Hey, I love these kinds of questions. (I?m just a 1st year med student
by the way.) Very insightful of you to wonder about drug interactions.
Now, just remember A) I?m not a doctor, and B) I?m not your doctor, so
I don?t know you, your history, etc.
There are at least three reactions that you should be on the look-out for:
1) rash and itchiness, a result from your atenolol and enalapril.
2) weakness caused by hyperkalemia, also a result from your atenolol and enalapril.
3) Nausea from the fish oil and metformin.
All of these are explained better below. Let me go through each drug
so that you can relate each to your medical history, while I discuss
interactions.
Atenolol is a beta1selective antagonist, meaning that it mainly causes
the heart to not pump so hard and also blocking the release of a
hormone called renin (and without causing bronchoconstriction if
you?re asthmatic). This reduces strain on the heart. The drug
accumulates in patients with renal failure. Dosage should be between
50 and 100 mg. Effective in hypertensice with a diuretic, but you?re
not taking diuretics because they can?t be given to diabetics.
Amlodipine is a calcium channel antagonist, which prevents calcium
from entering the smoot muscle cells that surround arteries. It is
more specific to smooth muscle than other drugs of this type, causing
less side effects on the heart. This prevents the muscle from
contracting too much, and lowers peripheral blood pressure (also
reducing strain on the heart.) These drugs were thought to be great in
theory, but in practice they have not been as successful as thought.
Amlodipine has shown improvement in patients with severe heart
failure, but no significant improvement in patients with nonischemic
cardiomyopathy. Drugs of this type are usually most effective in
treatment of heart failure from diastolic dysfunction, but are usually
not first-line therapy, and are usually reserved for patients who
can?t tolerate ACE inhibitors (like enalapril) or other vasodilators.
Usually 10 mg dose daily.
ACE (angiotensin converting enzyme) inhibitors such as enalapril are
very effective medicines with few side effects, esp. for diabetics
because they slow glomerulopathy (kidney disease). This works by
stopping the release of a hormone that constricts blood vessels, and
again lowering the strain on the heart. This is the preferred
first-line treatment for patients with left ventricular hypertrophy.
These types of drugs also enhance the effects of diuretics, but you
are not taking those, so no chance for interaction there.
ACE-inhibitors can increase potassium levels slightly, and this can be
enhanced by betablockers, so you may be experiencing hyperkalemia,
which you would notice as muscle weakness. This can be enhanced even
more if you take non-steroidal antiinflammatories like aspirin or
ibuprofen. Also, if you experience any signs of angioedema (swelling
and rash, itchiness) you should stop taking enalapril (and this
sometimes can be enhanced by the betablocker). This drug is given as
2.5-5 mg doses at first, and after time up to 40 mg daily.
Metformin is a biguanide drug, and is often given with a sulfonylurea
(which is what gliclizide is). It does not cause release of insulin
glucagons, cortisol, or anything. Instead, it decreases liver glucose
production and enhances insulin effects in muscle and fat, so it is
considered an antihyperglycemic. It rarely has been associated with
lactic acidosis, and should not be used if you have had cardiac
failure, renal disease, lung disease, or liver disease. Side effects
of this drug are diarrhea, nausea, metallic taste, and anorexia. Take
the drug with meals to reduce these effects, and don?t go long periods
without food. The drug inhibits absorbtion of vitamin B12 and folate,
but with calcium supplements the absorbtion of vitamin B12 is
normalized. Without B12 your blood cells slow their reproduction rate,
and this can have severe impairment of the nervous system, but this
would be rare with this drug. However, B12 is necessary for using odd
# fatty acids, which can be found in marine animals, such as the fish
oil you are taking. Without B12 you might have a buildup of
L-methylmalonyl CoA, which could possibly mimic the effects of
methylmalonyl academia (MMA) disorder (similar to ethylene glycol
poisoning). I?m not sure this has ever happened though; I?d have to
look into it more. Maximum dose is 2.5 g daily.
Gliclazide is a potent hypoglycemic. It works by stimulating insulin
release from the pancreas. Best when taken 30 minutes before eating.
Sulfonyl drugs can have lots of interactions with other sulfonyl
drugs, and can be kept in the body longer if taken with aspirin or
alcohol. Side effects of the drug include nausea and vomiting,
jaundice, anemia, skin reactions, and agranulocytosis. This drug
should not be used with type I diabetes, pregnancy, lactation, or
hepatic or renal insufficiency. Because of its short half-life (time
in the body) it should not cause the problem of causing hypoglycemia.
If you want I could look into how all these drugs interact with each
other and with liver enzymes (since many of these drugs have liver
cautions), but that would take a lot more time. Anyway, I hope this
helps! Too bad I?m not a google answer guy though! |
