Guest guest Posted September 22, 2004 Report Share Posted September 22, 2004 Hi , I am sorry you were diagnosed last July. I too took Lisinopril for years, but it was no longer effective in controlling my BP. If you are having unsatisfactory side effects, by all mean let your doctor know because there are many different drugs that you can try. I am now on Cozaar and Lopressor along with Plendil and my BP is finally under great control. With all the BP meds available, there is no reason to tolerate unacceptable side effects at all. Good luck with the search on your new Neph! In a message dated 9/22/2004 4:17:15 AM Pacific Daylight Time, zeekie43@... writes: > I have been taking Lisinopril since April 2004. Although I have not > been faithful to it day by day. I have been very streaky with it > becasue of the way it has made me feel. I have noticed numerous side > effects which seem to subside when I dont take the medicine on a > daily basis. This is the only med I have been prescribed as I am in > the process of looking for a new neph and my blood pressure has not > been significantly reduced as I would like it to be. > > I have found a website where others have shared their experience with > this ACE-I. My experience is not very different from the people who > have posted on the site. > > My question are these: What ACE-I (if any) are people taking? What > reason was it prescribed? (IE: to lower blood pressure or " protect > kidneys or something different) Are these (or any) drugs really able > to " protect the kidneys " ? > > I am looking for alternatives to suggest to my doc and > educated/experience from this group would be greatly appreciated. > > Background: > I was diagnosed with IgaN in July 2004. My prescription was intended > to lower blood pressure (prior to my referral to a neph and biopsy. > The neph I saw for the biopsy etc., has upped (5mg to 10mg) and > extended that prescription. I am not happy with the side efects at > all and have taken the drug for the last time today. I dont have my > recent labs back yet, but I know my kidneys are at 40% function at > disgnosis. Protein spillage is 1.5 in 24 hours with negative episodes > of gross blood in my urine. Microscopic blood in my urine. The rest > of the information is at home and I am typing this from work. > > Sorry for the long post. I appreciate this message board as it has > been a great asset in helping me deal with my recent diagnosis. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 Hi , I initially took 80 mg Diovan daily, was taken off of it when we tried to start a family, then started taking it again 3 months ago along with Tiazac (not an ACE inhibitor bp med) due to prednisone meds that I was taking. I preferred the Diovan, didn't have any side effects (although I think hiccupping was one possible one???) and it was pretty good at maintaining my bp for 2 years until I was taken off of it to try for a baby. Sophia > I have been taking Lisinopril since April 2004. Although I have not > been faithful to it day by day. I have been very streaky with it > becasue of the way it has made me feel. I have noticed numerous side > effects which seem to subside when I dont take the medicine on a > daily basis. This is the only med I have been prescribed as I am in > the process of looking for a new neph and my blood pressure has not > been significantly reduced as I would like it to be. > > I have found a website where others have shared their experience with > this ACE-I. My experience is not very different from the people who > have posted on the site. > > My question are these: What ACE-I (if any) are people taking? What > reason was it prescribed? (IE: to lower blood pressure or " protect > kidneys or something different) Are these (or any) drugs really able > to " protect the kidneys " ? > > I am looking for alternatives to suggest to my doc and > educated/experience from this group would be greatly appreciated. > > Background: > I was diagnosed with IgaN in July 2004. My prescription was intended > to lower blood pressure (prior to my referral to a neph and biopsy. > The neph I saw for the biopsy etc., has upped (5mg to 10mg) and > extended that prescription. I am not happy with the side efects at > all and have taken the drug for the last time today. I dont have my > recent labs back yet, but I know my kidneys are at 40% function at > disgnosis. Protein spillage is 1.5 in 24 hours with negative episodes > of gross blood in my urine. Microscopic blood in my urine. The rest > of the information is at home and I am typing this from work. > > Sorry for the long post. I appreciate this message board as it has > been a great asset in helping me deal with my recent diagnosis. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 Hi , there is a post from me from 7/17/04 entitled something like, Protein levels and Ramipril if your interested. It talks a little bit about the difference between an ACE and ARB. I love Altace, was on Max dose plus Avapro and did quite well. Was on both to decrease B/P and decrease proteinuria, and was improving my renal function by almost 50%. I'm on CellCept Research protocol now through Mayo, and the ACE for all patients is Lisinopril. I'm doing fine on that one as well, thank goodness. But some people do have side effects with Altace, others with Lisinopril. Kinda " to each their own " . There are so many awesome B/P meds out there and lots of combination drugs, we truely live in an awesome time where we have lots of options. I would surely discuss your side effects with your neph, and see if he would consider another ACE or ARB, if you are having side effects with the Lisinopril. These truely are drugs of choice to decrease proteinuria. The others are good to decrease B/P (calcium channel blockers, beta blockers, diuretics etc, however they do not decrease proteinuria like an ACE or ARB) They sometimes will do low dose ACE and add a calcium channel blocker such as Norvasc which is very kidney friendly, with some people can cause a bit of edema esp in the legs. However this combination does not decrease proteinuria as well as a higher dose in the ACE, or adding an ARB to the ACE. Anyway, I would be glad to answer any specific questions you might have regarding B/P meds, just give me a jingle. Sometimes it takes me a day or two to respond, cause I'm trying desperately to catch up at work before I leave for Mayo next week, so please be a bit patient for me to respond. Thanks! Bonnie Oh, by the way, I had less side effects of drowsiness when I cut my dose in half and took 1/2 in am and 1/2 in pm, but I always check with my nephs first before I " just do it " as the Nike saying goes. I did this with both the Altace and the Lisinopril, and the drowsiness was not near as severe. Bonnie yipee_ladybug wrote: Hi , I initially took 80 mg Diovan daily, was taken off of it when we tried to start a family, then started taking it again 3 months ago along with Tiazac (not an ACE inhibitor bp med) due to prednisone meds that I was taking. I preferred the Diovan, didn't have any side effects (although I think hiccupping was one possible one???) and it was pretty good at maintaining my bp for 2 years until I was taken off of it to try for a baby. Sophia > I have been taking Lisinopril since April 2004. Although I have not > been faithful to it day by day. I have been very streaky with it > becasue of the way it has made me feel. I have noticed numerous side > effects which seem to subside when I dont take the medicine on a > daily basis. This is the only med I have been prescribed as I am in > the process of looking for a new neph and my blood pressure has not > been significantly reduced as I would like it to be. > > I have found a website where others have shared their experience with > this ACE-I. My experience is not very different from the people who > have posted on the site. > > My question are these: What ACE-I (if any) are people taking? What > reason was it prescribed? (IE: to lower blood pressure or " protect > kidneys or something different) Are these (or any) drugs really able > to " protect the kidneys " ? > > I am looking for alternatives to suggest to my doc and > educated/experience from this group would be greatly appreciated. > > Background: > I was diagnosed with IgaN in July 2004. My prescription was intended > to lower blood pressure (prior to my referral to a neph and biopsy. > The neph I saw for the biopsy etc., has upped (5mg to 10mg) and > extended that prescription. I am not happy with the side efects at > all and have taken the drug for the last time today. I dont have my > recent labs back yet, but I know my kidneys are at 40% function at > disgnosis. Protein spillage is 1.5 in 24 hours with negative episodes > of gross blood in my urine. Microscopic blood in my urine. The rest > of the information is at home and I am typing this from work. > > Sorry for the long post. I appreciate this message board as it has > been a great asset in helping me deal with my recent diagnosis. > > To edit your settings for the group, go to our Yahoo Group home page: http://groups.yahoo.com/group/iga-nephropathy/ To unsubcribe via email, iga-nephropathy-unsubscribe Visit our companion website at www.igan.ca. The site is entirely supported by donations. If you would like to help, go to: http://www.igan.ca/id62.htm Thank you Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 , I take Lisinopril to reduce my protein spilling. At first I took 5mg daily, but had an emergency room visit due to high potassium, 6.4, and the emergency room doc wanted me off the drug all together as Lisispril can cause an increase in potassium. I refused since without it i spill about 1500 mg to 2000 mg per day of protein and with it my average spill has been 500, with the highest spill being 850mg . So a comprmise was met, I now take 2.5 mg daily, with my neph's blessing once he saw that I had no adverse effects with the reduced dose. So to your question, I suppose I take it to protect my kidneys. For now my BP is fine, it is actually too low sometimes, a trate I share with my mother. Your diagnosis is so new. I'm sorry you have such an awful time with it. I have had some trouble with a dry cough now and then, but nothing I can't live with. I hope you find a good alternative. peace, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 Hi Pierre, How is the unpacking going? Thank you so much for taking so much time to write such a comprehensive explanation of BP meds. I always learn so much from you! I was on ACE inhibitors for years, but due to my problems with potassium and the fact that my BP was continuing to climb, I changed to ARB (Cozaar) I also take Lopressor and Plendil, and to be honest, I don't even know which class of BP meds those two are in. You are definitely the undisputed expert when it comes to BP :-) In a message dated 9/24/2004 9:50:05 AM Pacific Daylight Time, pgl-groups@... writes: > > While most people can, I never could tolerate any of the ACE inhibitors. I > developed a constant dry cough, severe indigestion, and eventually I had the > reaction they call angioedema, in which the throat and the lips swell. > Preceding that, I had complained of sporadic episodes of red patches on my > torso and hands. These were dismissed by my doctor at the time, but in > hindsight, it was obviously a warning of a more serious reaciton to come - > and a warning that should have been heeded. That landed me in the local > Emerg and after that, I was never again on an ACE inhibitor. Now, this > doesn't happen to everyone, but it does happen. > > At about that same time, the first angiotensin II receptor blocker (ARB) > came on the market. These are close cousins of the ACE inhibitors, and the > first I was on was Cozaar (losartan potassium). It wasn't effective enough > on my BP on its own, and at one point, I was on Cozaar, diltiazem, clonidine > plus the diuretic hydrochlorothiazie (yes, that's four BP meds at the same > time, not an uncommon situation for people with IgAN who have a high blood > pressure problem). There were changes, and by the time I was approaching > esrd, I was on another more recent ARB called Avapro (irbesartan) and the > loop diuretic Lasix (furosemide). In all the years I had high blood > pressure, I was never better controlled than when I was taking Lasix along > with the Avapro. Unfortunately, by that time, I was already pretty close to > esrd, and taking an ARB from 1996 on did not prevent my eventually reaching > esrd in 2002. > > If you can't tolerate one ACE inhibitor, you might be able to tolerate a > different one. There are a number of different ones available - lisinopril, > accupril, monopril, ramipril, inhibace, enalapril, captopril, etc., but many > people who are especially sensitive to them find that they all feel more or > less the same. The side effects tend to be from the whole class of drugs, > rather than individual ones. If that's the case, then the next choice is an > ARB. There is a variety of these as well. They work on the same blood > pressure control system in the body as the ACE inhibitors (it's called the > renin-angiotensin system, or RAS for short), but at a slightly different > level. Both ACEIs and ARBs have been demonstrated to lower proteinuria > somewhat, and to possibly slow progression of glomerular kidney disease (of > which IgAN is one). Over the past couple of years, there has been increasing > use of both an ACEI and an ARB together. The theory is that this more > completely blocks the renin-angiotensin system than either drug alone. I > think the jury is still out on this. It is still very debatable in the > nephrology community as to whether it's better to combine an ARB with an > ACEI, or whether it's better to just push the dose of one to the maximum > dose. ARB's have only been on the market since 1995, and ACEIs weren't > really in common use until the end of the 1980's, or even the beginning of > the 1990's. So, that's a relatively short time, and nobody really knows what > the long term effects will be over many years. Presumably, since the body > did evolve a renin-angiotensin system that does many things, only one of > which is to participate in the regulation of blood pressure, it must be > there for a reason. There are still many unknowns about what it does, so, > who knows if it's a good idea to block its action too much. > > We're talking about degrees of effectiveness here. Heavy proteinuria isn't > likely to be helped much by either of them. You need a heavy hitter like > prednisone for that, or failing that, another kind of immunosuppressant. But > they do help. On the other hand, if the drug is making your life > intolerable, you and your doctor have to decide if it's worth taking any > drug. By degrees of effectiveness, I mean that is not black and white. It's > not like if you don't take an ACE inhibitor, you will automatically reach > esrd. There are some experts who will argue that the benefical effect of an > ACEI is the same as that of any other BP drug - that is, it's because of the > blood pressure lowering effect, and nothing else. > > There tends to be a misconception among many people with IgAN that > proteinuria today means dialysis tomorrow. This couldn't be further from the > truth. Proteinuria is a risk factor for progression, nothing more. It's a > significant risk factor, of course, but, whether your proteinuria is 0.8g/d > or 1 gram per day (which is the same as 800-1000mg/day) may not make that > much difference. Proteinuria that gets into the heavy range (approaching 3.5 > grams per day, however, is more serious, and it's generally recognized that > it must be treated. > > All this to preamble my answer to your question, as to why an ACE inhibitor > is prescribed. Simply, because (1) it lowers blood pressure - and this is > almost always considered to be a good thing when a person had chronic kidney > disease, (2) it may help slow progression of glomerular kidney disease > because of some specific action other BP meds may not have (ie. lowering the > blood pressure inside the glomeruli themselves), and (3) it can help lower > proteinuria - but it's not at all a replacement for prednisone in cases of > heavy proteinuria. All that together is thought to help delay the > progression of the disease towards esrd. At first, people were only > prescribed an ACE inhibitor if they had high blood pressure. But with kidney > disease, it's not clear where the limit is between normal BP and high BP > should be. So, there might be benefit for anyone who clearly does not have > BP that is too low. Therefore, over the past few years, it has been > prescribed more and more to people who don't really show high blood pressure > yet. > > So, this is why your doctor insists on you taking an ACE inhibitor, if you > can at all tolerate it. To most doctors, including nephrologists, relatively > " minor " side effects like headaches, indigestion, etc. are not a strong > enough reason to terminate the use of this drug, given the known benefits. > Similarly, dizziness may not be either. For example, if your blood pressure > doesn't catch up fast enough when you stand up suddenly and you get > momentarily dizzy, it's easy to just tell you to stand up more slowly. On > the other hand, if you're fainting while standing in line at the supermarket > and you can never get your groceries done, well, that may mean your BP is > being lowered too much. There is a happy medium in there somewhere. You can > only lower it so much. We have blood pressure for a reason. > > Should it be an ACEI or an ARB. Well, ACEI have been around longer, and > there is more accumulated experience and evidence with them. Unfortunately, > up to about 30% of patients will experience a nagging dry cough when on an > ACEI. This is not as insignificant as it may seem. You can actually > traumatize your vocal chords and enter a vicious cycle of coughing that > never end. If that's the case, or if there are other intolerable side > effects, then an ARB should probably be tried. The ARBs have a less > significant side effect profile, and they are less likely to cause the > cough - but they seem to have more or less the same benefits as an ACEI. > > If you can't possibly tolerate either, then, some of the other classes of > drugs may help. They might not help lower proteinuria, but they do help > lower blood pressure (and one particular calcium channel blocker may in fact > lower proteinuria a bit). These other classes of BP meds are also often used > along with an ACEI or ARB. > > Pierre Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 While most people can, I never could tolerate any of the ACE inhibitors. I developed a constant dry cough, severe indigestion, and eventually I had the reaction they call angioedema, in which the throat and the lips swell. Preceding that, I had complained of sporadic episodes of red patches on my torso and hands. These were dismissed by my doctor at the time, but in hindsight, it was obviously a warning of a more serious reaciton to come - and a warning that should have been heeded. That landed me in the local Emerg and after that, I was never again on an ACE inhibitor. Now, this doesn't happen to everyone, but it does happen. At about that same time, the first angiotensin II receptor blocker (ARB) came on the market. These are close cousins of the ACE inhibitors, and the first I was on was Cozaar (losartan potassium). It wasn't effective enough on my BP on its own, and at one point, I was on Cozaar, diltiazem, clonidine plus the diuretic hydrochlorothiazie (yes, that's four BP meds at the same time, not an uncommon situation for people with IgAN who have a high blood pressure problem). There were changes, and by the time I was approaching esrd, I was on another more recent ARB called Avapro (irbesartan) and the loop diuretic Lasix (furosemide). In all the years I had high blood pressure, I was never better controlled than when I was taking Lasix along with the Avapro. Unfortunately, by that time, I was already pretty close to esrd, and taking an ARB from 1996 on did not prevent my eventually reaching esrd in 2002. If you can't tolerate one ACE inhibitor, you might be able to tolerate a different one. There are a number of different ones available - lisinopril, accupril, monopril, ramipril, inhibace, enalapril, captopril, etc., but many people who are especially sensitive to them find that they all feel more or less the same. The side effects tend to be from the whole class of drugs, rather than individual ones. If that's the case, then the next choice is an ARB. There is a variety of these as well. They work on the same blood pressure control system in the body as the ACE inhibitors (it's called the renin-angiotensin system, or RAS for short), but at a slightly different level. Both ACEIs and ARBs have been demonstrated to lower proteinuria somewhat, and to possibly slow progression of glomerular kidney disease (of which IgAN is one). Over the past couple of years, there has been increasing use of both an ACEI and an ARB together. The theory is that this more completely blocks the renin-angiotensin system than either drug alone. I think the jury is still out on this. It is still very debatable in the nephrology community as to whether it's better to combine an ARB with an ACEI, or whether it's better to just push the dose of one to the maximum dose. ARB's have only been on the market since 1995, and ACEIs weren't really in common use until the end of the 1980's, or even the beginning of the 1990's. So, that's a relatively short time, and nobody really knows what the long term effects will be over many years. Presumably, since the body did evolve a renin-angiotensin system that does many things, only one of which is to participate in the regulation of blood pressure, it must be there for a reason. There are still many unknowns about what it does, so, who knows if it's a good idea to block its action too much. We're talking about degrees of effectiveness here. Heavy proteinuria isn't likely to be helped much by either of them. You need a heavy hitter like prednisone for that, or failing that, another kind of immunosuppressant. But they do help. On the other hand, if the drug is making your life intolerable, you and your doctor have to decide if it's worth taking any drug. By degrees of effectiveness, I mean that is not black and white. It's not like if you don't take an ACE inhibitor, you will automatically reach esrd. There are some experts who will argue that the benefical effect of an ACEI is the same as that of any other BP drug - that is, it's because of the blood pressure lowering effect, and nothing else. There tends to be a misconception among many people with IgAN that proteinuria today means dialysis tomorrow. This couldn't be further from the truth. Proteinuria is a risk factor for progression, nothing more. It's a significant risk factor, of course, but, whether your proteinuria is 0.8g/d or 1 gram per day (which is the same as 800-1000mg/day) may not make that much difference. Proteinuria that gets into the heavy range (approaching 3.5 grams per day, however, is more serious, and it's generally recognized that it must be treated. All this to preamble my answer to your question, as to why an ACE inhibitor is prescribed. Simply, because (1) it lowers blood pressure - and this is almost always considered to be a good thing when a person had chronic kidney disease, (2) it may help slow progression of glomerular kidney disease because of some specific action other BP meds may not have (ie. lowering the blood pressure inside the glomeruli themselves), and (3) it can help lower proteinuria - but it's not at all a replacement for prednisone in cases of heavy proteinuria. All that together is thought to help delay the progression of the disease towards esrd. At first, people were only prescribed an ACE inhibitor if they had high blood pressure. But with kidney disease, it's not clear where the limit is between normal BP and high BP should be. So, there might be benefit for anyone who clearly does not have BP that is too low. Therefore, over the past few years, it has been prescribed more and more to people who don't really show high blood pressure yet. So, this is why your doctor insists on you taking an ACE inhibitor, if you can at all tolerate it. To most doctors, including nephrologists, relatively " minor " side effects like headaches, indigestion, etc. are not a strong enough reason to terminate the use of this drug, given the known benefits. Similarly, dizziness may not be either. For example, if your blood pressure doesn't catch up fast enough when you stand up suddenly and you get momentarily dizzy, it's easy to just tell you to stand up more slowly. On the other hand, if you're fainting while standing in line at the supermarket and you can never get your groceries done, well, that may mean your BP is being lowered too much. There is a happy medium in there somewhere. You can only lower it so much. We have blood pressure for a reason. Should it be an ACEI or an ARB. Well, ACEI have been around longer, and there is more accumulated experience and evidence with them. Unfortunately, up to about 30% of patients will experience a nagging dry cough when on an ACEI. This is not as insignificant as it may seem. You can actually traumatize your vocal chords and enter a vicious cycle of coughing that never end. If that's the case, or if there are other intolerable side effects, then an ARB should probably be tried. The ARBs have a less significant side effect profile, and they are less likely to cause the cough - but they seem to have more or less the same benefits as an ACEI. If you can't possibly tolerate either, then, some of the other classes of drugs may help. They might not help lower proteinuria, but they do help lower blood pressure (and one particular calcium channel blocker may in fact lower proteinuria a bit). These other classes of BP meds are also often used along with an ACEI or ARB. Pierre > > > > I have been taking Lisinopril since April 2004. Although I have > not > > been faithful to it day by day. I have been very streaky with it > > becasue of the way it has made me feel. I have noticed numerous > side > > effects which seem to subside when I dont take the medicine on a > > daily basis. This is the only med I have been prescribed as I am > in > > the process of looking for a new neph and my blood pressure has > not > > been significantly reduced as I would like it to be. > > > > I have found a website where others have shared their experience > with > > this ACE-I. My experience is not very different from the people > who > > have posted on the site. > > > > My question are these: What ACE-I (if any) are people taking? What > > reason was it prescribed? (IE: to lower blood pressure or " protect > > kidneys or something different) Are these (or any) drugs really > able > > to " protect the kidneys " ? > > > > I am looking for alternatives to suggest to my doc and > > educated/experience from this group would be greatly appreciated. > > > > Background: > > I was diagnosed with IgaN in July 2004. My prescription was > intended > > to lower blood pressure (prior to my referral to a neph and > biopsy. > > The neph I saw for the biopsy etc., has upped (5mg to 10mg) and > > extended that prescription. I am not happy with the side efects at > > all and have taken the drug for the last time today. I dont have > my > > recent labs back yet, but I know my kidneys are at 40% function at > > disgnosis. Protein spillage is 1.5 in 24 hours with negative > episodes > > of gross blood in my urine. Microscopic blood in my urine. The > rest > > of the information is at home and I am typing this from work. > > > > Sorry for the long post. I appreciate this message board as it has > > been a great asset in helping me deal with my recent diagnosis. > > > > > > > > To edit your settings for the group, go to our Yahoo Group > home page: > http://groups.yahoo.com/group/iga-nephropathy/ > > To unsubcribe via email, > iga-nephropathy-unsubscribe > Visit our companion website at www.igan.ca. The site is entirely supported by donations. If you would like to help, go to: > http://www.igan.ca/id62.htm > > Thank you > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 Pierre, Your wisdom continues to amaze me! :-) ~Dana Re: Re: ACE Inhibitors/ While most people can, I never could tolerate any of the ACE inhibitors. I developed a constant dry cough, severe indigestion, and eventually I had the reaction they call angioedema, in which the throat and the lips swell. Preceding that, I had complained of sporadic episodes of red patches on my torso and hands. These were dismissed by my doctor at the time, but in hindsight, it was obviously a warning of a more serious reaciton to come - and a warning that should have been heeded. That landed me in the local Emerg and after that, I was never again on an ACE inhibitor. Now, this doesn't happen to everyone, but it does happen. At about that same time, the first angiotensin II receptor blocker (ARB) came on the market. These are close cousins of the ACE inhibitors, and the first I was on was Cozaar (losartan potassium). It wasn't effective enough on my BP on its own, and at one point, I was on Cozaar, diltiazem, clonidine plus the diuretic hydrochlorothiazie (yes, that's four BP meds at the same time, not an uncommon situation for people with IgAN who have a high blood pressure problem). There were changes, and by the time I was approaching esrd, I was on another more recent ARB called Avapro (irbesartan) and the loop diuretic Lasix (furosemide). In all the years I had high blood pressure, I was never better controlled than when I was taking Lasix along with the Avapro. Unfortunately, by that time, I was already pretty close to esrd, and taking an ARB from 1996 on did not prevent my eventually reaching esrd in 2002. If you can't tolerate one ACE inhibitor, you might be able to tolerate a different one. There are a number of different ones available - lisinopril, accupril, monopril, ramipril, inhibace, enalapril, captopril, etc., but many people who are especially sensitive to them find that they all feel more or less the same. The side effects tend to be from the whole class of drugs, rather than individual ones. If that's the case, then the next choice is an ARB. There is a variety of these as well. They work on the same blood pressure control system in the body as the ACE inhibitors (it's called the renin-angiotensin system, or RAS for short), but at a slightly different level. Both ACEIs and ARBs have been demonstrated to lower proteinuria somewhat, and to possibly slow progression of glomerular kidney disease (of which IgAN is one). Over the past couple of years, there has been increasing use of both an ACEI and an ARB together. The theory is that this more completely blocks the renin-angiotensin system than either drug alone. I think the jury is still out on this. It is still very debatable in the nephrology community as to whether it's better to combine an ARB with an ACEI, or whether it's better to just push the dose of one to the maximum dose. ARB's have only been on the market since 1995, and ACEIs weren't really in common use until the end of the 1980's, or even the beginning of the 1990's. So, that's a relatively short time, and nobody really knows what the long term effects will be over many years. Presumably, since the body did evolve a renin-angiotensin system that does many things, only one of which is to participate in the regulation of blood pressure, it must be there for a reason. There are still many unknowns about what it does, so, who knows if it's a good idea to block its action too much. We're talking about degrees of effectiveness here. Heavy proteinuria isn't likely to be helped much by either of them. You need a heavy hitter like prednisone for that, or failing that, another kind of immunosuppressant. But they do help. On the other hand, if the drug is making your life intolerable, you and your doctor have to decide if it's worth taking any drug. By degrees of effectiveness, I mean that is not black and white. It's not like if you don't take an ACE inhibitor, you will automatically reach esrd. There are some experts who will argue that the benefical effect of an ACEI is the same as that of any other BP drug - that is, it's because of the blood pressure lowering effect, and nothing else. There tends to be a misconception among many people with IgAN that proteinuria today means dialysis tomorrow. This couldn't be further from the truth. Proteinuria is a risk factor for progression, nothing more. It's a significant risk factor, of course, but, whether your proteinuria is 0.8g/d or 1 gram per day (which is the same as 800-1000mg/day) may not make that much difference. Proteinuria that gets into the heavy range (approaching 3.5 grams per day, however, is more serious, and it's generally recognized that it must be treated. All this to preamble my answer to your question, as to why an ACE inhibitor is prescribed. Simply, because (1) it lowers blood pressure - and this is almost always considered to be a good thing when a person had chronic kidney disease, (2) it may help slow progression of glomerular kidney disease because of some specific action other BP meds may not have (ie. lowering the blood pressure inside the glomeruli themselves), and (3) it can help lower proteinuria - but it's not at all a replacement for prednisone in cases of heavy proteinuria. All that together is thought to help delay the progression of the disease towards esrd. At first, people were only prescribed an ACE inhibitor if they had high blood pressure. But with kidney disease, it's not clear where the limit is between normal BP and high BP should be. So, there might be benefit for anyone who clearly does not have BP that is too low. Therefore, over the past few years, it has been prescribed more and more to people who don't really show high blood pressure yet. So, this is why your doctor insists on you taking an ACE inhibitor, if you can at all tolerate it. To most doctors, including nephrologists, relatively " minor " side effects like headaches, indigestion, etc. are not a strong enough reason to terminate the use of this drug, given the known benefits. Similarly, dizziness may not be either. For example, if your blood pressure doesn't catch up fast enough when you stand up suddenly and you get momentarily dizzy, it's easy to just tell you to stand up more slowly. On the other hand, if you're fainting while standing in line at the supermarket and you can never get your groceries done, well, that may mean your BP is being lowered too much. There is a happy medium in there somewhere. You can only lower it so much. We have blood pressure for a reason. Should it be an ACEI or an ARB. Well, ACEI have been around longer, and there is more accumulated experience and evidence with them. Unfortunately, up to about 30% of patients will experience a nagging dry cough when on an ACEI. This is not as insignificant as it may seem. You can actually traumatize your vocal chords and enter a vicious cycle of coughing that never end. If that's the case, or if there are other intolerable side effects, then an ARB should probably be tried. The ARBs have a less significant side effect profile, and they are less likely to cause the cough - but they seem to have more or less the same benefits as an ACEI. If you can't possibly tolerate either, then, some of the other classes of drugs may help. They might not help lower proteinuria, but they do help lower blood pressure (and one particular calcium channel blocker may in fact lower proteinuria a bit). These other classes of BP meds are also often used along with an ACEI or ARB. Pierre > > > > I have been taking Lisinopril since April 2004. Although I have > not > > been faithful to it day by day. I have been very streaky with it > > becasue of the way it has made me feel. I have noticed numerous > side > > effects which seem to subside when I dont take the medicine on a > > daily basis. This is the only med I have been prescribed as I am > in > > the process of looking for a new neph and my blood pressure has > not > > been significantly reduced as I would like it to be. > > > > I have found a website where others have shared their experience > with > > this ACE-I. My experience is not very different from the people > who > > have posted on the site. > > > > My question are these: What ACE-I (if any) are people taking? What > > reason was it prescribed? (IE: to lower blood pressure or " protect > > kidneys or something different) Are these (or any) drugs really > able > > to " protect the kidneys " ? > > > > I am looking for alternatives to suggest to my doc and > > educated/experience from this group would be greatly appreciated. > > > > Background: > > I was diagnosed with IgaN in July 2004. My prescription was > intended > > to lower blood pressure (prior to my referral to a neph and > biopsy. > > The neph I saw for the biopsy etc., has upped (5mg to 10mg) and > > extended that prescription. I am not happy with the side efects at > > all and have taken the drug for the last time today. I dont have > my > > recent labs back yet, but I know my kidneys are at 40% function at > > disgnosis. Protein spillage is 1.5 in 24 hours with negative > episodes > > of gross blood in my urine. Microscopic blood in my urine. The > rest > > of the information is at home and I am typing this from work. > > > > Sorry for the long post. I appreciate this message board as it has > > been a great asset in helping me deal with my recent diagnosis. > > > > > > > > To edit your settings for the group, go to our Yahoo Group > home page: > http://groups.yahoo.com/group/iga-nephropathy/ > > To unsubcribe via email, > iga-nephropathy-unsubscribe > Visit our companion website at www.igan.ca. The site is entirely supported by donations. If you would like to help, go to: > http://www.igan.ca/id62.htm > > Thank you > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 AWESOME POST PIERRE!!! Pharmacology in a nutshell. This one should be saved by everyone. Bonnie Pierre Lachaine wrote:While most people can, I never could tolerate any of the ACE inhibitors. I developed a constant dry cough, severe indigestion, and eventually I had the reaction they call angioedema, in which the throat and the lips swell. Preceding that, I had complained of sporadic episodes of red patches on my torso and hands. These were dismissed by my doctor at the time, but in hindsight, it was obviously a warning of a more serious reaciton to come - and a warning that should have been heeded. That landed me in the local Emerg and after that, I was never again on an ACE inhibitor. Now, this doesn't happen to everyone, but it does happen. At about that same time, the first angiotensin II receptor blocker (ARB) came on the market. These are close cousins of the ACE inhibitors, and the first I was on was Cozaar (losartan potassium). It wasn't effective enough on my BP on its own, and at one point, I was on Cozaar, diltiazem, clonidine plus the diuretic hydrochlorothiazie (yes, that's four BP meds at the same time, not an uncommon situation for people with IgAN who have a high blood pressure problem). There were changes, and by the time I was approaching esrd, I was on another more recent ARB called Avapro (irbesartan) and the loop diuretic Lasix (furosemide). In all the years I had high blood pressure, I was never better controlled than when I was taking Lasix along with the Avapro. Unfortunately, by that time, I was already pretty close to esrd, and taking an ARB from 1996 on did not prevent my eventually reaching esrd in 2002. If you can't tolerate one ACE inhibitor, you might be able to tolerate a different one. There are a number of different ones available - lisinopril, accupril, monopril, ramipril, inhibace, enalapril, captopril, etc., but many people who are especially sensitive to them find that they all feel more or less the same. The side effects tend to be from the whole class of drugs, rather than individual ones. If that's the case, then the next choice is an ARB. There is a variety of these as well. They work on the same blood pressure control system in the body as the ACE inhibitors (it's called the renin-angiotensin system, or RAS for short), but at a slightly different level. Both ACEIs and ARBs have been demonstrated to lower proteinuria somewhat, and to possibly slow progression of glomerular kidney disease (of which IgAN is one). Over the past couple of years, there has been increasing use of both an ACEI and an ARB together. The theory is that this more completely blocks the renin-angiotensin system than either drug alone. I think the jury is still out on this. It is still very debatable in the nephrology community as to whether it's better to combine an ARB with an ACEI, or whether it's better to just push the dose of one to the maximum dose. ARB's have only been on the market since 1995, and ACEIs weren't really in common use until the end of the 1980's, or even the beginning of the 1990's. So, that's a relatively short time, and nobody really knows what the long term effects will be over many years. Presumably, since the body did evolve a renin-angiotensin system that does many things, only one of which is to participate in the regulation of blood pressure, it must be there for a reason. There are still many unknowns about what it does, so, who knows if it's a good idea to block its action too much. We're talking about degrees of effectiveness here. Heavy proteinuria isn't likely to be helped much by either of them. You need a heavy hitter like prednisone for that, or failing that, another kind of immunosuppressant. But they do help. On the other hand, if the drug is making your life intolerable, you and your doctor have to decide if it's worth taking any drug. By degrees of effectiveness, I mean that is not black and white. It's not like if you don't take an ACE inhibitor, you will automatically reach esrd. There are some experts who will argue that the benefical effect of an ACEI is the same as that of any other BP drug - that is, it's because of the blood pressure lowering effect, and nothing else. There tends to be a misconception among many people with IgAN that proteinuria today means dialysis tomorrow. This couldn't be further from the truth. Proteinuria is a risk factor for progression, nothing more. It's a significant risk factor, of course, but, whether your proteinuria is 0.8g/d or 1 gram per day (which is the same as 800-1000mg/day) may not make that much difference. Proteinuria that gets into the heavy range (approaching 3.5 grams per day, however, is more serious, and it's generally recognized that it must be treated. All this to preamble my answer to your question, as to why an ACE inhibitor is prescribed. Simply, because (1) it lowers blood pressure - and this is almost always considered to be a good thing when a person had chronic kidney disease, (2) it may help slow progression of glomerular kidney disease because of some specific action other BP meds may not have (ie. lowering the blood pressure inside the glomeruli themselves), and (3) it can help lower proteinuria - but it's not at all a replacement for prednisone in cases of heavy proteinuria. All that together is thought to help delay the progression of the disease towards esrd. At first, people were only prescribed an ACE inhibitor if they had high blood pressure. But with kidney disease, it's not clear where the limit is between normal BP and high BP should be. So, there might be benefit for anyone who clearly does not have BP that is too low. Therefore, over the past few years, it has been prescribed more and more to people who don't really show high blood pressure yet. So, this is why your doctor insists on you taking an ACE inhibitor, if you can at all tolerate it. To most doctors, including nephrologists, relatively " minor " side effects like headaches, indigestion, etc. are not a strong enough reason to terminate the use of this drug, given the known benefits. Similarly, dizziness may not be either. For example, if your blood pressure doesn't catch up fast enough when you stand up suddenly and you get momentarily dizzy, it's easy to just tell you to stand up more slowly. On the other hand, if you're fainting while standing in line at the supermarket and you can never get your groceries done, well, that may mean your BP is being lowered too much. There is a happy medium in there somewhere. You can only lower it so much. We have blood pressure for a reason. Should it be an ACEI or an ARB. Well, ACEI have been around longer, and there is more accumulated experience and evidence with them. Unfortunately, up to about 30% of patients will experience a nagging dry cough when on an ACEI. This is not as insignificant as it may seem. You can actually traumatize your vocal chords and enter a vicious cycle of coughing that never end. If that's the case, or if there are other intolerable side effects, then an ARB should probably be tried. The ARBs have a less significant side effect profile, and they are less likely to cause the cough - but they seem to have more or less the same benefits as an ACEI. If you can't possibly tolerate either, then, some of the other classes of drugs may help. They might not help lower proteinuria, but they do help lower blood pressure (and one particular calcium channel blocker may in fact lower proteinuria a bit). These other classes of BP meds are also often used along with an ACEI or ARB. Pierre > > > > I have been taking Lisinopril since April 2004. Although I have > not > > been faithful to it day by day. I have been very streaky with it > > becasue of the way it has made me feel. I have noticed numerous > side > > effects which seem to subside when I dont take the medicine on a > > daily basis. This is the only med I have been prescribed as I am > in > > the process of looking for a new neph and my blood pressure has > not > > been significantly reduced as I would like it to be. > > > > I have found a website where others have shared their experience > with > > this ACE-I. My experience is not very different from the people > who > > have posted on the site. > > > > My question are these: What ACE-I (if any) are people taking? What > > reason was it prescribed? (IE: to lower blood pressure or " protect > > kidneys or something different) Are these (or any) drugs really > able > > to " protect the kidneys " ? > > > > I am looking for alternatives to suggest to my doc and > > educated/experience from this group would be greatly appreciated. > > > > Background: > > I was diagnosed with IgaN in July 2004. My prescription was > intended > > to lower blood pressure (prior to my referral to a neph and > biopsy. > > The neph I saw for the biopsy etc., has upped (5mg to 10mg) and > > extended that prescription. I am not happy with the side efects at > > all and have taken the drug for the last time today. I dont have > my > > recent labs back yet, but I know my kidneys are at 40% function at > > disgnosis. Protein spillage is 1.5 in 24 hours with negative > episodes > > of gross blood in my urine. Microscopic blood in my urine. The > rest > > of the information is at home and I am typing this from work. > > > > Sorry for the long post. I appreciate this message board as it has > > been a great asset in helping me deal with my recent diagnosis. > > > > > > > > To edit your settings for the group, go to our Yahoo Group > home page: > http://groups.yahoo.com/group/iga-nephropathy/ > > To unsubcribe via email, > iga-nephropathy-unsubscribe > Visit our companion website at www.igan.ca. The site is entirely supported by donations. If you would like to help, go to: > http://www.igan.ca/id62.htm > > Thank you > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 Hi , , Bonnie, Dana and everyone. The unpacking is still progressing. The hard part is figuring out where to put things The phone company assures me I should have my DSL back by Monday or Tuesday at the latest. I'm still just on dial-up at the moment, so I can only respond to emails intermittently. Pierre Re: Re: ACE Inhibitors/ > > Hi Pierre, > > How is the unpacking going? > > Thank you so much for taking so much time to write such a comprehensive > explanation of BP meds. I always learn so much from you! > > I was on ACE inhibitors for years, but due to my problems with potassium and > the fact that my BP was continuing to climb, I changed to ARB (Cozaar) I also > take Lopressor and Plendil, and to be honest, I don't even know which class > of BP meds those two are in. > > You are definitely the undisputed expert when it comes to BP :-) > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 Pierre, I can't imagine moving right now. I live in a big old home (100 years old this year) and I am the pack rat of the eternity. Working long hours as I do, does not help the situation at all, I just pack in more, and pitch less. I also have too many hobbies like weaving, scrapbooking, and gardening. So can you just imagine! I " feel " for you having to move, hope you haven't been the pack rat I have been. I hope you are able to rest a lot in between. You're health is so important Pierre. Please take it easy. Thinking of you every day. And regarding the DSL, don't we learn how to be humble and appreciative of what we have, especially when it is gone for awhile. This is so true in many aspects of life. Take good care of yourself!!! Have a good weekend. Bonnie Pierre Lachaine wrote: Hi , , Bonnie, Dana and everyone. The unpacking is still progressing. The hard part is figuring out where to put things The phone company assures me I should have my DSL back by Monday or Tuesday at the latest. I'm still just on dial-up at the moment, so I can only respond to emails intermittently. Pierre Re: Re: ACE Inhibitors/ > > Hi Pierre, > > How is the unpacking going? > > Thank you so much for taking so much time to write such a comprehensive > explanation of BP meds. I always learn so much from you! > > I was on ACE inhibitors for years, but due to my problems with potassium and > the fact that my BP was continuing to climb, I changed to ARB (Cozaar) I also > take Lopressor and Plendil, and to be honest, I don't even know which class > of BP meds those two are in. > > You are definitely the undisputed expert when it comes to BP :-) > > > To edit your settings for the group, go to our Yahoo Group home page: http://groups.yahoo.com/group/iga-nephropathy/ To unsubcribe via email, iga-nephropathy-unsubscribe Visit our companion website at www.igan.ca. The site is entirely supported by donations. If you would like to help, go to: http://www.igan.ca/id62.htm Thank you Quote Link to comment Share on other sites More sharing options...
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