Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 In a message dated 8/23/04 10:44:03 AM, wbongianni@... writes: Gloria: Spiro blocks all the mineracorticoids. Not just aldosterone. In men this leads to brest enlargment, and attendent pain. In women, this leads to breakthru bleeding. Wayne Please review spiros effect on the testosterone/estrogen receptors. This is where spiro generates sex hormone these side effects. They are not due to mineralocorticoid blockade. May your pressure be low! Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD Professor of Medicine and Epidemiology Medical College of Wisconsin Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Gloria: Spiro blocks all the mineracorticoids. Not just aldosterone. In men this leads to brest enlargment, and attendent pain. In women, this leads to breakthru bleeding. Wayne > I've been reading up on this condition and the treatments > recommended. On one web site I read that some patients can't > tolerate treatment with spiro....they didn't go on to say why. What > are the disadvantages and side effects of treatment with spiro? > > Thanks, > Gloria Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 HI If I had a reaction to Inspra (terrific headache, drunken feeling, some facial swelling, liquid retention, cardiac irregularity malaise) and was also taking the meds : Inspra 25mg. (NEW—1st dose, 8-21) Lisinopril 20mg 20mg Ameloride 5mg 5mg (down from 10/10mg on 8-20) Atenolol 12.5mg 12.5mg Clonazepam 0.125mg 0.125mg Nasacort 2 puffs @ bedtime w/saline cleaning 1st Spiriva 18mcg 1 inhalation capsule Clonidine patch, 10mcg/day/week's in-vivo and had a climbing aldo/renin ration on one remaining adrenal, what might this portend? Time for some latest testing at UCSF? Any comment appreciated Thanks, Dave > > In a message dated 8/23/04 10:44:03 AM, wbongianni@y... writes: > > > > Gloria: > > Spiro blocks all the mineracorticoids. Not just aldosterone. > > In men this leads to brest enlargment, and attendent pain. In women, > > this leads to breakthru bleeding. Wayne > > > > Please review spiros effect on the testosterone/estrogen receptors. This is > where spiro generates sex hormone these side effects. They are not due to > mineralocorticoid blockade. > > > > May your pressure be low! > > Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD > Professor of Medicine and Epidemiology > Medical College of Wisconsin > Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Many of the meds can alter the A/R ratio and might account for the rising ratio. Whatwas the exact DX on the removed adrenal tissue? How bad does your BP get off of all drugs? In general in difficult cases we work with the local MD to taper all meds and then when off them for 2 weeks to retest. What did your BP do with Spiro?. -- May your pressure be low! CE Grim MD Clinical Professor of Internal Medicine Professor of Epidemiology Board Certified in Internal Medicine, Geriatrics and Hypertension Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Facial Swelling? On INSPRA? Shouldn't that REDUCE facial swelling? It sounds like you had an allergic reaction to the inspra or one of the fillers. By your drug list, it seems that you have an allergy/asthma problem. Man, you are on a lot of drugs... Thanks, Mike > > > > In a message dated 8/23/04 10:44:03 AM, wbongianni@y... writes: > > > > > > > Gloria: > > > Spiro blocks all the mineracorticoids. Not just > aldosterone. > > > In men this leads to brest enlargment, and attendent pain. In > women, > > > this leads to breakthru bleeding. Wayne > > > > > > > Please review spiros effect on the testosterone/estrogen receptors. > This is > > where spiro generates sex hormone these side effects. They are > not due to > > mineralocorticoid blockade. > > > > > > > > May your pressure be low! > > > > Clarence E. Grim, BS (Chemistry and Mathematics), MS > (Biochemistry), MD > > Professor of Medicine and Epidemiology > > Medical College of Wisconsin > > Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Yes Mike, it should if I had been able to take Inspra for more than a couple days. I happen to be a social science researcher who has worked on a study of healthcare provider attitudes (translate, part unconscious assumption or " doxastic knowledge, " and the other part intentional stacking of grounds to support a professional culture-based worldview) about pharmaceuticals. They have lots of benefits. Also lots of problems. Seems when you spend most of your time learning how, and then prescribing these, it becomes hard for many to even think about them causing problems OTHER than the ones familiar in the practicum. This is the old clinician vs researcher story, but interesting with physicians and their minions. They really have trouble thinking about it. More so than any other group except dentists and psychiatrists, and of course clergy. Manufacturers and reps are more aware of the interactions and side effects when tested. Hell, I have trouble and I am a researcher, supposedly on the lookout for " extraneous variables. " Obviously one of, or some combination of these meds can cause my A/R ratio to climb. The fact that when the aldo goes up, the renin does not suppress within expected parameters, and vice-versa, should be a clue. Especially when added to no scan evidence of hyperplasia or adenoma. Dr Grim's suggestion of a taper, 2 weeks off meds and retest IS the only way to be scientific about it. But my pressure will hover around 190 / 100 if I do. PROBABLY, based on earlier regimens. Thanks for making me think, Dave Original Message: >From: " lord_mike_the_great " <lord_mike_the_great@...> >hyperaldosteronism >Subject: Re: Spiro Treatment >Date: Tue, 24 Aug 2004 07:51:36 -0000 >Facial Swelling? On INSPRA? Shouldn't that REDUCE facial >swelling? It sounds like you had an allergic reaction to the inspra >or one of the fillers. By your drug list, it seems that you have an >allergy/asthma problem. Man, you are on a lot of drugs... > >Thanks, > >Mike > > > >> > >> > In a message dated 8/23/04 10:44:03 AM, wbongianni@y... writes: >> > >> > >> > > Gloria: >> > > Spiro blocks all the mineracorticoids. Not just >> aldosterone. >> > > In men this leads to brest enlargment, and attendent pain. In >> women, >> > > this leads to breakthru bleeding. Wayne >> > > >> > >> > Please review spiros effect on the testosterone/estrogen >receptors. >> This is >> > where spiro generates sex hormone these side effects. They are >> not due to >> > mineralocorticoid blockade. >> > >> > >> > >> > May your pressure be low! >> > >> > Clarence E. Grim, BS (Chemistry and Mathematics), MS >> (Biochemistry), MD >> > Professor of Medicine and Epidemiology >> > Medical College of Wisconsin >> > Board certified in Hypertension, Internal Medicine and Geriatrics > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Good question, Dr. G. The other mail answers, in part. I just spoke to the supervisor of my case and 1999 surgery (done at Alameda County Med Ctr, UC teaching hospital), and he could not recall if they took the whole right. gland, or sectioned...except that it was benign, around 1cm. I am getting the path report and balance of chart now. Believe it or not, my primary & I can't recall if I tried spiro. Get the chart. After surgery, BP dropped to 120/80 for about 5 weeks, then crept back up to 180/90. They assumed " essential hypertension. " This endo-surgeon was a friend before the case, and I trust him, but must be cautious now. He wants me to go to UCSF for advanced testing. It is the only place except Stanford where they can do vein studies and complex endo-interaction investigation hereabouts. With COPD and " apnea syndrome " (after 10-15 yrs of undiagnosed/untreated upper-10% severity apnea, autonomic " masquerading " as other diseases " ), this is, as Dr Harness said in one of his letters, " a rare and complex metabolic case... " and found me in a sort of mental-blocking state until recently when symptoms started in again. I sure wish not, Dave Original Message: >From: lowerbp2@... >hyperaldosteronism >Subject: Re: Re: Spiro Treatment >Date: Mon, 23 Aug 2004 18:57:33 -0400 > >Many of the meds can alter the A/R ratio and might account for the rising ratio. Whatwas the exact DX on the removed adrenal tissue? > >How bad does your BP get off of all drugs? In general in difficult cases we work with the local MD to taper all meds and then when off them for 2 weeks to retest. > >What did your BP do with Spiro?. > > >-- > > >May your pressure be low! > >CE Grim MD >Clinical Professor of Internal Medicine >Professor of Epidemiology > >Board Certified in Internal Medicine, Geriatrics and Hypertension > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 > " Please review spiros effect on the testosterone/estrogen receptors. This is > where spiro generates sex hormone these side effects. They are not due to > mineralocorticoid blockade. " Dr. Grim: I think we are saying the same thing in different ways. When researcher were looking for a substitute for spiro they were trying to minimize the side effects. In " Effects of Aldosterone Antagonism " , found at medscape.com/viewartical/422919-11, the research discusses the benefits of eplerenone over spiro as: 20:1 less effective in blocking mineral corticoid receptors 2000:1 less effective in blocking androgen receptors 200:1 less effective in blocking progesterone 10:1 less effective in blocking glucocorticoid If spiro blocked testosterone effectively, there would be a greater effect on libido then currently reported. I was on Lupron, for the treatment of prostate cancer, and in no way was spiro ever as potent as Lupron. The effect of Lupron on libido is profound, spiro just led to tender breasts. Wayne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Google it and read package insert then you can assess the risks for you with your Dr. May your pressure be low! Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD Professor of Medicine and Epidemiology Medical College of Wisconsin Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Lupron works in adifferrent way to increase breasts as I recall. May your pressure be low! Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD Professor of Medicine and Epidemiology Medical College of Wisconsin Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 What you want to know is: Was the adenoma like those seen in Conn's or something else? Were there other small bumps (nodular hyperplasia) in the rest of the gland. Both Stanford and USCF are top rated places and either would b excellent. I the chief of HTN at USCG could ask him who you should see. Ted Kurtz is his name. In a message dated 8/24/04 3:03:41 PM, dp@... writes: Good question, Dr. G. The other mail answers, in part. I just spoke to the supervisor of my case and 1999 surgery (done at Alameda County Med Ctr, UC teaching hospital), and he could not recall if they took the whole right. gland, or sectioned...except that it was benign, around 1cm. I am getting the path report and balance of chart now. Believe it or not, my primary & I can't recall if I tried spiro. Get the chart. After surgery, BP dropped to 120/80 for about 5 weeks, then crept back up to 180/90. They assumed "essential hypertension." This endo-surgeon was a friend before the case, and I trust him, but must be cautious now. He wants me to go to UCSF for advanced testing. It is the only place except Stanford where they can do vein studies and complex endo-interaction investigation hereabouts. With COPD and "apnea syndrome" (after 10-15 yrs of undiagnosed/untreated upper-10% severity apnea, autonomic "masquerading" as other diseases"), this is, as Dr Harness said in one of his letters, "a rare and complex metabolic case..." and found me in a sort of mental-blocking state until recently when symptoms started in again. I sure wish not, Dave Original Message: >From: lowerbp2@... >hyperaldosteronism >Subject: Re: Re: Spiro Treatment >Date: Mon, 23 Aug 2004 18:57:33 -0400 > >Many of the meds can alter the A/R ratio and might account for the rising ratio. Whatwas the exact DX on the removed adrenal tissue? > >How bad does your BP get off of all drugs? In general in difficult cases we work with the local MD to taper all meds and then when off them for 2 weeks to retest. > >What did your BP do with Spiro?. > > >-- > > >May your pressure be low! > >CE Grim MD >Clinical Professor of Internal Medicine >Professor of Epidemiology > >Board Certified in Internal Medicine, Geriatrics and Hypertension > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Other info of use is 1. did the K correctand even become transiently increased? 2. did the renin rise and the aldo fall? In a message dated 8/24/04 3:03:41 PM, dp@... writes: Good question, Dr. G. The other mail answers, in part. I just spoke to the supervisor of my case and 1999 surgery (done at Alameda County Med Ctr, UC teaching hospital), and he could not recall if they took the whole right. gland, or sectioned...except that it was benign, around 1cm. I am getting the path report and balance of chart now. Believe it or not, my primary & I can't recall if I tried spiro. Get the chart. After surgery, BP dropped to 120/80 for about 5 weeks, then crept back up to 180/90. They assumed "essential hypertension." This endo-surgeon was a friend before the case, and I trust him, but must be cautious now. He wants me to go to UCSF for advanced testing. It is the only place except Stanford where they can do vein studies and complex endo-interaction investigation hereabouts. With COPD and "apnea syndrome" (after 10-15 yrs of undiagnosed/untreated upper-10% severity apnea, autonomic "masquerading" as other diseases"), this is, as Dr Harness said in one of his letters, "a rare and complex metabolic case..." and found me in a sort of mental-blocking state until recently when symptoms started in again. I sure wish not, Dave Original Message: >From: lowerbp2@... >hyperaldosteronism >Subject: Re: Re: Spiro Treatment >Date: Mon, 23 Aug 2004 18:57:33 -0400 > >Many of the meds can alter the A/R ratio and might account for the rising ratio. Whatwas the exact DX on the removed adrenal tissue? > >How bad does your BP get off of all drugs? In general in difficult cases we work with the local MD to taper all meds and then when off them for 2 weeks to retest. > >What did your BP do with Spiro?. > > >-- > > >May your pressure be low! > >CE Grim MD >Clinical Professor of Internal Medicine >Professor of Epidemiology > >Board Certified in Internal Medicine, Geriatrics and Hypertension > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 I have had 100s of patients with difficult HTN stop their pills of Dx testing for 2 weeks and have not had any problems--but someday we may. The first VA HTN study required men to have diastolic BPs greater than 115 for 4 months before the study was started. May your pressure be low! Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD Professor of Medicine and Epidemiology Medical College of Wisconsin Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 So is Siro maybe more untolerable for men than women. Breakthru bleeding, breast enlargement and tenderness are some of the side effects that I experienced with birth control pills. Is Spiro not indicated for a women who has a high risk for developing breast cancer? Gloria > > I've been reading up on this condition and the treatments > > recommended. On one web site I read that some patients can't > > tolerate treatment with spiro....they didn't go on to say why. > What > > are the disadvantages and side effects of treatment with spiro? > > > > Thanks, > > Gloria Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 The guys at UCSF are Orlo and Quan-Yang Duh. But I will ask anyway. Thanks for the tip. Dave On Tuesday, August 24, 2004, at 06:42 PM, lowerbp2@... wrote: > What you want to know is: > > Was the adenoma like those seen in Conn's or something else? > > Were there other small bumps (nodular hyperplasia) in the rest of the > gland. > > Both Stanford and USCF are top rated places and either would b > excellent. > > I the chief of HTN at USCG could ask him who you should see. > > Ted Kurtz is his name. > > > In a message dated 8/24/04 3:03:41 PM, dp@... writes: > > > > Good question, Dr. G. The other mail answers, in part. > > I just spoke to the supervisor of my case and 1999 surgery (done at > Alameda County Med Ctr, UC teaching hospital), and he could not > recall if they took the whole right. gland, or sectioned...except that > it was benign, around 1cm. I am getting the path report and balance > of chart now. Believe it or not, my primary & I can't recall if I > tried spiro. Get the chart. > > After surgery, BP dropped to 120/80 for about 5 weeks, then crept back > up to 180/90. They assumed " essential hypertension. " > > This endo-surgeon was a friend before the case, and I trust him, but > must be cautious now. He wants me to go to UCSF for advanced > testing. It is the only place except Stanford where they can do vein > studies and complex endo-interaction investigation hereabouts. > > With COPD and " apnea syndrome " (after 10-15 yrs of > undiagnosed/untreated upper-10% severity apnea, autonomic > " masquerading " as other diseases " ), this is, as Dr Harness said in one > of his letters, " a rare and complex metabolic case... " and found me in > a sort of mental-blocking state until recently when symptoms started > in again. > > I sure wish not, > > Dave > > > > Original Message: > >From: lowerbp2@... > >hyperaldosteronism > >Subject: Re: Re: Spiro Treatment > >Date: Mon, 23 Aug 2004 18:57:33 -0400 > > > > > >Many of the meds can alter the A/R ratio and might account for the > rising ratio. Whatwas the exact DX on the removed adrenal tissue? > > > >How bad does your BP get off of all drugs? In general in difficult > cases we work with the local MD to taper all meds and then when off > them for 2 weeks to retest. > > > >What did your BP do with Spiro?. > > > > > >-- > > > > > >May your pressure be low! > > > >CE Grim MD > >Clinical Professor of Internal Medicine > >Professor of Epidemiology > > > >Board Certified in Internal Medicine, Geriatrics and Hypertension > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Yes to both questions. K stayed around 4.1, and the A/R ratio around 32. Lately, I end up in the ER with 2.3 K and the ratio is up to 48 as of 7-30-04 (34.7 on 7-15-13, 40 on 5-7-04). The idea that medicine may be part or even all of this seems supported by my endo, who said " your renin is not as low as most HA patients. " Just the aldo way up. Dave On Tuesday, August 24, 2004, at 06:44 PM, lowerbp2@... wrote: > Other info of use is > > 1. did the K correctand even become transiently increased? > 2. did the renin rise and the aldo fall? > > In a message dated 8/24/04 3:03:41 PM, dp@... writes: > > > > Good question, Dr. G. The other mail answers, in part. > > I just spoke to the supervisor of my case and 1999 surgery (done at > Alameda County Med Ctr, UC teaching hospital), and he could not > recall if they took the whole right. gland, or sectioned...except that > it was benign, around 1cm. I am getting the path report and balance > of chart now. Believe it or not, my primary & I can't recall if I > tried spiro. Get the chart. > > After surgery, BP dropped to 120/80 for about 5 weeks, then crept back > up to 180/90. They assumed " essential hypertension. " > > This endo-surgeon was a friend before the case, and I trust him, but > must be cautious now. He wants me to go to UCSF for advanced > testing. It is the only place except Stanford where they can do vein > studies and complex endo-interaction investigation hereabouts. > > With COPD and " apnea syndrome " (after 10-15 yrs of > undiagnosed/untreated upper-10% severity apnea, autonomic > " masquerading " as other diseases " ), this is, as Dr Harness said in one > of his letters, " a rare and complex metabolic case... " and found me in > a sort of mental-blocking state until recently when symptoms started > in again. > > I sure wish not, > > Dave > > > > Original Message: > >From: lowerbp2@... > >hyperaldosteronism > >Subject: Re: Re: Spiro Treatment > >Date: Mon, 23 Aug 2004 18:57:33 -0400 > > > > > >Many of the meds can alter the A/R ratio and might account for the > rising ratio. Whatwas the exact DX on the removed adrenal tissue? > > > >How bad does your BP get off of all drugs? In general in difficult > cases we work with the local MD to taper all meds and then when off > them for 2 weeks to retest. > > > >What did your BP do with Spiro?. > > > > > >-- > > > > > >May your pressure be low! > > > >CE Grim MD > >Clinical Professor of Internal Medicine > >Professor of Epidemiology > > > >Board Certified in Internal Medicine, Geriatrics and Hypertension > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Mine gets that high, but only when systolic is 110 +. Dave On Tuesday, August 24, 2004, at 06:54 PM, lowerbp2@... wrote: > I have had 100s of patients with difficult HTN stop their pills of Dx > testing for 2 weeks and have not had any problems--but someday we > may. > > The first VA HTN study required men to have diastolic BPs greater than > 115 for 4 months before the study was started. > > > > May your pressure be low! > > Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD > Professor of Medicine and Epidemiology > Medical College of Wisconsin > Board certified in Hypertension, Internal Medicine and Geriatrics > > <image.tiff> > > <image.tiff> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Are you saying that inspra is 20 times less potent than aldactone? Does that mean that 500mg of Inspra is needed to have the equivilant effect of 25mg Aldactone? That doesn't seem right... Thanks, Mike > > > " Please review spiros effect on the testosterone/estrogen > receptors. This is > > where spiro generates sex hormone these side effects. They are > not due to > > mineralocorticoid blockade. " > > Dr. Grim: > I think we are saying the same thing in different ways. When > researcher were looking for a substitute for spiro they were trying > to minimize the side effects. In " Effects of Aldosterone > Antagonism " , found at medscape.com/viewartical/422919-11, the > research discusses the benefits of eplerenone over spiro as: > 20:1 less effective in blocking mineral corticoid receptors > 2000:1 less effective in blocking androgen receptors > 200:1 less effective in blocking progesterone > 10:1 less effective in blocking glucocorticoid > > If spiro blocked testosterone effectively, there would be a > greater effect on libido then currently reported. I was on Lupron, > for the treatment of prostate cancer, and in no way was spiro ever as > potent as Lupron. The effect of Lupron on libido is profound, spiro > just led to tender breasts. Wayne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2004 Report Share Posted August 25, 2004 In a message dated 8/24/04 10:04:13 PM, dp@... writes: Mine gets that high, but only when systolic is 110 +. Diastolic? May your pressure be low! Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD Professor of Medicine and Epidemiology Medical College of Wisconsin Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2004 Report Share Posted August 25, 2004 <lord_mike_the_great@y...> wrote: > Are you saying that inspra is 20 times less potent than aldactone? > Does that mean that 500mg of Inspra is needed to have the equivilant > effect of 25mg Aldactone? That doesn't seem right... Mike: The drug designers were trying to get a drug that only blocks aldosterone receptors. An aldosterone antagonist only, if you will. To be selective, it shouldn't block other mineralcorticoid sites. As a result, the amount of epelerenone needed to reduce blood pressure is the only dose level of importance. The problem is that spiro does too much, giving rise to the side effects that make people go off of it. Wayne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2004 Report Share Posted August 25, 2004 In a message dated 8/25/04 11:51:53 AM, wbongianni@... writes: <lord_mike_the_great@y...> wrote: > Are you saying that inspra is 20 times less potent than aldactone? > Does that mean that 500mg of Inspra is needed to have the equivilant > effect of 25mg Aldactone? That doesn't seem right... Mike: The drug designers were trying to get a drug that only blocks aldosterone receptors. An aldosterone antagonist only, if you will. To be selective, it shouldn't block other mineralcorticoid sites. As a result, the amount of epelerenone needed to reduce blood pressure is the only dose level of importance. The problem is that spiro does too much, giving rise to the side effects that make people go off of it. Wayne They both block the mineralocorticoid receptor, but E occupies fewer troublesome receptors-like the one that makes breasts in men enlarge and get tender. May your pressure be low! Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD Professor of Medicine and Epidemiology Medical College of Wisconsin Board certified in Hypertension, Internal Medicine and Geriatrics Quote Link to comment Share on other sites More sharing options...
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