Questionmy husband had somewhat high blood pressure and was put on
Lotrel....he is suffering terribly from reflux and feels uneasy in his
gut...has put on some weight and feels full all the time....he is not
over weight and takes no other meds...i am wondering if the Lotrel
could be causing the reflux...the doctor has evaluated him and said
he is fine but he is miserable especially at night....the timing of
things points to the Lotrel but doctor says no.... i am tempted to
tell him to discontinue and see if there is improvement..do you
think Lotrel can be behind the reflux and GI disturbances?
AnswerHello Dawn,
Lotrel is a combination agent, consisting of benazepril (an ACE inhibitor) and amlodipine (a calcium channel blocker).
Typically these two agentsare not implicated in gastro- esophageal reflux. Individually the incidence is quite low with amlodipine, having 1 to 2% patients with dyspepsia, benazepril had 0%.
The most common side effects of Lotrel are cough, elevated blood potassium levels, low blood pressure, dizziness, headache, drowsiness, weakness, abnormal taste (metallic or salty taste), and rash. It may take up to a month for coughing to subside, and if one ACE inhibitor causes cough it is likely that the others will too.
Having said all that, I tend to agree with you. It sounds like there is a cause and effect relationship here. And despite the percentage is reported by the drug manufacturers, and it's entirely possible that it this medication is causing the side affecting your husband.
The good thing about GERD, is that it's relatively easy to treat in that patience gets significant relief from a very bothersome syndrome. These days, I don't even bother with the antihistamines and go straight to the proton pump inhibitors such as omeprazole or Prevacid. There is one the date of behavior modification that has profound impact on GERD, and that is smoking cessation. I don't know if your husband smokes, but a lot of times when smokers are describing their GERD. It's worse at night. This is because smoking decreases the tone of the lower esophageal sphincter muscle thereby allowing acid to reflux up into the esophagus and result in symptoms that are worse at night.
If you do choose to start a PPI therapy remember that it takes a few days to reach maximum efficacy. These medications work at an intracellular level to block the production of acid, where it is produced. It may take a few days, but once the acid production is suppressed it will remain suppressed. Clearly he will get some relief from this course of therapy. The other convenient thing about PPI therapy, is that it's now over-the-counter. Prilosec would be my choice at 20 mg a day.
Good luck, and thanks for your patience.
Dr. T.
