I had a patient’s wife contact me this week. She was concerned about her forty-something year old husband’s medicine and the side effects. I tend to focus on making an impact on clients taking five or more medications. This gentleman was only taking one for high blood pressure.
He had initially been started on Lisinopril, an ACE Inhibitor. This is a good choice, first-line antihypertensive medication. He had been on it for 5 years and had a horrible cough, which is a well known side effect of Lisinopril. Fortunately someone recognized that his cough was due to his medication and switched him to and Angiotensin II Receptor Blocker (ARB), which is my go to class of medications when a patient experiences an ACE cough.
Within two weeks of the switch, the wife noticed his mood changed – he seemed depressed and had a flat affect, a severe reduction in emotional expressiveness. She had reached out to ask me if it could be his medicine and if there any other options. After a thorough investigation, I discovered that most of the medications in this class of drugs have the side effect she had described IN LESS THAN 1% OF THE PATIENTS TAKING THE MEDICATION.
I was able to confirm her suspicions and recommend some other potential high blood pressure medications he could try. I was also able to encourage her to have him lose weight and increase his physical activity to potentially eliminate the need for medications.
And then I thought,
- What would have happened if he had gone to another health care provider with these complaints?
- Would the symptoms have been link to the medication? It is certainly not a common or well know side effect.
- Would he have been put on another medication to help with the depressive symptoms?
- What if he wasn’t in his forties and was in his eighties. Would it have been looked at as “just a sign of getting older”?
The beginnings of the prescribing cascade have been averted! I only hope and pray that more patients and caregivers and other health care providers use pharmacists as the medication experts that we are trained to be.
If you have questions about medications, please reach out syneRxgy@gmail.com.