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My partner's Consultant has taken him off the Ramipril because he was having a persistent cough at night, chest pains and back pains.
No alternative is being offered at the moment and given that his ESRD was attributed to malignant high bp (cause unknown) I am anxious at the Consultant's attitude of 'well you're having your bp checked three times a week at dialysis if it rises again we'll try something else ' !
Talk about play with fire, do these consultants not check the previous history of each patient? I worry about my bf so much and the 'suck it and see' approach worries me even more, has anyone else experienced this with their 'professionals'?
The first suggestion I'd make is to get your partner to ask the consultant the logic behind not assigning him to an alternative therpay. I'm sure there is a straight forward clinical reason. It just isn't apparent.
Whilst there are a vast swathe of anti-hypertensives out there, there are really only three groups - Beta-blockers, ACE inhibitors and AIIR antogonsits. Persistent dry cough is a well known side-effect of ACE-inhibitors (Ramipril is in this group) and the same effect would most likely be experienced if he was switched to a different ACE-inhibitor (so that rules out a lot - Captopril, Lisinopril, Cilazapril, Perindopril... and any others that you've heard of which mostly end in "pril"). So in one fell swoop that cough has seriously restricted the docs available meds. Beta-blockers are fairly numerous, but they themselves have reasons they shouldn't be given (they can cause serious problems in asthamtic patients, for example). AIIR antogonist are sometimes given to patients who can't have ACE inhibitors, as they don't cause the cough, but again they have reasons they shouldn't be given, and side effects that could make things worse. As you can see, it only takes a few factors to rule all three types out, and therefore all antihypertensive drugs.
It might simply be the case that your boyfriend is in a situation where no hypertension control is the lesser of two evils. And the "we'll see how it goes" is simply to make sure that situation stays the same. If his BP got worse, and suddenly the benefit of redcuing his BP outways the reasons for not giving, e.g. Beta-blockers, changes, then I'm sure they would address that.
Having said that I'm NOT medically trainined (I work in the clinical industry and after 15 years you pick up a lot of stuff, but I'm no doctor...) - so please take the above as intended - well intended advice. But get your boyfriend to ask his clinical team. If nothing else, at least it'll put both your minds at rest to know there is a reason, and you're not simply being ignored.
He is more laid back about it than me for sure ! He is also on Amlodipine and Bisoprolol Fumarate ( I think that's what they are called ) but I don't know exactly what their function is. If they are bp meds then maybe the ramipril cessation will not have any effect on him (only relief of side effects), I just can't help worrying
When he goes for dialysis tomorrow I will ask him to get the nurses to explain what all his drugs do ( the alfacalcidol and phosphate binders are quite specific) so that we both understand what role they play in his treatment.
I take 10mg of Ramipril every evening on top of 10mg Amlodipine and 4mg of Doxazosin in the morning and 2mg in the evening and luckily I have not seen any of the mentioned side effects.
I was put onto Ramipril to try to reduce a BP of 160/100 average that has not come down since dialysis started, the addition of the Ramipril just seems like an idea to make my pharmacist a richer man, it has done nothing to my average BP level. I am going to question the need for this and also Amlodipine as this can help the body retain fluid, could be the source of my high BP although I am pretty close to my dry weight! Its a balancing act the doctors have to play...unfortunatley its the patient who sort of suffers through confusion and sometimes feeling unwell.
Now 35 with Alports and I had my first kidney-versary 18th feb 2013....I hope to have many more.
My living donor and his family are doing all well.
Bisoprolol is one of the class called beta-blockers I mentioned. Pretty much anything ending in "olol" is a beta-blocker. I can't remember precisely what Amlodipine is, but I know a lot of cardiac patients take it as well. So it sounds like he's well covered even without the Ramipril
Wow thanks peeps you've really helped to put my mind at rest.
He seems to be ok but the cough hasn't gone yet, it must take a few days to get the drug out of his system.
When he 'crash landed' his bp was well over 200 top and bottom ! So this is why I am concerned when they tinker with the meds, that was one scary time for us.
I was on Amlodipine and Ramipril - but got the cough, not too bad - more an irritation, especially as I was singing in a choir and had to sit quietly on stage behind an orchestra, so dry coughs not welcome at all! I was switched from Ramipril to Irbesarten, and the cough disappeared pretty quickly.
After a while (a year or 2) my BP was consistently lowish, so I stopped the Irbesarten, though it's recently increased again, so back onto that, and a higher dose of Amlodipine - am definitely noticing the fluid retention happening from that - very stocky ankles every night with a big groove where the top of my socks have been.
