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Can Atenolol And Digoxin Cause Decreased Heart Rate?
Question: Regarding my mother. Active 96 year old lives alone on family farm. Drives to town, (until very recently) gets own groceries etc. suffers from arthritis, A -Fib, high blood pressure. In past 6 months, quality of life has declined , possibly in part to over medication? Had an incident of severe A-fib three months ago, hospitalized for two days, discharged to home with new additional medications. Her main complaints can best be described by reading the list of side effects of the meds she is on. They include tiredness, loss of appetite, dizziness, light headed or faint feeling, "shakiness", confusion or inability to concentrate, occasional blurred vision. Her blood pressure varies widely, (190/90 to 90/52). She has consulted with her family practice doctor several times, being told that she just needs to "get used to the meds". And to only take the most recent addition (prozosin) once daily instead of twice. After some research, I am concerned that the meds she is prescribed are interacting or over medicating her for some issues? Should we be concerned about this and what course should we take?
She is on: Atenolol, Benazepril, Ranitidine, Isosorbide, Digoxin, Furosemide, Prozosin(after recent hospitalization).
Thank you
She is on: Atenolol, Benazepril, Ranitidine, Isosorbide, Digoxin, Furosemide, Prozosin(after recent hospitalization).
Thank you
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern and would like to explain that at your mother's age it is quite easily possible to encounter adverse medication effects; as the overall metabolism is slowed down and several body system dysfunctions may be present.
I would explain that Atenolol and Digoxin may increase their effects by pharmacodynamic synergism, which may lead to severe bradyarrhythmia and serious life-threatening interaction.
Also Prazosin, Benazepril and Atenolol exert important interaction with each others, leading to potentially serious hypotensive effects.
Remember that your mother is taking five drugs with antihypertensive properties (Atenolol, Benazepril, Isosorbite, Prazosin, Furosemide), so a daily dose adjustment and a careful scheduled regimen of dose fractioning is very important.
I would recommend avoiding from taking Prazosin, as here is a high risk of orthostatic hypotension in advanced age. Instead, more safe alternatives should be sought (adjustment of other existing drugs or addition of a low dose calcium channel blocker).
If Prazosin remains a necessary alternative it is strongly recommended to take it quite apart from Benazepril to avoid an exaggerated hypotensive response.
Kidneys and liver function tests should be done to rule in/out possible underlying dysfunctions, which could be responsible for increased adverse effects of digoxin, Benazepril.
Also blood electrolites should be periodically checked to avoid an important dyskalemia (which could lead to digoxin toxicity).
Thyroid function tests should be performed to exclude any underlying dysfunctions (and consequently any possible triggers for hypertension).
If renal dysfunction is present, digoxin should be totally avoided from therapy.
At the end, my advice is to closely monitor her blood pressure values for a couple of days (several times daily); write them down and discuss with her attending physician about the above mentioned issues, to find a better and more safe strategy for her high BP monitoring.
If after a good BP balance, her complains keep persisting, then a comprehensive neurological status evaluation by a neurologist should be performed (to identify also potential atrial fibrillation implication in any possible cardio-embolic events).
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern and would like to explain that at your mother's age it is quite easily possible to encounter adverse medication effects; as the overall metabolism is slowed down and several body system dysfunctions may be present.
I would explain that Atenolol and Digoxin may increase their effects by pharmacodynamic synergism, which may lead to severe bradyarrhythmia and serious life-threatening interaction.
Also Prazosin, Benazepril and Atenolol exert important interaction with each others, leading to potentially serious hypotensive effects.
Remember that your mother is taking five drugs with antihypertensive properties (Atenolol, Benazepril, Isosorbite, Prazosin, Furosemide), so a daily dose adjustment and a careful scheduled regimen of dose fractioning is very important.
I would recommend avoiding from taking Prazosin, as here is a high risk of orthostatic hypotension in advanced age. Instead, more safe alternatives should be sought (adjustment of other existing drugs or addition of a low dose calcium channel blocker).
If Prazosin remains a necessary alternative it is strongly recommended to take it quite apart from Benazepril to avoid an exaggerated hypotensive response.
Kidneys and liver function tests should be done to rule in/out possible underlying dysfunctions, which could be responsible for increased adverse effects of digoxin, Benazepril.
Also blood electrolites should be periodically checked to avoid an important dyskalemia (which could lead to digoxin toxicity).
Thyroid function tests should be performed to exclude any underlying dysfunctions (and consequently any possible triggers for hypertension).
If renal dysfunction is present, digoxin should be totally avoided from therapy.
At the end, my advice is to closely monitor her blood pressure values for a couple of days (several times daily); write them down and discuss with her attending physician about the above mentioned issues, to find a better and more safe strategy for her high BP monitoring.
If after a good BP balance, her complains keep persisting, then a comprehensive neurological status evaluation by a neurologist should be performed (to identify also potential atrial fibrillation implication in any possible cardio-embolic events).
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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