Amitriptyline+ indapamide= heart attack

[gilmarpersonal]

I was reading that amitriptyline and indapamide have a drug interaction, increasing the QT interval time, which can cause a heart attack.

 

[Ghoul]

I was reading that amitriptyline and indapamide have a drug interaction, increasing the QT interval time, which can cause a heart attack.

Amitriptyline increases QT interval all by itself, raising the risk of arrhythmia.

Indapamide can induce hypokalemia, which can also cause arrhythmia.

Sweating during exercise can induce hypokalemia and cause an arrhythmia.

Sometime arrhythmias trigger a heart attack in vulnerable individuals, so two or more factors that can cause arrhythmias makes the potential heart attack risk higher than one or none. But the risk is extremely low in healthy individuals.

Notice that these drugs aren't contraindicated, there are no warnings not to use them together and no data showing an actual increase in heart attacks. It's a mechanistic possibility, but nothing to be concerned with unless you have heart problems

Still. tricyclic antidepressants are toxic garbage with safer and more effective alternatives for all the conditions Amitriptyline treats. It's only still used because it's dirt cheap, along with lazy doctors not putting the effort into educating themselves about the newer alternatives.

 

[gilmarpersonal]

Amitriptyline increases QT interval all by itself, raising the risk of arrhythmia.

Indapamide can induce hypokalemia, which can also cause arrhythmia.

Sweating during exercise can induce hypokalemia and cause an arrhythmia.

Sometime arrhythmias trigger a heart attack in vulnerable individuals, so two or more factors that can cause arrhythmias makes the potential heart attack risk higher than one or none. But the risk is extremely low in healthy individuals.

Notice that these drugs aren't contraindicated, there are no warnings not to use them together and no data showing an actual increase in heart attacks. It's a mechanistic possibility, but nothing to be concerned with unless you have heart problems

Still. tricyclic antidepressants are toxic garbage with safer and more effective alternatives for all the conditions Amitriptyline treats. It's only still used because it's dirt cheap, along with lazy doctors not putting the effort into educating themselves about the newer alternatives.

Im taking olmesartan 20mg, anlodipine 5mg, indapamide 1.5mg and nebivolol 5mg

My blood pressure is 120/80 but my Heart rate 95. I do not use stimulants.Do you think it would be interesting to increase nebivolol to 10mg?

 

[Ghoul]

Im taking olmesartan 20mg, anlodipine 5mg, indapamide 1.5mg and nebivolol 5mg

My blood pressure is 120/80 but my Heart rate 95. I do not use stimulants.Do you think it would be interesting to increase nebivolol to 10mg?

That would work, but Nebivolol has potential side effects (fatigue/libido).

I think (based on what you've said, I don't know what other factors may be involved) this is reflex tachycardia. IE, drop in BP triggering a rise in heart rate,

Not sure where you are, but if you can get Cilnidipine (cheap from India pharma) replacing Amlodipine with it should drop RHR by 12-15, and actually lower overall side effect risk from where it is now. It'll also provide significant kidney protection, and blunt stress related spikes in BP. It's superior to Amlodipine in every way, including nearly eliminating the risk of leg edema developing that Amlodipine tends to cause over time.

10mg Ciln is equal to 5mg Amlodipine for BP reduction, but you may want to plan for titrating to 20mg, since that'll lower RHR further, provide more kidney protection, and only drop BP down to approx 167/77, so no risk of hypotension.

 

[gilmarpersonal]

That would work, but Nebivolol has potential side effects (fatigue/libido).

I think (based on what you've said, I don't know what other factors may be involved) this is reflex tachycardia. IE, drop in BP triggering a rise in heart rate,

Not sure where you are, but if you can get Cilnidipine (cheap from India pharma) replacing Amlodipine with it should drop RHR by 12-15, and actually lower overall side effect risk from where it is now. It'll also provide significant kidney protection, and blunt stress related spikes in BP. It's superior to Amlodipine in every way, including nearly eliminating the risk of leg edema developing that Amlodipine tends to cause over time.

10mg Ciln is equal to 5mg Amlodipine for BP reduction, but you may want to plan for titrating to 20mg, since that'll lower RHR further, provide more kidney protection, and only drop BP down to approx 167/77, so no risk of hypotension.

I can't buy Cilnidipineand Telmisarta..

Do you think this combination would be bad olmesartan 20mg, amlodipine 5mg, nebivolol 5mg and Doxazosin 2mg

That would work, but Nebivolol has potential side effects (fatigue/libido).

I think (based on what you've said, I don't know what other factors may be involved) this is reflex tachycardia. IE, drop in BP triggering a rise in heart rate,

Not sure where you are, but if you can get Cilnidipine (cheap from India pharma) replacing Amlodipine with it should drop RHR by 12-15, and actually lower overall side effect risk from where it is now. It'll also provide significant kidney protection, and blunt stress related spikes in BP. It's superior to Amlodipine in every way, including nearly eliminating the risk of leg edema developing that Amlodipine tends to cause over time.

10mg Ciln is equal to 5mg Amlodipine for BP reduction, but you may want to plan for titrating to 20mg, since that'll lower RHR further, provide more kidney protection, and only drop BP down to approx 167/77, so no risk of hypotension.

I searched in my country, but cilnidipine is not available and they do not allow imports. Do you have any other suggestions? Thank you.