I take a drug called demadex to get water out of my system.  I take
80mg twice a day.  I have been having low blood pressure and a chronic
cough with a lot of mucus.  My doctors do not know why I am having
this problem.  How safe is Demadex?

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Request for Question Clarification by pinkfreud-ga on 29 Oct 2004 21:44 PDT

Drugs such as Demadex are generally prescribed to treat high blood
pressure. You say you have low blood pressure. Did you have high blood
pressure before you took the Demadex? If not, what condition is being
treated by the Demadex?

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Clarification of Question by babs1234-ga on 30 Oct 2004 08:21 PDT

I have had two triple heart by-pass surgeries.  The last one was in
2001.  I am 76 years old. I have chf I am a dibetic.  Ever since I had
heart by-pass I have developed a cough and cough up a lot of mucus. 
This happens every day.  I have seen a allergy doctor, ent doctor 2
lung doctors my heart doctor and my family doctor.  They have run all
kinds of tests and can't find the problem.  The problem is getting
worse.  I choke when I swallow fluids or eat.  I have had a swalling
test and that was ok.  I had ex-ray of my head and that was ok.  I
take coreg and cozzar and demadex.  I take a lot of demadex and I feel
it brings down my blood pressure.  Last night my bp was 60/36 and I
feel terrible.  I cough everyday and spit up at least a cup of mucus. 
There must be an answer.  The doctors just don't want to hear it. 
It's getting so my wife and I can't go anywhere because I start
coughing and sneezing every time I eat.  It starts 15 minutes after I
eat and only when I stand up.  I never have the cough when laying down
at night only when I get up in the morning and I spend about 10
coughing and spitting up mucus.  I don't know where to go next.  Thank
you for any advice you could give me.
Ben Lewis

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Clarification of Question by babs1234-ga on 18 Nov 2004 22:26 PST

To answer hicyrus-ga question on Nov. 18, 2004.  I have had a ct of
the chest a swallowing test and have never smoked.  I did not have
this problem until my surgery in 2001.  The Doctor has lowered my dose
of demadex to 40mg twice a day instead of 80mg twice a day.  He also
told me to take zantac 75 twice a day.  No matter what I do I still
cough.  I have cough so hard at times I have fallen on the floor.  I
am glad she is with me.  My mucus is so thick.  I have been to 2 ent
doctors, 2 long doctors an allergy doctor my heart doctor and I even
went back to the doctor that did my surgery.  The doctors all say they
don't know what the problem is.  No matter what I do I still cough.  I
am afraid to spot the Demedix because I do have chf and retain fluid. 
I appreciate all your help.  I pray someone out there has the same
problem I do.  I want to thank all of you for your help.
Ben Lewis
P.S. I guess when you get to be 76 you fall apart.  I just get tired of coughing.

Issue #1:  If your bp is that low, you may well need an adjustment to
one or more of your meds. Take your blood pressure log to your doctor
and point out the low blood pressure reading that you had. Ask him if
you need an adjustment in your medication.

Issue #2:  I don't know about the side effect of mucus, but there are
lots of different medications for congestive heart failure, and you
could tell the doctor that since you have tried everything else such
as going to specialists, you would now like to switch medications (one
at a time) to see if any of them could be causing the side effect.

If your doctor won't work with you or pay attention to your low blood
pressure reading, then please go to another doctor. It might not be
comfortable for you to be assertive with your doctor.  If not, try
enlisting the help of a relative or friend.

Also, try to build your general health through gentle exercise if you
are allowed,and healthy eating.  Good luck to you!

One more comment.  Cozaar can sometimes have the side effect of
increased cough, upper respiratory infections or sinus probs, per
www.healthsquare.com.

Also, per my Monthly Prescribing Reference (I am not a doctor), if you
have a sulfa alleregy, you should not take Cozaar.  Do you happen to
have a sulfa allergy by any chance?

Well, again, I stress to you that you if your bp is dropping (and
staying) as low as you mentioned, then you definitely want to ask your
doctor about changing or maybe cutting back on meds.

Your blood pressue is definitely an issue and is way too low.  It
could be that the dose of Demadex you are on is lowering your blood
pressure too much.    You don't mention whether or not you noticed the
mucus problem following the addition of one or another of the
medications you are taking.  It could be that for you, you are having
an adverse reaction to one or more, or a combination of the
medications you are taking.  It is time to get more aggressive with
your doctor with the blood pressure issue and the mucus issue. I agree
that if this doctor doesn't work with you on this, find another one.

JR

Ben
I would definitely seek advice from another MD.  First, I would choose
a specialists who is board certified in "Pulmonary Disease" and
"Critical Care Medicine", meaning he/she would be double board
certified or look for one whom is triple board certified by adding
"Internal Medicine."

If you want the top MDs I would go to http://www.mdnationwide.org or
http://www.castleconnolly.com or http://www.bestdoctors.com  

I hope this can guide you in a better direction.  Best of luck:)

You seem to be having multiple problems.  
1. Choking when swallowing: normally the vocal cords close when you
swallow. Seems like this is not happening in your case and the food is
going down your windpipe. Seems like you have developed either a nerve
damage which could have happened during your by-pass or could be a
local muscular problem. An ENT surgeon and a swallowing evaluation by
speech therapist should clarify that or a barium swallow test.

2. Cough and mucus post surgery: Possibilities: 
A. Chronic Bronchitis. It is possible that you have developed chronic
bronchitis (if you did not already have it earlier! Were you a smoker
before?
This could also be caused by repeatedly aspirating food and liquids
into your lungs. And this seems be most likely. Chronic bronchitis is
difficult to diagnose by xrays or CT...only symptoms help make the
diagnosis. Treatment is not easy but can help reduce the symptoms.

B. Bronchiectasis: which is a small localized lung abnormality which
is prone to recurrent infections and mucuc collectios. This can
develop after a lung infection. Broncheictasis is usually diagnosed by
a CT of the chest which i presumed has been done and is normal. If not
done, request your doctor for a chest CT as some of your symptoms are
very suggestive of this as well.

3. Low blood pressure: Demadex, coreg, and cozaar can all cause low
BP. You have to be cautious with these medications if your BP is
running low (and 60/36 is LOW!!) So check with your cardiologist is
all of these are necessary and if you need to take all the
medications. You could not take your demedex and monitor your weight
daily. If it goes up by a couple of lbs then you are probably
retaining fluid and then could take the demadex if your BP is not very
low.
Hope this helps and take care. 
ps. i do not want to get paid for this.

So would you mind sharing the results of those tests and CT. You could
ask for printed copies of reports if they have not been given yet
including the doctors opinion.