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Are the drugs, which my father is taking for hypertension fine?

Saturday, 04 September 2004
Answered by: Chandra M. Gulhati
Editor,
MIMS,
New Delhi
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Q. My father is 51 years old and has high B.P. for the last 8 years. He started treatment with tenoclor-50 and listril-10. Then for the last one year the doctor prescribed him Amcard-AT and Listril-10. Now for the last one month he is taking Tenoric-50 and Ramistar-A. His B.P. is more or less under control with occasional increase to 160/100, otherwise it remains at 130/90. I want to know whether the medicine he is taking currently is fine? He also gets occasional bleeding with stools without pain & takes Deflon for that. His recent blood test has shown normal readings except platelet count at 0.65 lac/cumm. Is it because of the medications?

A.  You have given brand names and not names of the medicines. It is important to appreciate that many brands have same ingredients. For example Tenoclor-50 and Tenoric-50 are exactly the same and it is difficult to imagine as to why the brand was changed. Tenoclor-50 is manufactured by a well known reputed company. The patient was first given atenolol + chlorthalidone (Tenoclor-50) and lisinopril (Listril). Then he was shifted to atenolol + amlodipine (Amcard-AT) and lisinopril (Listril). In other words out of three medicines atenolol, chlorthalidone and lisinopril, one (chlorthalidone) was replaced with amlodipine. It is difficult to appreciate the reason because it is necessary to use a diuretic there are many but chlorthalidone is one of the older ones) as a first line therapy. Currently the patient is taking atenolol + chlorthalidone (Tenoric-50 which is same as Tenoclor-50) and atenolol + ramipril. There is not much of a difference between lisinopril and ramipril. Incidentally the brand Ramistar-A does not appear on the international drug data bank of reputed manufacturers. Based on extensive, large trials in the United States and Britain, it is now internationally agreed that the first line treatment of high blood pressure should be a diuretic (a medicine that increases urine output). There are many diuretics but a slow-release preparation of indapamide such as Indicontin Continus that is taken just once a day is preferable. If the blood pressure is not controlled in 2-3 weeks time, one can add amlodipine (such as Amlodac) 5mg once a day. In case even this addition does not produce adequate response, one can add a member of another group such as lisinopril 2.5 to 5mg daily (sold under various brand names such as Lipril, Listril etc.). The attempt is to control blood pressure with one medicine; if not use two and in some cases three medicines on a stepped up approach basis.

A.  You have given brand names and not names of the medicines. It is important to appreciate that many brands have same ingredients. For example Tenoclor-50 and Tenoric-50 are exactly the same and it is difficult to imagine as to why the brand was changed. Tenoclor-50 is manufactured by a well known reputed company. The patient was first given atenolol + chlorthalidone (Tenoclor-50) and lisinopril (Listril). Then he was shifted to atenolol + amlodipine (Amcard-AT) and lisinopril (Listril). In other words out of three medicines atenolol, chlorthalidone and lisinopril, one (chlorthalidone) was replaced with amlodipine. It is difficult to appreciate the reason because it is necessary to use a diuretic there are many but chlorthalidone is one of the older ones) as a first line therapy. Currently the patient is taking atenolol + chlorthalidone (Tenoric-50 which is same as Tenoclor-50) and atenolol + ramipril. There is not much of a difference between lisinopril and ramipril. Incidentally the brand Ramistar-A does not appear on the international drug data bank of reputed manufacturers. Based on extensive, large trials in the United States and Britain, it is now internationally agreed that the first line treatment of high blood pressure should be a diuretic (a medicine that increases urine output). There are many diuretics but a slow-release preparation of indapamide such as Indicontin Continus that is taken just once a day is preferable. If the blood pressure is not controlled in 2-3 weeks time, one can add amlodipine (such as Amlodac) 5mg once a day. In case even this addition does not produce adequate response, one can add a member of another group such as lisinopril 2.5 to 5mg daily (sold under various brand names such as Lipril, Listril etc.). The attempt is to control blood pressure with one medicine; if not use two and in some cases three medicines on a stepped up approach basis.

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