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Suggest Safe Antidepressants For An Elderly Person

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Posted on Tue, 22 Mar 2016
Question: I am 73 years old and have been on anti hypertensives for 50 years - currently I'm on Celol 200mg, Candesartan 16mg and bendrofluazide 5mg per day. I read that these should be given with caution in the elderly, and Celol taken long term causes side effects. I think that some of my current symptoms may be due to these tablets. I would like to have a reassessment of my medications. Please could you advise if you think this necessary.
doctor
Answered by Dr. Priyank Mody (1 hour later)
Brief Answer:
Careful monitoring wd be more wiser than changing. Let me know exact sympto

Detailed Answer:
Hello , I am Dr. Mody and I would be addressing your concern.

As I start I would like to know the symptoms you are facing so I can determine if they are due to medication and if yes , which is the culprit and hence balance out risk / benefit for each medication for you .

So please do send me all the symptoms you have .

Now as you are very right that some medication can cause more side effects in elderly as the metabolism and particularly the kidney and liver function changes with age , however I am of a strong belief that as you have been taking the medication for 50 long years sudden changing is NOT wise , rather more frequent monitoring of the side effects should be done to prevent any future untoward event and substitute one only if that is the reason of all your symptoms.

1) celol is heart selective beta blocker so all the side effects you read are not commonly seen with it .

However you may feel more tired , libido may decrease as a common problem. Hence keeping a tab on your pulse rate and checking sugar every 6 months is justified.

2) The bendrofluazide is a diuretic and is notorious to cause depletion of sodium and potassium and increase your uric acid leading to subtle cognitive slowing , gait disturbance ( low sodium ) , muscle pains ( low potassium ) and joint pain ( uric acid ) , do every 3 monthly check creatinine, electrolytes and uric acid .

3) Candesetran may increase potassium and effect your kidney status , however it's most safe acid nd effective medication of the three .

Every drug has listing of loads of side effects however it's present in less than 1 % of patients taking them .

So according to your symptoms we can change the culprit medication after evaluation and ruling out other cause and add calcium channel blockers which would be very safe at your age and efficacious.
Let me know the symptoms and I would advice like wise .

Any clarification needed , I would be happy to help .

Regards
Dr Priyank Mody

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Priyank Mody (47 hours later)
Thank you for your reply. As I mentioned I have had Essential Hypertension (familial/genetic) for 50 yrs, and been on various medications over this time. I have been on the current ones mentioned previously for approx. 15 yrs (+ levothyroxine) During this time I have been diagnosed with Senear Usher syndrome + Lichen Planus (autoimmune) During the past 2 years I have started having other relatively minor symptoms - Rhinitis with blocked nose nocte and disturbed sleep - cough from mucus and occasional earache - swollen ankles (non pitting) - tinnitus - peripheral neuritis in feet (making walking slow and laboured) - joint pain (not too severe), and most recently dizziness which I'm told is BPV. These symptoms which keep appearing make me suspicious of medication as I grow old - or do I just have to accept that they are solely due to my advanced age? I used to have both systolic + diastolic raised, but now my diastolic reads between 70 and 85 but my systolic fluctuates between 145 and 160. I have to keep my walks short now, but I go to Modified Yoga and basic Tai Chi classes each week. I would appreciate your comments.
doctor
Answered by Dr. Priyank Mody (24 hours later)
Brief Answer:
Changing BP medication is not justified in your case

Detailed Answer:
Hello ,
I would enumerate my observations.
1) As I said I am not defending the fact that the blood pressure medication may have side effects , however considering your systolic blood pressure is still high and so continuation is justified and even the other medication for blood pressure will have its own drawbacks and considering your body system has accommodated with the present medication for 50 years changing is on basis of the symptoms you have mentioned is not a good option .
2) The difference between the systolic and diastolic BP id very common in older age group as the elasticity of the arteries decrease , however it will not cause any problem and rather is an adaptive phenomenon so blood reaches the exercising muscles more effectively.
3) The disturbance in sleep and cough may be because of post nasal drip due to rhinitis .
No medication you are on causes rhinitis
4) The joint pain and peripheral neuritis may be the result of autoimmune syndrome you have been diagnosed.
Rather sometimes there are chances of kidney involvement loss of protein which will be taken care of by candesartan.
5) long term celiprolol , if we suddenly stop they will be reflex increase in your heart rate and blood pressure which can be detrimental.
6) diuretic in older age may cause electrolyte imbalance which is even more significant I'd the skin involvement in usher syndrome is large .
One may add CCB like amlodipine to control the blood pressureand may replace the diuretic with the same.
Lastly the decrease in exercise capacity may point towards and underlying heart condition, an echocardiography and treadmill test would help us in its evaluation.
Let me know if any clarification needed furthur and I would be happy to help .
Do rate for other pals reference
Regards Dr Priyank Mody
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 918 Questions

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Suggest Safe Antidepressants For An Elderly Person

Brief Answer: Careful monitoring wd be more wiser than changing. Let me know exact sympto Detailed Answer: Hello , I am Dr. Mody and I would be addressing your concern. As I start I would like to know the symptoms you are facing so I can determine if they are due to medication and if yes , which is the culprit and hence balance out risk / benefit for each medication for you . So please do send me all the symptoms you have . Now as you are very right that some medication can cause more side effects in elderly as the metabolism and particularly the kidney and liver function changes with age , however I am of a strong belief that as you have been taking the medication for 50 long years sudden changing is NOT wise , rather more frequent monitoring of the side effects should be done to prevent any future untoward event and substitute one only if that is the reason of all your symptoms. 1) celol is heart selective beta blocker so all the side effects you read are not commonly seen with it . However you may feel more tired , libido may decrease as a common problem. Hence keeping a tab on your pulse rate and checking sugar every 6 months is justified. 2) The bendrofluazide is a diuretic and is notorious to cause depletion of sodium and potassium and increase your uric acid leading to subtle cognitive slowing , gait disturbance ( low sodium ) , muscle pains ( low potassium ) and joint pain ( uric acid ) , do every 3 monthly check creatinine, electrolytes and uric acid . 3) Candesetran may increase potassium and effect your kidney status , however it's most safe acid nd effective medication of the three . Every drug has listing of loads of side effects however it's present in less than 1 % of patients taking them . So according to your symptoms we can change the culprit medication after evaluation and ruling out other cause and add calcium channel blockers which would be very safe at your age and efficacious. Let me know the symptoms and I would advice like wise . Any clarification needed , I would be happy to help . Regards Dr Priyank Mody