Question :

I am 64 years old and taking 50 mg of Lopressor twice a day as well as 75mg of Levothyroxine, simvastatin 20 mg every night, 150 mg of ranitidine twice daily,40 mg daily of esomeprazole, and 5 mg of amlodipine a day and I feel like I am dying.

Please tell me if this is too much medicine at one time.

Please respond. I do not have medical insurance and this medicine has been issued from the emergency room in the last 3 weeks.

I also know my potassium level is very low.

Patrice

Answer:

Dear Patrice,

Lopressor is a beta-adrenergic blocking agent (beta-blocker) and is used for treating high blood pressure.

Amlodipine is a long-acting calcium channel blocker and is used to treat high blood pressure.

Pharmacologic Beta blockade is superior to Calcium channel blockade regarding chronotropic properties of the myocardium.

Ranitidine is a histamine H2-receptor antagonist that inhibits stomach acid production and is used to treat ulcers and gastroesophageal reflux disease (GERD).

Esomeprazole is a proton pump inhibitor and is used to treat gastroesophageal reflux disease (GERD).

For patients who are experiencing inadequate control of NAB (Nocturnal Acid Breakthrough)on a twice daily PPI (proton pump inhibitor), the addition of an H2RA (histamine H2-receptor antagonist) to twice daily PPI therapy may be more cost effective than adding a third bedtime dose of a PPI.

Converting a state of hypothyroidism (underactivity) to a normal state (euthyroid state) with levothyroxine may decrease the actions of certain beta-blocking drugs, [for example, metoprolol (Lopressor)]. It may be necessary, therefore, to change the dose of beta-blocker.

For people taking a Beta Blocker, [for example, metoprolol (Lopressor)] and Simvastatin, possible patient's adverse outcomes are:

Tinnitus
Paraesthesia
Heart Rate Decreased
Feeling Hot
Cardio-respiratory Arrest
Pupil Fixed
Ventricular Fibrillation
Mydriasis

For people taking Simvastatin, Metoprolol Tartrate and Levothyroxine, possible patient's adverse outcomes are:

Vision Blurred
Transient Ischaemic Attack
Rash (Rashes)
Hyperkalaemia (Hyperkalemia)
Chest Pain
Pain

The effects of low potassium in the body are the formation of a potentially fatal state called as "Hypokalemia".

A severe condition of this disease leads to:

= serious arrhythmias
= muscle weakness and myalgia
= disturbed heart rhythm
= more risk of hyponatremia with confusion and seizures

The signs and symptoms of low potassium are usually mild and at times vague. It is not unusual to have more than one symptom concerning the kidneys, muscles, nerves, heart and gastrointestinal tract. Some of the common symptoms are:

= weakness or tiredness
= cramping in arm or leg muscles. This is sometimes severe enough to make it impossible to move arms or legs, similar to paralysis
= abdominal cramping or bloating
= nausea or vomiting
= tingling or numbness
= passing large quantity of urine or a frequent sensation of thirst
= irregular psychological behavior like depression, psychosis, delirium, confusion or seeing or hearing things (hallucinations)
= fainting due to low blood pressure
= palpitations
= constipation
= abnormal heart rhythms (arrhythmias)

Severe hypokalemia is not linked with any symptoms, but may cause:

= muscle weakness - inability to exert force with one's muscles to the expected degree
= myalgia or muscle pain
= disturbed heart rhythm including ectopy (disturbance of the electrical conduction system of the heart where beats arise from the wrong part of the heart muscle)
= serious arrhythmias (electrical activity of the heart is irregular i.e. faster or slower than normal)
= greater risk of hyponatremia (an electrolyte disturbance in humans when the sodium concentration in the plasma decreases below 135 mmol/L) with confusion and seizures

The recommended starting Lopressor dosage for people with high blood pressure (hypertension) is 100 mg once a day or 50 mg twice a day. After a week or longer, your healthcare provider may increase or decrease your dosage based on the blood pressure response and/or Lopressor side effects.

Levothyroxine is not a "one-size-fits-all" medication, and there is no "standard" levothyroxine dosage. People have varying degrees of hypothyroidism and other thyroid problems (and varying responses to the medication), and, as a result, the levothyroxine dose must be individualized.

The average daily Simvastatin dose is 5 mg to 80 mg

In healthy subjects a single 75 mg dose of ranitidine significantly reduced meal-stimulated intragastric acidity.

A single oral dose of esomeprazole at 510 mg/kg (about 103 times the human dose on a body surface area basis), was lethal to rats.

The maximum dose of esomeprazole is:

Erosive esophagitis: 40 mg/day
GERD: 20 mg/day
H. pylori eradication: 40 mg/day

The usual initial antihypertensive oral dose of Amlodipine besylate tablets is 5 mg once daily with a maximum dose of 10 mg once daily.

Starting amlodipine or adding amlodipine at 2.5 mg in hepatically impaired patients is recommended.

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