Q: I am a hypertensive male aged 45 years. Due to chronic fatigue and leg cramps, my doctor suggested Omega 3 fatty acids. What is the brand name of this medicine (Mexepa- E Merck)? He also advised Vtamin E and Cod liver oil (brand name E Cod -Universal) I am on LosarBeta (Unisearch) twice and amlodac 10 mg once. I go for a brisk one hour walk daily but weight loss is very slow.

A:You are taking three medicines for high blood pressure: losartan + atenolol (Losarbeta) and amlodipine (Amlodac). There is now adequate scientific evidence to suggest that when a person is put on more medicines, one of them should invariably be a diuretic (to produce more urine, get rid of excess salt and reduce pressure on heart in addition to lowering blood pressure). If the response is not adequate then second, and in some less common cases, third medicine should be added on a step-up basis. One has to be particularly careful while prescribing medicines to young, sexually active males. Administering more medicines invariably leads to more side effects. High blood pressure itself causes fatigue. Atenolol also causes fatigue. Losartan causes muscle pain. It would be prudent to review your medication. One can start with a low-dose, long-acting diuretic such as indapamide 1.5mg (sold under the trade name of Indicontin Continus) plus amlodipine (Amlodac) 10mg daily. If after say 2-3 weeks, the response is inadequate, one can add losartan (Losacar), starting with 25mg and increasing to 50mg, if at all required. In any case the use of Fixed Dose Combination (FDCs) medicines needs to be avoided because it is not possible to titrate doses. For example LosarBeta contains losartan 50mg and atenolol 50mg. How do we titrate the dose if we wish to give atenolol 50mg and losartan 25mg? Such a combination is not permitted in any advanced country such as United States, Britian, Canada, Australia etc. In India, laws are too lax and their implementation even poorer with the result that such irrational combinations can be sold and are being prescribed. Maxepa (not Mexepa) is the brand name of a product that contains fatty acids. It is given to those patients whose triglycerides are high. The normal requirement of vitamin E is 3-15mg a day. Unfortunately most brands contain far more quantity that can lead to side effects. It migh interest you to know that one of the side effects of too much consumption of vitamin E is fatigue and muscle weakness. Cod liver oil contains vitamins A and D. It also contains fatty acids, the same as Maxepa. If you take vitamin Maxepa as well as Cod liver oil, you would be taking fatty acids twice. In general, people in India consume just too many synethetic vitamin supplements under the totally wrong perception that they are useful as well as harmless. Such a perception helps pharma companies a lot but hurts patients. It is much more important to take green vegetables and fruits which are much more beneficial and much less costly.