robert1562
New member
Is there anyone out there who has had an annurysm repair with a mechanical valve replacement who is on heart medications for life other than Coumadin? Can it be possible to only be on Coumadin?
Lifetime medications ???
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Ross
Well-known member
Not quite sure I understand your question. Is it possible to take only Coumadin and no other heart related medications? Is that the question?
Let me just say this, it's possible, but not very likely. I was looking at your profile and it appears you have some issues with Atrial fibrillation? If so, have any other methods of controlling it been tried, such as ablation or any other such thing?
Let me just say this, it's possible, but not very likely. I was looking at your profile and it appears you have some issues with Atrial fibrillation? If so, have any other methods of controlling it been tried, such as ablation or any other such thing?
I looked at profile too, and it is unusual, IMO, to be on Amiodarone so long. Why are they giving you dig? (Digoxin). I had AVR this January, mech valve and am currently on Amiodarone (Doctor says it will be stopped in about a month, that the main need for it post AVR is just for a few months post surgery), Metroprolol (Doc also says will be discontinued at some point after the other one), in addition to anticoagulant.
I am not a doctor, but the reason I am surprised at Digoxin/or whatever form of dig you are taking, is that I believe is normally used to strengthen the contractile force of the left ventricle. Usually the reason AVR patients (as my surgeon explained to me) take Metroprolol is to slow heart rate to lessen workload of LV. So, that is why that drug seems odd to me. (If I have mis-stated something, I hope someone more in the know will correct me.)
Edited to add, I found this in Wikipedia, http://en.wikipedia.org/wiki/Digoxin which includes cautionary note 'Quinidine, verapamil, and amiodarone increases plasma levels of digoxin (by displacing tissue binding sites and depressing renal digoxin clearance) so plasma digoxin must be monitored carefully.'. Also as Amiodarone is notorious for building up in the body over time, very long half life, you could accidentally be overdosed on one or the other. How often is the doctor checking these blood levels?
p.s. to Robert, I was glad to see you mentioned horses in your profile. I can hardly wait until my sternotomy is healed enough that I can ride again! (I am a lifelong horsewoman who is very eager to get back in the saddle!)
I am not a doctor, but the reason I am surprised at Digoxin/or whatever form of dig you are taking, is that I believe is normally used to strengthen the contractile force of the left ventricle. Usually the reason AVR patients (as my surgeon explained to me) take Metroprolol is to slow heart rate to lessen workload of LV. So, that is why that drug seems odd to me. (If I have mis-stated something, I hope someone more in the know will correct me.)
Edited to add, I found this in Wikipedia, http://en.wikipedia.org/wiki/Digoxin which includes cautionary note 'Quinidine, verapamil, and amiodarone increases plasma levels of digoxin (by displacing tissue binding sites and depressing renal digoxin clearance) so plasma digoxin must be monitored carefully.'. Also as Amiodarone is notorious for building up in the body over time, very long half life, you could accidentally be overdosed on one or the other. How often is the doctor checking these blood levels?
p.s. to Robert, I was glad to see you mentioned horses in your profile. I can hardly wait until my sternotomy is healed enough that I can ride again! (I am a lifelong horsewoman who is very eager to get back in the saddle!)
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After surgery, I was on a few drugs, including Digioxin, only for a few months. For 35 years after that I took only Coumadin/Warfarin. In my mid60s the docs added hi-blood pressure and cholesterol meds. Still on hi-blood pressure meds along with Warfarin. I had a bad aortic valve only, and when that was fixed, the need for meds other than an anti-coagulant was unecessary.
robert1562
New member
Thanks for the response Ross. I guess my question was is it the norm to be on Amiodarone, Digoxin, and Metoprolol after this type of surgery? I was told that these medications would help keep my heart beating strong and not have an abnormal beat. I have had no complications from the surgery other than fatigue every once in a while.
AVR replaced with a ST Jude mechnical valve. I am on these medication for life.
Warfarin 6mg day
Lisinopril- Blood pressure
Metoprolol 75mg
Warfarin 6mg day
Lisinopril- Blood pressure
Metoprolol 75mg
Ross
Well-known member
Amiodarone is to control Afib or rhythm issues. It is a dangerous drug and should not be used for any great length of time. You can do a search for it here and find tons of information discussing it's dangers. It's the sledgehammer of anti arrhythmics. You may want to discuss with your Doctor about alternatives such as Betapace/Sotolol instead or maybe find out how long he plans on you taking it. It's not abnormal at all to be on a variety of meds following surgery. Sometimes they are necessary for a little while and sometimes they are for life.
Your surgery was almost 4 years ago. Has your cardio ever reviewed the need to keep you on these extra meds?
The only Rxes I take are warfarin and generic Fosamax. Recently I began taking flush-free niacin (my choice).
Where is your cardio? Canton isn't that big of a city to offer many choices in specialists.
The only Rxes I take are warfarin and generic Fosamax. Recently I began taking flush-free niacin (my choice).
Where is your cardio? Canton isn't that big of a city to offer many choices in specialists.
ALCapshaw2
Well-known member
Robert -
First, I recommend that you Read the information sheet that your Pharmacy should provide with your Amiodarone.
You may also want to do a Search on VR.com and/or Google for Amiodarone. Also read the FDA Warning.
You could also ask your Pharmacist about the side effects and Long Term Use of Amiodarone.
Once you are educated about the potential Side Effects, then have a Discussion with whichever Doctor prescribed Amiodarone for you. I would Demand that you be checked for ALL of the potential Side Effects. Then ask about discontinuing that drug. There is a New Alternative (Multaq) that supposedly has fewer side effects. Sotalol has worked well in controlling A-Fib for several of our members.
'AL Capshaw'
\
First, I recommend that you Read the information sheet that your Pharmacy should provide with your Amiodarone.
You may also want to do a Search on VR.com and/or Google for Amiodarone. Also read the FDA Warning.
You could also ask your Pharmacist about the side effects and Long Term Use of Amiodarone.
Once you are educated about the potential Side Effects, then have a Discussion with whichever Doctor prescribed Amiodarone for you. I would Demand that you be checked for ALL of the potential Side Effects. Then ask about discontinuing that drug. There is a New Alternative (Multaq) that supposedly has fewer side effects. Sotalol has worked well in controlling A-Fib for several of our members.
'AL Capshaw'
\
Philip B
Well-known member
Meds
Meds
I've visited with my cardiologist about the necessity of continuing meds for potential issues like high blood pressure and cholesterol. His rationale is that the meds are simply insurance and probably not really necessary. The meds are relatively inexpensive so I really haven't worried about discontinuing the prescriptions.
If I quit with the BP and cholesterol meds, I'd simply be taking coumadin and an 81 mg asprin. The 81 mg asprin simply makes blood platelets less likely to stick together; it's not absoultely necessary either. So, yes, it's possible to do coumadin as a stand alone medication after AVR and aortic graft surgery.
My cardiologist did tell me once that he'd like to see everyone on Metoporol because it would reduce the amount of business he gets. He tried to put me on it, but I had an extreme allergic reaction to it. The head to toe itchy rash I got within minutes of taking the first pill was not much fun.
-Philip
Meds
I've visited with my cardiologist about the necessity of continuing meds for potential issues like high blood pressure and cholesterol. His rationale is that the meds are simply insurance and probably not really necessary. The meds are relatively inexpensive so I really haven't worried about discontinuing the prescriptions.
If I quit with the BP and cholesterol meds, I'd simply be taking coumadin and an 81 mg asprin. The 81 mg asprin simply makes blood platelets less likely to stick together; it's not absoultely necessary either. So, yes, it's possible to do coumadin as a stand alone medication after AVR and aortic graft surgery.
My cardiologist did tell me once that he'd like to see everyone on Metoporol because it would reduce the amount of business he gets. He tried to put me on it, but I had an extreme allergic reaction to it. The head to toe itchy rash I got within minutes of taking the first pill was not much fun.
-Philip
karen14
Well-known member
Hi Robert! Just wanted to add that I was put on Coumadin & Metoprolol after my AVR (St. Jude Mechanical). Those are the ONLY med's I was given, and am still on them. Be it I have to stay on the Coumadin, I've inquired as to whether I can get off the beta-blocker (metoprolol) or not.
There are very good reasons to stay on it, but I hate the side-effects. Beta-blockers can save your heart in the event, God forbid, of a heart attack. However, the side effects for me make me sluggish, with frequent numbness in the hands. This is a very hard decision for myself personally, so I'm going to stay on it untill I speak with my cardiologist soon. I've decided to go with what my doctor(s) thinks is best for me.
~Karen
There are very good reasons to stay on it, but I hate the side-effects. Beta-blockers can save your heart in the event, God forbid, of a heart attack. However, the side effects for me make me sluggish, with frequent numbness in the hands. This is a very hard decision for myself personally, so I'm going to stay on it untill I speak with my cardiologist soon. I've decided to go with what my doctor(s) thinks is best for me.
~Karen
As a followup to what I said earlier, my cardiologist told me this week that I can stop the Amiodarone at the end of this month. My surgery was in mid January. The cardiologist also had me go to lab this week for CBC, electrolytes, thyroid panel and lipids testing. Robert, I do not want to upset you or alarm you, however if your Doctor(s) have not been checking your thyroid, liver enzymes and doing a repeat echo recently, then IMO you are receiving extremely substandard, possibly even negligent (if no thyroid follow up) care. As Ross and ALCapshaw2 said, read about Amiodarone. It is beneficial in short term for most people, but can be a very bad thing to be on, long term.
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Mileena46
Well-known member
I have been on Amiodarone for the 8 months since surgery. Started out at 400mg a day then Cardio moved me to 100mg a day. I had all the test done and all came back fine, including my thyroid, but I guess as a side effect I am on thyroid meds now too, because the Amiodarone really threw me off balence in the hospital. They had to call in a specialist....I am taking a rather low dose and everything was back to normal at test time.
I have an appointment on 31s to see my Cardio and am half expecting him to want to take me off the Amiodarone. I will fight this....but whether I win or not....I don't know. My heart is sooooo steady....no jumping no PVCs....no extra or missed beats.....no fast heartrate.....I don't want to lose this!!
Good Luck with your meds.....it would be nice to be taking nothing but Warfarin! I guess if I lose my Amio...I might be on that and Lisinopril only!
Mileena
I have an appointment on 31s to see my Cardio and am half expecting him to want to take me off the Amiodarone. I will fight this....but whether I win or not....I don't know. My heart is sooooo steady....no jumping no PVCs....no extra or missed beats.....no fast heartrate.....I don't want to lose this!!
Good Luck with your meds.....it would be nice to be taking nothing but Warfarin! I guess if I lose my Amio...I might be on that and Lisinopril only!
Mileena
Hey Robert, I seem to be in a similar situation out of the chute as you. I had AVR on Jan 7, 2010 and was put on Amiodarone and Metoprol. I just quit the Amio which was to control early A-fib. Have to see how this works out! The other meds I take are 81mg aspirin, Crestor, and of course my Coumadin. I had some issues with the Amio early on but after a reduction in dose, everything was fine. I would definately be talking to my Cardio about continuing the Amio!!
If the Crestor is a statin, did you know you should also be supplementing your diet with Co Enzyme Q10, unless you are eating a lot of eggs and meat? I knew that from past research but I thought it was very interesting that the nurse in charge of the cardiac rehab program in which I am enrolled mentioned that she takes both. I did not think to ask her whether her Doctor was the smart person who said to take both, or if she figured it out on her own. When the first statin drug was patented, the developer (forgot who, maybe Merck?) also patented a formulation combining statin and Co Q10, but never marketed it that way. That indicates the drug developer knew damn well that the statin was going to increase need for that nutrient. I think it is horrible that they just 'sat on' that knowledge. Sigh...one of many reasons I distrust 'big pharma'.
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Jeanie,
Interesting you mention the COQ10. I am wanting to get on this but at my last ACT Clinic visit they preferred I kick the Amio for a couple of weeks before I add something new to confound my INR with the Coumadin. The Amio really plays with your dose and INR levels.
Interesting you mention the COQ10. I am wanting to get on this but at my last ACT Clinic visit they preferred I kick the Amio for a couple of weeks before I add something new to confound my INR with the Coumadin. The Amio really plays with your dose and INR levels.
Yes, I guess that makes sense. It is best to make just one change at a time.
I will have to look it up to be sure, but I thought I read that the Amio intensifies the action of Coumadin, and this reference http://www.umm.edu/altmed/articles/coenzyme-q10-000950.htm says COQ10 may decrease the effect of Coumadin. If I am analyzing correctly, let's say hypothetically a 3mg dose of Coumadin/Warfarin is producing correct INR with Amio, going off Amio might normally require an upward dose adjustment of the anticoagulant. Addiing CO Q10 which would reduce effect could also require upward dose adjustment. Where it becomes really, really murky, is no one knows - per many articles I have read - exactly how long it takes for Amio to clear out of the body. One of the articles I put in says on the average 58 days, but some I have read put it at much longer than that.) This is an interesting abstract, http://jpp.sagepub.com/cgi/content/refs/20/6/469.
The Wikipedia link below contains reference "Unlike most other drugs, which are excreted via the urine, excretion is primarily hepatic and biliary with almost no elimination via the renal route and it is not dialyzable [Package Insert- Pacerone(R)]. Elimination half-life average of 58 days (ranging from 25-100 days [Remington: The Science and Practice of Pharmacy 21st edition]) for amiodarone and 36 days for the active metabolite, desethylamiodarone (DEA) ".
When I read this, http://en.wikipedia.org/wiki/Amiodarone "Amiodarone can worsen the cardiac arrhythmia brought on by Digitalis poisoning." that is why I was concerned about OP being on dig also. If Doctors are not monitoring his Digoxin level, which can build up in the body sometimes (likely to be the case since they do not seem to monitoring anything else!
), then Robert1562 could be in a 'pickle' as the saying goes, and nobody knows. His Doctors really are negligent, IMO.
Anyway, I only remember to take the CO Q10 sporadically, mostly on days that for some reason I am not eating much meat or any eggs (those being good dietary sources). I found something interesting on Amiodarone, that might especially be of interest to our original poster, http://www.aafp.org/afp/2003/1201/p2189.html. (It includes the statement "Laboratory studies to assess liver and thyroid function should be performed at least every six months.")
I will have to look it up to be sure, but I thought I read that the Amio intensifies the action of Coumadin, and this reference http://www.umm.edu/altmed/articles/coenzyme-q10-000950.htm says COQ10 may decrease the effect of Coumadin. If I am analyzing correctly, let's say hypothetically a 3mg dose of Coumadin/Warfarin is producing correct INR with Amio, going off Amio might normally require an upward dose adjustment of the anticoagulant. Addiing CO Q10 which would reduce effect could also require upward dose adjustment. Where it becomes really, really murky, is no one knows - per many articles I have read - exactly how long it takes for Amio to clear out of the body. One of the articles I put in says on the average 58 days, but some I have read put it at much longer than that.) This is an interesting abstract, http://jpp.sagepub.com/cgi/content/refs/20/6/469.
The Wikipedia link below contains reference "Unlike most other drugs, which are excreted via the urine, excretion is primarily hepatic and biliary with almost no elimination via the renal route and it is not dialyzable [Package Insert- Pacerone(R)]. Elimination half-life average of 58 days (ranging from 25-100 days [Remington: The Science and Practice of Pharmacy 21st edition]) for amiodarone and 36 days for the active metabolite, desethylamiodarone (DEA) ".
When I read this, http://en.wikipedia.org/wiki/Amiodarone "Amiodarone can worsen the cardiac arrhythmia brought on by Digitalis poisoning." that is why I was concerned about OP being on dig also. If Doctors are not monitoring his Digoxin level, which can build up in the body sometimes (likely to be the case since they do not seem to monitoring anything else!
), then Robert1562 could be in a 'pickle' as the saying goes, and nobody knows. His Doctors really are negligent, IMO.Anyway, I only remember to take the CO Q10 sporadically, mostly on days that for some reason I am not eating much meat or any eggs (those being good dietary sources). I found something interesting on Amiodarone, that might especially be of interest to our original poster, http://www.aafp.org/afp/2003/1201/p2189.html. (It includes the statement "Laboratory studies to assess liver and thyroid function should be performed at least every six months.")
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Ross
Well-known member
Yes, I guess that makes sense. It is best to make just one change at a time.
I will have to look it up to be sure, but I thought I read that the Amio intensifies the action of Coumadin, and this reference http://www.umm.edu/altmed/articles/coenzyme-q10-000950.htm says COQ10 may decrease the effect of Coumadin. If I am analyzing correctly, let's say a 3mg dose of Coumadin/Warfarin is producing correct INR with Amio, going off Amio might normally require an upward dose adjustment of the anticoagulant. Addiing CO Q10 which would reduce effect could also require upward dose adjustment. Where it becomes really, really murky, is no one knows - per many articles I have read - exactly how long it takes for Amio to clear out of the body. One of the articles I put in says on the average 58 days, but some I have read put it at much longer than that.) This is an interesting abstract, http://jpp.sagepub.com/cgi/content/refs/20/6/469.
The Wikipedia link below contains reference "Unlike most other drugs, which are excreted via the urine, excretion is primarily hepatic and biliary with almost no elimination via the renal route and it is not dialyzable [Package Insert- Pacerone(R)]. Elimination half-life average of 58 days (ranging from 25-100 days [Remington: The Science and Practice of Pharmacy 21st edition]) for amiodarone and 36 days for the active metabolite, desethylamiodarone (DEA) ".
When I read this, http://en.wikipedia.org/wiki/Amiodarone "Amiodarone can worsen the cardiac arrhythmia brought on by Digitalis poisoning." that is why I was concerned about OP being on dig also. If Doctors are not monitoring his Digoxin level, which can build up in the body sometimes (likely to be the case since they do not seem to monitoring anything else!
Anyway, I only remember to take the CO Q10 sporadically, mostly on days that for some reason I am not eating much meat or any eggs (those being good dietary sources). I found something interesting on Amiodarone, that might especially be of interest to our original poster, http://www.aafp.org/afp/2003/1201/p2189.html. (It includes the statement "Laboratory studies to assess liver and thyroid function should be performed at least every six months.")
Both drugs mess with INR in a negative way. You cannot rely on something like 3 mg as everyone is different and requires differnent dosages of Coumadin. This is where home testing is very much important.
Jeanie come down to the anticoagulation forum and we can clear this all up for the both of you.
Ross, sorry if I was unclear. In your reference 'You cannot rely on something like 3 mg as everyone is different and requires differnent dosages of Coumadin.', you may have inadvertently missed that the number I plugged in was a hypothetical 'any dose' for the sake of example.
At this point, although many do fine on home testing my meds are about to be changed so I am better off with continuing followup by medical professional at my UNMC facility, who specializes in coumadin followup and dosage adjustment.
hope that clears up any misunderstanding...
Jeanie
p.s. My Husband self-tests as he has A-Fib, but for some reason, his machine is too temperamental or needs larger sample; we have not been able to do a test calibration of his machine versus the one at clinic, so for now it is actually less trouble for me to go to the clinic for it.
At this point, although many do fine on home testing my meds are about to be changed so I am better off with continuing followup by medical professional at my UNMC facility, who specializes in coumadin followup and dosage adjustment.
hope that clears up any misunderstanding...
Jeanie
p.s. My Husband self-tests as he has A-Fib, but for some reason, his machine is too temperamental or needs larger sample; we have not been able to do a test calibration of his machine versus the one at clinic, so for now it is actually less trouble for me to go to the clinic for it.
Ross
Well-known member
Just test someone not on Coumdin with his machine. If they are .9 to 1.2, then his machine is accurate. You can't test yours against there's. Reagents are different and will give different results. May I ask which machine he has?
