ARBs(Benicar) + Heparin for PWCs is probably dangerous

[Guest guest]

Given that 50% of PWCs have adrenal glands that are 50% of normal

size…. [ " The right and left adrenal gland bodies were reduced by over

50% in the CFS subjects indicative of significant adrenal atrophy in

a group of CFS patients with abnormal endocrine parameters "

Small adrenal glands in chronic fatigue syndrome: a preliminary

computer tomography study. LV, Teh J, Reznek R, A,

Sohaib A, Dinan TG. Psychoneuroendocrinology. 1999 Oct;24(7):759-68.]

" Heparin and its congeners are predictable, potent inhibitors of

aldosterone production…. Decreases in aldosterone levels may occur

with heparin dosages as low as 5,000 U BID. … reduction in both the

number and affinity of the angiotensin-II receptors in the zona

glomerulosa "

Authors: Oster JR. Singer I. Fishman LM.

Institution: Medical Service, Department of Veterans Affairs Medical

Center, Miami, Florida 33125, USA.

Title: Heparin-induced aldosterone suppression and hyperkalemia.

[Review] [85 refs]

Source: American Journal of Medicine. 98(6)575-86, 1995 Jun.

Authors: Bleasel JF. Rasko JE. Rickard KA. s G.

Institution: Rheumatology Department, Forster Hospital,

Redfern, NSW.

Title: Acute adrenal insufficiency secondary to heparin-induced

thrombocytopenia-thrombosis syndrome.

Source: Medical Journal of Australia. 157(3)192-3, 1992 Aug 3.

" Heparin, increased risk of hyperkalaemia when angiotensin-II

receptor antagonists

given with heparin. "

Additional citations of interest:

Hypoaldosteronism induced by low molecular weight heparins]

Presse Med. 1991 Jan 5-12;20(1):35

Low molecular weight heparins and hypoaldosteronism.

BMJ. 1990 Jun 2;300(6737):1437-8.

Pseudo-hypoaldosteronism induced by heparin in an elderly non-

diabetic female patient] Presse Med. 1990 Apr 28;19(17):818

Selective hypoaldosteronism after using heparin in patients with

chronic glomerulonephritis] Klin Med (Mosk). 1987 Jul;65(7):94-6.

Effects of heparin-induced aldosterone deficiency on renal function

in patients with chronic glomerulonephritis. Nephrol Dial Transplant.

1987;2(4):219-23.

Heparin-induced hypoaldosteronism. Report of a case. JAMA. 1981 Nov

13;246(19):2189-90.

SELECTIVE HYPOALDOSTERONISM AFTER PROLONGED HEPARIN ADMINISTRATION. A

CASE REPORT, WITH POSTMORTEM FINDINGS. Am J Med. 1964 Apr;36:635-40.

The effect of aldosterone and aldosterone antagonists in patients

with hypoaldosteronism caused by heparinoid.] Ned Tijdschr Geneeskd.

1962 Mar 24;106:617-20

Ken Lassesen,

[Permission to repost elsewhere granted -- including on the unnamed

board]

[Guest guest]

That's a very sharp post, Ken. Much appreciated, I like seeing these

individual issues elaborated.

Good work.

>

> Given that 50% of PWCs have adrenal glands that are 50% of normal

> size…. [ " The right and left adrenal gland bodies were reduced by

over

> 50% in the CFS subjects indicative of significant adrenal atrophy

in

> a group of CFS patients with abnormal endocrine parameters "

> Small adrenal glands in chronic fatigue syndrome: a preliminary

> computer tomography study. LV, Teh J, Reznek R, A,

> Sohaib A, Dinan TG. Psychoneuroendocrinology. 1999 Oct;24(7):759-

68.]

>

> " Heparin and its congeners are predictable, potent inhibitors of

> aldosterone production…. Decreases in aldosterone levels may occur

> with heparin dosages as low as 5,000 U BID. … reduction in both

the

> number and affinity of the angiotensin-II receptors in the zona

> glomerulosa "

>

> Authors: Oster JR. Singer I. Fishman LM.

> Institution: Medical Service, Department of Veterans Affairs

Medical

> Center, Miami, Florida 33125, USA.

> Title: Heparin-induced aldosterone suppression and hyperkalemia.

> [Review] [85 refs]

> Source: American Journal of Medicine. 98(6)575-86, 1995 Jun.

>

> Authors: Bleasel JF. Rasko JE. Rickard KA. s G.

> Institution: Rheumatology Department, Forster Hospital,

> Redfern, NSW.

> Title: Acute adrenal insufficiency secondary to heparin-induced

> thrombocytopenia-thrombosis syndrome.

> Source: Medical Journal of Australia. 157(3)192-3, 1992 Aug 3.

>

>

>

> " Heparin, increased risk of hyperkalaemia when angiotensin-II

> receptor antagonists

> given with heparin. "

>

>

>

> Additional citations of interest:

>

> Hypoaldosteronism induced by low molecular weight heparins]

> Presse Med. 1991 Jan 5-12;20(1):35

>

> Low molecular weight heparins and hypoaldosteronism.

> BMJ. 1990 Jun 2;300(6737):1437-8.

>

> Pseudo-hypoaldosteronism induced by heparin in an elderly non-

> diabetic female patient] Presse Med. 1990 Apr 28;19(17):818

>

> Selective hypoaldosteronism after using heparin in patients with

> chronic glomerulonephritis] Klin Med (Mosk). 1987 Jul;65(7):94-6.

>

> Effects of heparin-induced aldosterone deficiency on renal

function

> in patients with chronic glomerulonephritis. Nephrol Dial

Transplant.

> 1987;2(4):219-23.

>

> Heparin-induced hypoaldosteronism. Report of a case. JAMA. 1981

Nov

> 13;246(19):2189-90.

>

> SELECTIVE HYPOALDOSTERONISM AFTER PROLONGED HEPARIN

ADMINISTRATION. A

> CASE REPORT, WITH POSTMORTEM FINDINGS. Am J Med. 1964 Apr;36:635-

40.

>

> The effect of aldosterone and aldosterone antagonists in patients

> with hypoaldosteronism caused by heparinoid.] Ned Tijdschr

Geneeskd.

> 1962 Mar 24;106:617-20

>

>

>

> Ken Lassesen,

>

> [Permission to repost elsewhere granted -- including on the

unnamed

> board]

[Guest guest]

Good warning to those who do have adrenal problems. But, that problem

isn't something we all deal with. As sick as I was, that was not a

problem for me or my daughter. I think the benefits of heparin are to

profound when treating hypercoagulation to just turn and run from it

based on this information. Although in light of this info, it is

probably a real good idea to have your adrenals checked out before

venturing into this territory. I really don't believe I would be at

95% remission without the heparin.

Now, I wonder if this applies to NattoK too, as it also blocks

Angiotensin.

[Guest guest]

Absolutely agreed -- the studies are that it impacts 50% of PWCs.

Testing is warranted and if low, ongoing monitoring.

Long term( > 6 months) ARBs (Benicar) cause a significant drop. The

documented threshold for problems with heparin is 5000 IU (so lower

levels would be suggested). It is interesting to note that it appears

to occur for both regular heparin and lovenox (low molecular weight).

Natto is a good question -- since it works by desolving deposits, the

plus and minus is likely more complex.

>

> Good warning to those who do have adrenal problems. But, that problem

> isn't something we all deal with. As sick as I was, that was not a

> problem for me or my daughter. I think the benefits of heparin are to

> profound when treating hypercoagulation to just turn and run from it

> based on this information. Although in light of this info, it is

> probably a real good idea to have your adrenals checked out before

> venturing into this territory. I really don't believe I would be at

> 95% remission without the heparin.

>

> Now, I wonder if this applies to NattoK too, as it also blocks

> Angiotensin.