Women's Health

What`s causing cloudy thinking/irritable?

04/22/2008

Question:

I am wondering if the meds are causing my clouded,confused thinking and irritableness? or the conditions themselves? These are my meds: Enalapril 10mg BID, Amlodipine 10mg 1/2 OD, Atenolol 50mg OD, Levothyroxin 100mcg OD, HCTZ 50mg OD, Lovastatin 40mg OD, Amytriptyline 25mg HS. I have hypertension,hypothyroidsm,RLS,and was just tested a month ago and now am pre diabetic. I have been eating healthy low sodium,fat,sugar(mostly sugarfree)and have lost 16 pounds so far. But these symptoms have been going on for quite a while and the Doctor says its not any meds he is giving me. Any thoughts?? My last month test showed my thyroid where it should be. Yet the above mentioned symptoms and a few small ones in addition (hair loss,dry skin,tiredness,nervousness)have me at a loss. Thank you for your time, it is much appreciated!

Answer:

Each individual responds to medicines in a unique way. When a medicine is first studied, prior to approval by the FDA, subjects keep track of symptoms they are experiencing while on the study drug (or on placebo). The analysis afterwards then compares the frequency of the symptoms to those that are listed for the placebo, and those that are noted more frequently with the drug (compared to the placebo) are listed. If one were to look at the information packet for each drug, the "adverse" effects are astounding.
With that as a background, the most common symptoms (and these are usually only about 1-3% of subjects) experienced by people on the various drugs are as follows:

1. enalapril - low blood pressure, dizziness, fatigue, high potassium, nausea/vomiting, elevated kidney function, musculoskeletal pain, cold symptoms

2. amlodipine - swelling, headache, fatigue, palpitations, dizziness, nausea, flushing

3. atenolol - low heart rate, low blood pressure, fatigue, dizziness, cold extremities, depression, shortness of breath, low blood pressure on standing, leg pain, chest tightness and wheezing, lightheadedness, lethargy, diarrhea, nausea, vertigo, drowsiness

4. levothyroxine - palpitations, increased appetite, fast heart rate, tremor, nervousness, weight loss, sweating, diarrhea, abdominal cramps, insomnia, fever, headache, loss of hair, heat intolerance, menstrual irregularities, nausea, anxiety (note: you noted that your thyroid hormone is properly replaced, so it would be unlikely that any of these would occur at the proper dose)

5. HCTZ - lots of chemical issues that would be picked up by blood tests (e.g., low potassium, sodium, magnesium; high glucose, calcium, etc), dizziness, anorexia, diarrhea, abdominal pain, headache, weakness, muscle cramps, photosensitivity, rash, sexual dysfunction

6. lovastatin - infection, headache, joint pain, sinusitis, back pain, flu syndrome, pain, flatulence (gas), muscle aches, urinary tract infections, abdominal pain, diarrhea, dizziness, weakness, elevated liver enzymes

7. amitriptyline - drowsiness, dry mouth, dizziness, constipation, blurred vision, palpitations, fast heart rate, incoordination, increased appetite, nausea/vomiting, sweating, weakness, disorientation, confusion, restlessness, insomnia, anxiety/agitation, urinary retention or frequency, rash/hives, itching, weight gain, changes in libido, impotence, large breasts or discharge from the nipples, tremor, high or low blood sugar, numbness, sensitivity to light

Now, that's a long list! Fortunately, the vast majority of people taking these medicines will not experience any of these side effects, or if they do, most wear off with time. When I look at the dosages of the medicines you are on, all of them seem appropriate and at a low dose (except for HCTZ - some will recommend keeping it at 25 mg or lower).
So, to answer your question, it could be that one (or more) of the medicines are causing your symptoms, but none stand out as the primary cause. It could also be that the conditions for which you are being treated can cause these also. If you continue to exercise and lose weight, there is a great chance that you can come off some of the blood pressure medicines, which might help. The only other option is to experiment with your doctor - pick a drug and come off it (with or without a substitution) - then see if your symptoms go away.

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Response by:

W. Fred Miser, MD
Associate Professor of Family Medicine
Department of Family Medicine
College of Medicine
The Ohio State University