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How to manage vitamin B12 deficiency and low pulse rate?

Q: I am 47 years old. I am undergoing treatment for vitamin B12 deficiency. Six 6 months back my BP was on the higher side. Since then I have been taking Lodoz 2.5mg once a day. After that whenever I checked my BP, the upper level is between 110 to 140 and lower level is between 70 to 90. Can I stop taking this medication? At this age I play badminton for 3 to 6 hours a week. I also do yoga occasionally. But my heart rate is always between 50 to 60. Resting pulse is 55 or less. I checked the ECG and treadmill ECG, which was OK. Some doctors say that it is OK for some people to have low heart rate. Is my heart rate OK? I am not diabetic.

A:Lodoz is the brand name of a medicine called bisoprolol. It belongs to a group of drugs called betablockers. While they do bring the blood pressure down, one of their side effects is reduction in pulse (heart) rate. It is possible that the pulse rate may be even lower than 50 while you are asleep. In patients with low heart rate, we avoid betablockers. Also we generally prefer not to give betablockers to sexually active males since they can cause erectile dysfunction. The drug of choice in your case will be an ACE inhibitor such as enalapril 5mg sold under the brand names of BQL (by Cadila Healthcare) or Enam (by Dr. Reddys Lab). The first dose is always 2.5mg; subsequently most people stabilize at 5-10 mg daily. People in India consume tons of vitamins which are not required at all. Normal Indian food with a good helping of tropical fruits contains more than required quantities of all vitamins. This has been brought out in the Report of the National Commission on Macroeconomics and Health issued by the Ministry of Health. The Commission has termed vitamins (such as Becosules, Polybion, Evion and equivalent brands) as useless if not hazardous. Vitamin B-12 is to be taken ONLY if there is proven, documented deficiency. In any case Diapill contains all sorts of ingredients in addition to B-12 which you do not require and in fact can lead to hypervitaminosis. It is also very expensive in relation to its constituents, not to mention the fact that the brand does not appear on the national and international databank of quality Fixed-Dose Combinations (FDCs). Such irrational, multi-ingredients combinations are not prescribed or permitted in any advanced country. If at all you are deficient in vitamin B-12, then you can take just B-12 or mecobalamin alone such as Methycobal (from Wockhardt) that costs Rs. 5 per tablet. With regard to your blood pressure, one cause could be your weight - 80 kg for your height of 167 cm is at least 10 kg+. I can assure you that if you reduce to your normal weight (67-70 kg), not only you may not need medicines but overall you will feel much better. General statement on selection of brands: There are scores, sometimes hundreds, of brands of the same medicine. Against about 300 pharmaceutical manufacturers in western countries like Britain, there are over 20,000 producers in India that market more than 60,000 brands. Most manufacturers do not have quality testing laboratories. Hence selection of brands is important. Many companies give incentives to prescribers to patronise their products. Patients should check the reputation of manufacturers before consuming medicines.

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