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Writer's picture: Concise Curated CounsellingConcise Curated Counselling

Should you really reach for that diuretic?

 

Click here for previous newsletters.


1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.




Counselling Conundrum: "I just started a new blood pressure pill that looks like a white stop sign, and now I have swelling in my ankles. Can you give me a water pill for that? My blood pressure is also still a bit high."

 

Concise Conclusion: This is a common side effect with amlodipine, however diuretics don't generally solve this problem. I will check if you're taking any medications that could be stopping your body from getting rid of the drug from your system, which could cause more side effects. Assuming no interactions, we can either reduce the dose, or add a new medication called an ACE inhibitor or an "ARB', which typically helps balance things out so the swelling comes down. Sounds like in your case the latter would be best, seeing as your blood pressure is still high.

 

Quick Wrap-up: DHP-CCBs often cause peripheral edema, which leads many patients to discontinue the drug. It's thought to be due to arteriolar dilation that pushes fluid into the interstitial space, and diuretics don't appear to be effective. Our options are to reduce the dose, or add an ACEi/ARB, which balances the pressure gradient.

 

 

Dive Deeper

 

We hope you have found this useful. A reply to this email with any feedback or topic suggestion you may have would be greatly appreciated. Your input will be the key to making this newsletter the best it can be.

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