Q: My wife, 54 years old, has been suffering from palpitations in the heart. She is also suffering from mild diabetes and high cholesterol. She has been advised to take atorvastatin, clopidogrel, metformin and anghizaar H. Can clopidogrel be substituted with ASA?

A:For cholesterol atorvastatin (such as Atorva) 10 mg once daily, for diabetes metformin (such as Glyciphage) 250 mg to 500 mg 1-3 times daily, as needed, are fine. Anghizaar H is a combination of two medicines: losartan and hydrochlorothiazide. It is indicated in the treatment of high blood pressure and not palpitations. Furthermore hydrochlorothiazide can worsen diabetes. Hence it needs to be avoided in patients who are already suffering from diabetes. It is not clear as to why this combination product has been prescribed unless the patient is also suffering from high blood pressure of which there is no mention in the details given. Please also see general information on combination products below. Clopidogrel, like aspirin, is a blood thinner and is indicated in angina and certain cases of heart arrhythmias. The cause of palpitations, if any, is not given. If there is no secondary reason for palpitations, blood thinners like clopidogrel or aspirin are not indicated. If needed and not contraindicated clopidogrel can be substituted by aspirin in females (but not males since there is increased risk of stroke). Fixed-Dose Combinations (FDCs): Medicines are discovered individually and are supposed to be taken separately. A huge number of irrational, illegal combinations of drugs are being sold in India; quite a few without mandatory approval of the Drugs Controller General, India (DCGI). Except in a few cases (such as TB medicines), it is always better to take medicines separately so that dosage can be adjusted and side effects monitored.