Changing meds---equivalences.

[Titch]

Originally Posted by johnep

I have tried to get reasessment and perhaps changed to a calcium antagonist but Drs won't change while BP controlled.

If irbesartan much more expensive then that could be a reason for change.
johnep

Based on current prices you can have a year of amlodipine 10mg for less than one month of irbesartan 300mg.

Assuming from your post you are actually on individual irbesartan, hydrochlorothiazide and indapamide?
If yes - what strengths for the latter 2 - cannot consider switch suggestions without all info....

[Jeff]

Originally Posted by johnep

Ok. I am on irbesartan 300mg/hydrochlothiazide and would like to have something a bit more potent so mgm dose could be reduced. What do I suggest to my GP?
johnep

Eh? You mean that you would be happier taking 30mg of something different rather than 300mg of irbesartan just because it's a lower number?

So that means that diclofenac 50mg is preferable to paracetamol 500mg?

I don't get it

Jeff

[johnep]

Hydrochlorothiazide content in co-aprovel is 12.5mg. indapamide dose is 2.5mg . Whatever they do to my BP, neither seem to act as diuretics as frequently stay at dispensing bench all morning.

Theory that lower dose might be fewer side efects based on the idea that side effects can be due to therapeutic action or simply to the actual molecule.

Eg the original diuretic Saluric was a 500mg dose and closely related to the sulphonamides with associated side effects, hydrosaluric was 50mg dose and standard dose of bendro was originally 5mg. Along the way the sulphonamide side effects were lost.

That is why I got changed from 50mg atenolol to 5mg bisoprolol.

weight for weight frusemide has fewer side effects than bumetanide but as the dose of bumetanide is 1mg, then side effects due to the actual molecule are very much reduced.

With regard to paracetamol and diclofenac, then different things entirely.

Classic example of a side effect that developed into different area was the observation that pts became euphoric on isoniazide. The tuberculostatic iproniazide 'marsilid' was an early MAOI. Roche developed this into isocarboxazide 'Marplan', but this was superceded by phenelzine 'Nardil' which is only surviving MAOI left.

I have forgotten the details, but the progression from antihistamines to the tricyclics and amitryptyline was a similar process I believe.

All known as 'molecular manipulation' in the old days.

consider the following: nicotinamide (vitamin), nicotinic acid (vasodilator)
isonicotinyl acid hydrazide (isoniazide tuberculostatic), iproniazide (tuberculostatic and maoi), isocarboxazide (maoi), procarbazine (cytotoxic)

all related chemically. I expect the molecular chemists can give other examples.
johnep