Q: My father is 70 years old. For the last two years he is facing a problem of spondylitis and high blood pressure. His physician has adviced him medicines which have to be taken life-long. Once he had forgotton the name of my niece, is it due to the medication? Otherwise he is a very active and agile person. The medicines he is taking are: Envas 2.5, Enalapril maleate - 1 daily at night. Nodon, B-blocker, Nebivolol Tab 5 mg - 1 daily at night. Venlor-XR-75, Venlafaxine hydrochloride Extended release capsule - 1 daily in the morning. Nitrest-10, zolpidem tartrate Tab - 1 daily at bedtime; Lonazep - 0.25, Clonazepam Tab- 0-0 daily in the morning; Zevit, Vitamin B capsule, 1 daily in the morning. What are the side effects of these medicines?

A:In patients of high blood pressure, more so in elderly subjects, the first line treatment should ideally be a diuretic [i.e. medicines that increase urine output such as slow-release indapamide (sold under various brand names such as Indicontin Continus) or metolazone (trade name: Metolaz)]. If the response is not adequate, another medicine can be added such as a betablocker (e.g.nebivolol) or an ace-inhibitor (such as enalapril). In some cases a patient may even need three medicines but in all cases, one of them should invariably be a diuretic. I am unable to understand the use of the other three drugs used in your fathers case. Venlafaxine is indicated in either major depression (not responding to other treatments) or treatment of Generalised Anxiety Disorder (GAD) characterised by chronic and excessive worry and anxiety sufficient to cause impairment of everyday functioning for atleast six months. There is no reference to this problem in your father's case. One of the common side effects of venlafaxine is increase in blood pressure. Hence it can not, in any case, be given to patient who is already suffering from high blood pressure because it will make the matters worse. Zolpidem is meant for short term treatment of insomnia (sleeplessness) in only those situations where it is debilitating or is causing severe distress for the patient. It must not be used for more than four weeks. Its side effects include loss of memory, confusion and depression. Long term use leads to addiction. The chances of all side effects, particulalry addiction and physical dependence increase if it is given when clonazepam is also being used. Elderly patients are particularly susceptible to side effects. The maximum dose in patients above 65 years should not exceed 5mg. Clonazepam is meant for the treatment of epilepsy only. It can cause confusion, depression and addiction. It increases the effect of zolpidem. You have not given any complaint of epilepsy in your father's case. Zevit is a multivitamin preparation and hence may be useful in your father's case.