Q: I am a 8 years old man with hypertension and taking Amlodac-AT and Losacar 50 twice a day. I also take Tgtor 10 mg and Ecosprin 75. Recently, my doctor suggested me to take Amlopress AT twice, Losacar-50 mg once and Polytorva (USV). He told me that this new drug will curtail my dose frequency. I want to know about Ploytorva (USV)?

A:Amlodac-AT contains amlodipine + atenolol. Losacar contains losartan. Tgtor contains atorvastatin. Ecosprin contains aspirin. Ploytorva contains atorvastatin 10 mg + ramipril 5 mg + aspirin 75 mg. Thus, you are already taking 5 medicines. In the new suggested medication you have been advised to take: Amlodac-AT (as before) Losartan 50 mg instead of 100 mg Atorvastatin 10 mg Ramipril 5 mg Aspirin 75 mg. Thus, in all you will be taking 6 medicines. Good clinical practice demands that an attempt should always be made to treat high blood pressure with minimal medication (particularly in young sexually active males) and maximum life style changes. Amlodipine, atenolol and losartan are all meant for reducing high blood pressure. Atorvastatin is meant to reduce cholesterol level if it is high. Aspirin is supposed to reduce the chances of heart attacks and strokes. For your height of 178 cm, your weight (100 kg) is above normal. Obesity is not only a cause of high blood pressure but can lead to complications and result in ever increasing number of medicines and their doses. A reduction of 10 kg can result in the BP going down by at least 14 mm Hg. In addition mild exercise in the form of brisk walk for a minimum of 45 minutes daily to cover no less than 4.5 km will help bring down the BP in addition to helping in reducing the weight. Needless to say there should be moderation in salt intake. For instance pickles contain huge amounts of salt. The recent research on aspirin is causing concern. It has been found that in hypertensive male patients, the chances of haemorrhagic stroke are increased by approximately 70%. Hence it is no longer recommended for males unless there are compelling reasons. You have not given your lipid (cholesterol, triglyceride etc) levels. Hence I am unable to comment on the utility of atorvastatin in your case. As per globally accepted guidelines, the first choice initial therapy in young hypertensive (under 55 years of age) males should be either losartan (Losacar) 50 mg 1-2 times daily or enalapril (BQL, Enam) 5-10mg 1-2 times daily. Since you are already on Losacar 50 mg twice daily, you should continue to do so. If a second drug is required, then amlodipine (Amlodac) 5 mg 1-2 times daily can be used. Since you are already on amlodipine (Amlodac) 5mg twice daily, it is best to stick to this medicine. If at all a third drug is required, then it should invariably be a diuretic such as low dose, long acting indapamide (Indicontin Continus) 1.5 mg once daily. Once these three medicines in their therapeutic doses are taken, there will be hardly any patients who need a fourth drug. It is always better to avoid combination medicines (such as Polytorva) since it is neither possible to adjust doses of components nor it is possible to pinpoint side effects if they occur. Please see general note on Fixed-Dose Combinations below. 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.