ACE Inhibitors

[francie12]

I just read with interest the thread on Beta Blockers. I would be interested in any similar info on ACE Inhibitors and other's experience with them, side-effects, etc. Matt is just starting on Lisinopril, 5 mg to start and going up 5 mg every two weeks until he reaches 20 mg. The benefits of this medication seem obvious, but I'll be nervous until I see that he tolerates it well. Thanks everyone.

 

[Yaps]

here ya go

here ya go

GENERIC NAME: lisinopril
BRAND NAME: Zestril, Prinivil
DRUG CLASS AND MECHANISM: Lisinopril is an angiotensin converting enzyme (ACE) inhibitor. Angiotensin is a chemical that is made by the body continuously. It narrows blood vessels and thereby maintains (elevates) blood pressure. When the enzyme is blocked by lisinopril, angiotensin cannot be converted into its active form. As a result, blood pressure falls.

Interestingly, lisinopril and other ACE inhibitors were developed from the venom of a poisonous Brazilian snake.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: 5mg, 10mg, 20mg, and 40mg oral tablets.

STORAGE: Lisinopril should be stored in a dry place at 15-30°C (59-86 °F).

PRESCRIBED FOR: Lisinopril is used to treat elevated blood pressure and heart failure.

DOSING: Lisinopril should be taken at doses specifically directed by the physician. Lisinopril can be taken with or without food. Lisinopril should be taken at the same time each day to maintain consistent blood levels. Lisinopril should not be taken within two hours of taking an antacid since the antacid binds lisinopril and prevents its absorption. Lisinopril is often tapered when discontinuing.

DRUG INTERACTIONS: First doses of lisinopril or any ACE inhibitor should be taken under observation if the patient also is taking diuretics (water pills). In such patients, blood pressure can drop quickly (though this is unusual).

In general, lisinopril should not be taken with potassium supplements or diuretics that conserve potassium, e.g., Dyazide, since blood potassium levels may rise to dangerous levels.

PREGNANCY: Lisinopril should not be taken during pregnancy.

SIDE EFFECTS: First doses of lisinopril can cause dizziness due to a drop in blood pressure. Lisinopril should be stopped if there are symptoms or signs of an allergic reaction including feelings of swelling of the face, lips, tongue or throat. Severe allergic reactions (anaphylaxis) and hives occasionally occur.

An uncommon but dangerous side effect is a drop in the white blood cells which fight infection. Cough is a known side effect of this drug.

Lisinopril can impair the function of the kidneys, and every person taking this medication should have their kidney function checked. Lisinopril rarely can cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction.

 

[Barry]

I take Enalapril, another ACE inhibitor. Only side effect I get is the cough - and it is sometimes really really annoying.

 

[francie12]

Thanks so much, Yaps and Barry, for the info. It makes a great deal of difference to hear someone's personal experience. You filled in some info not even contained on the pharmacist's fact sheet and very pertinent to our situation. Matt takes antacids of various types on an almost daily basis and no one has brought up the interactions with ACE Inhibs. So glad you responded. Matt loves the poisonous snake origins!!

 

[gijanet]

Just saw this.........

Just saw this.........

Katie has been on captopril for over three years now. Since Katie is only four, I am not sure that we would know any mundane, annoying type side effects. She did have the captopril dry hack the first few months she was on it, but that subsided. She is a bundle of energy, so it doesn't seem to have slowed her down any. She doesn't get sick very often, but when she does, it does seem to last about twice the average duration (ie, last ear infection we had to do two courses of antibiotics as opposed to one for most kids). Course this might be due to her lowered oxygen sats and polysplenia as opposed to the captopril. WEll, now that I look back on my response, I haven't helped much at all, but since I typed it up, I'm sending it anyway. If you have any more questions that I can't answer, please feel free to give me a shout. Hugs. Janet

 

[ALCapshaw2]

Welcome Francie,

I developed a persistent dry cough about 3 months after starting Zestril. My cardiologist switched me to Cozaar (another ACE inhibitor) and the cough went away in another week or two.

Does your son have Acid Reflux Disease (a.k.a. Gastro Esophageal Reflux Disease or GERD)? If so, he should probably be put on Nexium or Prilosec for better control. Pepcid 'may' control milder cases. In any event, he should be evaluated for GERD by a knowledgable Internist or GI doctor.

'AL Capshaw' (another GERD sufferer)

 

[geebee]

WEll, now that I look back on my response, I haven't helped much at all, but since I typed it up, I'm sending it anyway. If you have any more questions that I can't answer, please feel free to give me a shout. Hugs. Janet

Janet,

Every website should have at least one member to go to when we don't want questions answered. (That's a joke everyone).

Seriously, you are always there to help people and your Katie stories more than make up for any questions you can't answer.

 

[gijanet]

Heehee! Thanks, Gina...........

Heehee! Thanks, Gina...........

not to steal this thread, but I needed a laugh! And awwwwwwwww, shucks! on the rest. You make me blush. And seriously, Francie, the offer still stands. There are lots more things I don't know anything about. Hugs to all. Janet

Janet,

Every website should have at least one member to go to when we don't want questions answered. (That's a joke everyone).

Seriously, you are always there to help people and your Katie stories more than make up for any questions you can't answer.

 

[Georgia]

I started with Mavik (ACE inhibitor) after surgery; requested a change to a generic when our copay increased. Got Lisinopril and got the dreaded dry cough. After about 4 months, I changed back to Mavik, which doesn't make me cough.

If Matt gets the cough, be sure to request a change to another brand - he'll probably be able to find one that doesn't make him hack incessantly.

 

[Emma]

Chloe took captopril for a while before her replacement and had the evil, dry, hacking cough side effect of it but now takes enalapril with no side effects at all.

Emma
xxx

 

[Harpoon]

Been on lisinopril even before my valve job. I spend a few months on another ACE inhibitor (I can't recall the name) but got off it because the cough didn't change and it was WICKED expensive for someone without prescription coverage...

Diovan, that's what it was.


The cough comes and goes, usually it's worst at night when I'm trying to get to sleep. A sip of a beverage or a cookie or a piece of chewing gum is usually enough to quash it.

On occassion I've also tried spicy foods.

I've also got the acid reflux and I'm on Prilosec OTC for that so it's hard to say sometimes if the cough is from the lisinopril, the acid reflux, or a CHF related cough.

 

[francie12]

Thanks, guys

Thanks, guys

Janet and Gina--Thanks for the info and even more for the laughs! I don't know about anyone else, but the stories and jokes and asides you guys tell are just as important to me as the factual advice. They seem to put things in perspective, which is just what I need! I feel like I owe most of my understanding and acceptance of Matt's situation to coming here and seeing how all of you handle everything. By the way, that is an unbelieveably cute picture of Katie!

Thanks, Al--Yes, Matt does have GERD. He has been on Nexium for a couple of months and is now back to Prilosec OTC. He goes back to the peds GI specialist in a couple of weeks. Is it my imagination or do alot of people with valve problems also have acid reflux problems? Maybe it's just a high percentage of the general population that suffer from this, valvers included. It's just that after 12 healthy years, it seems like such a coincidence that Matt's murmer was finally noticed within weeks of the onset of acid reflux. (it wasn't anxiety related--he has never been anxious about the heart thing) Someone awhile back said that their long-standing GERD went away after their valve replacement. Interesting.

Georgia and Emma--Thanks for the good info on switching types of ACE Inhibs. Hope we are the lucky ones without the cough, but glad to hear there is "wiggle-room."

Harpoon--Good tips on dealing with the possible cough. I'm putting Diovan on the "avoid if poss." list. Good luck with the acid reflux. It's a bear.

All the best, Jane (Francie is my airedale terrier )

 

[Harpoon]

...Is it my imagination or do alot of people with valve problems also have acid reflux problems? Maybe it's just a high percentage of the general population that suffer from this, valvers included. It's just that after 12 healthy years, it seems like such a coincidence that Matt's murmer was finally noticed within weeks of the onset of acid reflux. (it wasn't anxiety related--he has never been anxious about the heart thing) Someone awhile back said that their long-standing GERD went away after their valve replacement. Interesting....

I suspect (and this is MERELY a highly suspicious conjecture at best based on my own experiences and the limited reading on the subject in here) that the high incidence of acid reflux among valvers is two fold:

A) We've all (post-op people anyways) have been on a vent for at least half a day, some MUCH longer...

B) We've all (most of us anyways) have been on a variety of medications for a long time (some years, some a lifetime) and that's gotta have something to do with how well the stomach processes acids and how that hipoglottis or whateverthehelltheycallit valve between the bottom of the esophagus and the entrance to the stomach functions.


At least that seems to be the case in my case. Granted, the trach tube isn't supposed to go down that far (or even down that pipe!) but being on it for an extended period does some weird things in weird places and I wouldn't be suprised if acid reflux is listed as one of the many side-effects of being intubated for extended periods of time.


In addition, at least in my own experience, one of the "happy" side-effects of fluid retention was a LOT of basically regurgitation of fluids and (sometimes) food...

Eeewww... I know, that's not pleasant, but it happens to some of us at least, I doubt I was the only one since it was a clear sign to my cardiologist that I NEEDED to be evaluated in Cleveland ASAP.

Well, if you're doing that, you're also kicking acid back up through the esophagus and that's acid reflux in a nutshell.


I don't think you can put heart conditions and acid reflux together hand in hand as if to say if you have one you probably have the other. I think having a heart condition and receiving certain treatments for it (medical or surgical) can lead to problems like acid reflux.


I personally may have something of a predisposition to it as well. My mom has acid reflux (she takes Pepcid as I recall, and watches her diet better than I do 'cause she has better self-control than I do) she doesn't have any form of heart condition, never has.


I wanted to ask, besides possibly cost (I understand Nexium is more expensive) what made you switch back to Prilosec? My ENT has brought up trying Nexium once or twice and I'm considering it, though I don't care for the increased expenses involved. I pay way the hell too much now for my meds every month.

 

[ALCapshaw2]

Re: GERD treatment

My Gastroenterologist has some tear-off sheets with a list of things to do / not do if you have GERD.

These include:

Avoid CAFFEINE* (coffee, tea, soft drinks such as colas, Mellow Yellow, etc...read the label!)

Avoid mints / peppermint* / peppermint gum

Limit tomato products

Do NOT wear TIGHT Pants (around the waist).

Elevate the head of his bed 6 to 8 inches.

OTHERS (that I have forgotten).

* Caffeine and peppermint cause the Lower Esophageal Sphincter to relax and allows stomach acid to 'come up' into the esophagus. Continuous and/or repeated incidents can irritate the esophagus and eventually lead to more serious issues (such as cancer of the esophagus... NOT GOOD).

'AL Capshaw'

 

[gijanet]

You're welcome..........

You're welcome..........

Janet and Gina--Thanks for the info and even more for the laughs! I don't know about anyone else, but the stories and jokes and asides you guys tell are just as important to me as the factual advice. They seem to put things in perspective, which is just what I need! I feel like I owe most of my understanding and acceptance of Matt's situation to coming here and seeing how all of you handle everything. By the way, that is an unbelieveably cute picture of Katie!

All the best, Jane (Francie is my airedale terrier )

and I have tons more pics if you want to see them...... kidding! Just my two cents - and you know what that's worth but I think GERD goes hand-in-hand with CHF period - at least in kids. This is a subject that is repeatedly brought up in my ped CHD support group as most of our heart kids have suffered from GERD at various stages of their lives. Katie was on Reglan and Zantac the first two years. It was so bad at one point early on that they were threatening us with a surgery called the fundoplication, which wraps part of the stomach around the esophogus...........ugh! We fought that one tooth and nail............and finally won. I would not be surprised if Matt's GERD goes away after his repair/replacement procedure. Good luck on all in the meantime and please keep us posted. Hugs. J.

 

[francie12]

Gerd

Gerd

Harpoon--Your conjectures about the vent and meds make alot of sense. Janet's post does make me think that peds issues may be different from , especially for kids who haven't yet had surgery or meds.

****Janet--How do I find your peds suport group?****

We switched from Nexium to Prilosec OTC for financial reasons but were happy to find that the dizziness side-effects caused by the Nexium did not happen with the Prilosec. The two medications have similar effectiveness for Matt's GERD (they help alot, but do not completely cure the problem )

Thanks, Al--We're doing most of these--will lose the peppermint now too!

 

[gijanet]

Just sent a post, but it is lost in cyberspace......

Just sent a post, but it is lost in cyberspace......

Harpoon--Your conjectures about the vent and meds make alot of sense. Janet's post does make me think that peds issues may be different from , especially for kids who haven't yet had surgery or meds.

****Janet--How do I find your peds suport group?****
!

Hmmmmmmmmmm.............scratches head and looks dumb . Anyway, trying again. My fav is PDHeart at www.tchin.org. Costs $20 a year, but they will waive it for financial hardship. There is another good one at Yahoo. CHD Families. But it is a very busy group. I rarely post there as it is just too voluminous for me. Here is a link to a previous thread on this (read that as I am too lazy to type them all in)

http://www.valvereplacement.com/forums/showthread.php?t=9940

Hope to see you on one soon. Hugs. J.

 

[Debbrn]

I have been on enalapril for a few years. I take 5 mg twice a day. (A relatively low dose). I have "repaired" Tetralogy of fallot with mild left ventricle dysfunction. My cardio put me on it to help protect the left ventricle. I currently am having very few side effects. At first he had to increase the dose very slowly because of lightheadedness that I was having. At the time I was on an antidepressant that seemed to interact with enalapril. After I came off of the antidepressant he was able to up the dose.

Debbie

 

[SHerrin Hutt]

I am allergic to bata-blocker so I they have tried many others on me because I have uncontrolable B/p since 1992. I have been on lisinopril for my OHS in 2002. So far I haven't had any problems.