Q: I am a 50-year-old hypertensive person. I am on Amlopress AT and Losacar 50 twice Ecosprin - 75 mg (prophylaxis). I had developed mild asthma and my physician started Unicontin-400 one at night. Further, he has suggested to take clodrel 75 (Clopidogrel) in place of Ecosprin since Ecosprin has a tendency to aggravate asthma and rhinitis. Is Aspirin contraindicated in asthmatic patients? He told me that Atenolol in Amlopress AT tends to impair libido and atenolol is discouraged in sexually active patients. He asked me to take Amlodac-5 mg twice and Bisoprolol 5 mg (Zebesta by USV). I solicit your advise about the modified drug regimen.

A:Your doctor has taken the right decisions by discontinuing aspirin. Many patients develop bronchospasm when given aspirin. Unicontin-400 Continus is the correct choice because of its long duration of action. Clopidogrel (sold under several brand names such as Noklot etc.) is also the right choice of medicine. However I have reservations about the use of bisoprolol on two counts. Being a betablocker it is in the same category as atenolol and hence can cause both bronchospasm as well as impotence. Even otherwise, there is international consensus that a diuretic (such as controlled release indapamide, sold under the trade name of Indicontin Continus) should invariably be one of the initial medications. Thus, it will be in addition to Amlodac-5 but replace a betablocker. 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 40,000 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.