from depressed AV node conduction, you may need appropriate drugs or a temporary pacemaker; you must discontinue use of this drug slowly; take with food; check pulse often and notify doctor if gets below 60 bpm .

    COMBINED REACTIONS OF ABOVE MENTIONED MEDICATIONS

    Central Nervous System
    anxiety, nervousness, confusion, headache, hallucinations, nightmares, psychiatric disturbances, weakness, drowsiness, fatigue, depression, intracranial hemorrhage
    Cardiovascular
    orthostatic hypotension, chest pain, palpitations, heart failure, arrythmias
    Eyes, Ears, Nose, Throat
    conjunctivitis, dry mouth, dry eyes, blurred vision, nasal congestion, nose bleeds, intraocular hemorrhage, sinusitis, tinnitis
    Gastro-intestinal
    constipation, nausea, abdominal pain and cramps, diarrhea, vomiting, anorexia, elevated liver function tests, hepatitis.
    Genito-urinary
    decreased libido, impotence, painful urination, frequent urination, night time urination, erectile dysfunction, blood in urine, urinary retention.
    Skin
    dermatitis, purpura, rash, urticaria, photosensitivity, jaundice, petechiae
    Musculo
    back pain, tenderness and pain in the muscles, joint stiffness, muscle cramps
    Respiratory
    broncho spasms, respiratory depression, congestion, cough, respiratory infection, wheezing
    Blood
    anemia, decreased platelets, decreased WBC (white blood cells)

    SEPARATE INTERACTIONS

    TENEX, NORVASC, PROCARDIA, TOPROL – all interact to create greater risk of increased hypotension and orthostatic hypotension.

    TOPROL reacts with NORVASC AND PROCARDIA – increased risk of heart failure and increased hypotension.

    PROCARDIA reacts with CALCIUM SUPPLEMENTS. This decreases it's activity. Therefore, you can’t take calcium supplements and as a result of that, the risk of osteoporosis increases.

    COUMADIN interacts with TOPROL, creating a risk of increased bleeding

    PERCOSET reacts with COUMADIN, creating a risk of increased bleeding

    PERCOSET AND TOPROL react with MAO INHIBITORS. It is recommended to avoid taking St. Johns Wort which is a natural MAO inhibitor.

    ALL interact with ALCOHOL which increases central nervous system depression and bleeding, acetaminophen- induced hepatotoxicity, and an increased hypotensive effect.

    NORVASC AND PROCARDIA both react with grapefruit juice, which intensifies the drug activity

    MOST interact with NSAIDs (ibuprofen) and aspirin, resulting in increased bleeding and a decreased therapeutic effect.

    ALL cause constipation; it is recommended to take extra fiber

    ALL can cause depression, nausea, and headaches

    MOST cause muscle, joint, back pain

    ALL cause decreased libido and impotence

    MOST cause congestion and breathing problems

    ALL cause skin problems

    DON’T STOP TAKING ANY OF THEM ABRUPTLY. This may cause a dangerous rise in blood pressure or anxiety, nervousness, and arrythmias.