Irbesartan Medication

[themalteser]

Hi all - Hopefully someone can shed some light. My cardiogist asked me to stop taking Atenolol (25mg x 2 per day) and start on Irbesaran 300mg x 1 per day. I've been taking Atenolol for nearly 4 years, but my cardiologist said that their are currently some benefits on slowing down the aortic dilation progression, which is currently at 46/47mm.

Since I started on Irbesartan and stopped Atenolol, last week, I feel awful, I mean literary, I feel terrible. I have shakes, I feel my hand is not mine, chest discomfort, palpitations, anxiety etc. So I called my GP and told him about my side effects. He said that clinically, he would have never started me on 300mg and that he thinks I should get back to my cardiologist and ask him whether I should stop it or reduce it.

I called my cardiologist and he told me to persevere. He said that the symptoms will go away, but I should persevere and try to manage the symptoms.

Is there anyone on Irbesartan and feel like me? - I'm also a bit frustrated by the differences of opinion. I aint an expert and rely on experts to provide me with a good advice. My doctor also said that he needs to take blood 3 weeks after medication to check my kidneys, which its very sensible, but sort got me a bit concerned, especially when my cardiologist said that I can have a bottle of wine at weekends as long as I do not over do it.


I look forward to hearing your opinions.

 

[cldlhd]

I never heard of it so can't say too much about it but those side effects would definitely concern me. The difference of opinion is something I and I'm sure a lot out here can relate to. My root is about the same size as yours, 47-48mm, and my cardiologist and the surgeon who did my cath said they'd wait but my surgeon said I could wait but there's really nothing to be gained by it. Is the surgeon just more proactive by nature because he's confident in his abilities and trained to view surgery as the answer? Who knows.

 

[pellicle]

Hi

My cardiogist asked me to stop taking Atenolol (25mg x 2 per day) and start on Irbesaran 300mg x 1 per day.
...
I look forward to hearing your opinions.

well I don't know the drug but my gut feeling is to listen to your body and if you're feeling lousy then that says something to me. I personally would be encouraged by your doctor (who I assume you trust somewhat) and I would pressure the cardiologist to justify the drug and the amount.

By justify I mean explain in terms you can grasp what the goals are and how it is expected that it will get you there and in what time frame. Why it is you would even consider "pushing through" on feeling lousy and why it is that such feelings (lousy) are not an indicator that things are bad (I mean its a good indicator if you ask me).

If they can't give you a plan like I've suggested then they are a quack

 

[Eva]

I'd listen to my body too. Maybe the dose is too high to start with. If he won't listen to your concerns, I would look for another cardio!

Keep us posted.

 

[themalteser]

Dear all thank you for your replies already. So I got in touch with my cardiologist and said that, I could reduce it down to 150mg for 1 week, but go back up to 300mg. I think the dose is bit high as you mentioned Eva. He said that I should try and keep it, as there is ongoing research at the moment that it could slow down the dilation rate and that is his goal. He is confident that symptoms will subside in 1 week. Pellicle, I used your points, so really thank you. He than also said that if I cannot cope, I will talk to him and will switch me back to atenolol.

There are too many uncertainties . It's nice to have 1 same opinion across. Also, my GP concerned me about testing my kidneys as I mentioned, but he is being responsible. My cardiologist did not say anything about this.

So I'm going to try and reduce from tomorrow for a week and see how I get on. If I still feel the same, I will switch back to atenolol. I cannot beleive I stopped atenolol like that either, after nearly 5 years. This med apparently is exactly the same as losartan?

CLDLHD are you doing surgery in UK?

 

[epstns]

Some years ago I was taking irbesartan, combined with hydrochlorothiazide in a med called Avalide. IIRC, though, my irbesartan dosage was only 125 mg/day. The med worked quite well for me (for BP control) for as long as I took it. After my valve surgery, they changed me to metoprolol, to keep my heart rate within bounds.

 

[themalteser]

Hi epstns, thanks for your reply. May I kindly ask you, did it give you any side effects and did you take it every morning? I was reading that some people take it before bed, but forgot to ask whether that's an option. Thank you.

 

[Northernlights]

All the ARBS like irbesartan generally have far fewer side-effects and are better tolerated than beta -blockers like atenolol. My husband takes the similar ARB candesartan for his hypertension, and was delighted to switch to it from his beta-blocker. Irbesartan has been having very good results in stopping and even reversing aortic dilation in Marfan's connective tissue disorder, much better than betablockers, and doubtless that is why your cardiologist has switched you. 300 mg is seen as the most effective dose for this purpose. So it is worth persevering, as your symptoms may be in part anxiety or more to do with stopping atenolol than starting irbesartan. Slowing down dilation rate is a worthwhile goal! ARBS are protective in kidney disease, but a blood test is always sensible.
All the best and I hope dropping the dose at first helps.

 

[Eva]

Checking the liver functioning is a normal procedure to make sure the medicine is not affecting your liver. I take simvastatin and my GP checks my liver functioning yearly to be on safe side.

Good luck with the lower dose. Keep us posted.

 

[cldlhd]

Dear all thank you for your replies already. So I got in touch with my cardiologist and said that, I could reduce it down to 150mg for 1 week, but go back up to 300mg. I think the dose is bit high as you mentioned Eva. He said that I should try and keep it, as there is ongoing research at the moment that it could slow down the dilation rate and that is his goal. He is confident that symptoms will subside in 1 week. Pellicle, I used your points, so really thank you. He than also said that if I cannot cope, I will talk to him and will switch me back to atenolol.

There are too many uncertainties . It's nice to have 1 same opinion across. Also, my GP concerned me about testing my kidneys as I mentioned, but he is being responsible. My cardiologist did not say anything about this.

So I'm going to try and reduce from tomorrow for a week and see how I get on. If I still feel the same, I will switch back to atenolol. I cannot beleive I stopped atenolol like that either, after nearly 5 years. This med apparently is exactly the same as losartan?

CLDLHD are you doing surgery in UK?

No I'm having my surgery at The University of Pennsylvania in Philadelphia, Pa. I've never had issues with high BP but my cardiologist put me on a beta blocker due to the aneurysm. My surgeon says the operation is a "cure and a definitive solution " to that problem so as long as my BP is good I'll be able to get off them in time. My cardiologist trained under my surgeon for awhile so I think his opinion carries a lot if weight with her.

 

[themalteser]

All the ARBS like irbesartan generally have far fewer side-effects and are better tolerated than beta -blockers like atenolol. My husband takes the similar ARB candesartan for his hypertension, and was delighted to switch to it from his beta-blocker. Irbesartan has been having very good results in stopping and even reversing aortic dilation in Marfan's connective tissue disorder, much better than betablockers, and doubtless that is why your cardiologist has switched you. 300 mg is seen as the most effective dose for this purpose. So it is worth persevering, as your symptoms may be in part anxiety or more to do with stopping atenolol than starting irbesartan. Slowing down dilation rate is a worthwhile goal! ARBS are protective in kidney disease, but a blood test is always sensible.
All the best and I hope dropping the dose at first helps.

This is very helpful Northernlights. Thank you. I read some research after seeing your post. It showed as you said that, taking the maximum dose approved by FDA, had truly reversed the dilation or significantly reduced its dilation rate. It also said that the key was to have a high dose. So this is cutting edge and therefore GPs might not be aware of this.

The only worry is the possibility of hyperaklemia? but over the Internet I always find the worst possible outcomes, as probably they will err on the legal side etc! And also I read, as you said, that this medication is given to renal imaired patients.

I had 150mg this morning and do feel really lousy. I'll stick with it, as the drug sounds promising. Hopefully these symptoms will go away.

Cldlhd - I do think surgery will put a lot of worries away, eventually. Is your valve also bicuspid? I beleive you said they are keeping your valve? Are they doing any re suspension to it or anything else?

Thanks Eva for your reply and reassurance. Ill keep you all posted.

 

[cldlhd]

Thanks,I'm hoping it will also. The plan is to keep the valve, surgeon says it has minimal leakage and should be relatively easy to fix. Good luck adjusting to the meds I've known people on different meds that had side effects lessen a lot over time.

 

[epstns]

Malteser - I took my Irbesartan/hydrochlorothiazide in the morning, daily, for about 3 or 4 years with no noted side effects. If I didn't also have worries about afib, I would be pressing my cardio to go back to the irbesartan.

 

[themalteser]

Epstns - thank you for your reply. Did you had any side effects when you stopped it at all?

Today I feel much better, but checked my BP this eve and it's still quite high. It varies from 145/76 to 131/67. Maybe till the medication adjusts.

 

[epstns]

I really couldn't say if I had any side effects of stopping the Avalide (Irbesartan/Hydrochlorothiazide combo), since it was stopped right at the time I had valve surgery. From that point on, my medication protocol changed dramatically, as did life in general.

 

[Marcuse807]

I am not surprised you are feeling lousy coming straight off one medication and going straight on to another. Typically, we are advised to come off beta blockers (ie atenonol) slowly and to start with ACEI or ARBs progressively. You really should have cut the former down slowly over a few weeks (ie from 25 twice a day to 20, to 15, to 10 etc) and titrated the ARB. So what you are experiencing is the withdrawal from the beta blocker - which could lead to faster heart rate, palpitations and anxiety - and side effects from the ARB (which could be anything). But over time your body will adjust to this. It could though take many weeks and maybe even a month or two.

 

[themalteser]

Hi all - just an update. The side effects / withdrawal symptoms seems to be going down, I can now cope with the med, even at 300mg. Still have itchiness, occasional dizzy and quite depressed/emotional at times. The problem is that I check my BP in the evening (I take the pill mornings) and it's always around 135-148 top number and 60-80 bottom number. Heart rate is up aswell it goes from 70-100 ! ... I feel that this is quite high, especially when I'm on this med. The other issue is that I am not sleeping well. I'm clenching my teeth all night and have jaw pains in morning. Don't know whether this is a side effect or just me. My plan was to speak again with my cardiologist and ask him to review my med. I will also speak to my GP and see whether there is anything I can take with this med to relieve this sadness and maybe sleep well. I might also try to join a meditation/ yoga or tai chi group to try and calm down. I'm dont like taking all these pills aswell. I'm 32, does this mean I got to take these all my life? It's pretty scary as I feel that something else will crop up as a byproduct of these meds during my lifetime. Is there anything else that you can recommend to me please?

 

[cldlhd]

I would be concerned with that high blood pressure also. I also share your concern with the medications. Currently I'm only on 120 milligrams of verapimil for my aneurysm which is slightly larger than yours, 47 to 48 mm, and that's one of the reason I decided to have the operation which is scheduled for tomorrow. I don't know if your blood pressure is normally high but mine has always been good to a little on the low side so this beta blockers has me down to like 105 over 70.
Have you become more depressed with the new medication?

 

[themalteser]

Hi cldlhd - I have emailed by cardio yesterday email and received a reply this morning. He said that the BP reading is because I'm anxious every time I put the cuffs. He said that I should not worry.... I do have white coat syndrome. My BP always goes really high when I'm infornt of a doc. By yesterday I was deep breathing etc, and it was still reading high. So I was getting more anxious I suppose. I had a 24 hr BP monitor before which ranged between 120 to 160 top.


I feel more depressed since the appointment and since starting this med and stopping the other. Previously I had severe anxiety, but now I also feel down, got no real excitment at all about present or future.

 

[cldlhd]

I know it's easy for me to say but in the future this will all be behind you. I've had occasional down moods wondering if i'll be back to my normal self an doing all of my activities but generally I'm an optimist so I guess that's helping me through this. I'm no doctor but it seems the change in medication has made you more depressed and that needs to be addressed.