How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Anthony Bray, MD Your Own Question
Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10341
Experience:  14 years experience in the field of Family Practice
Type Your Medical Question Here...
Anthony Bray, MD is online now
A new question is answered every 9 seconds

My mother is 83 years old. She is on hydrochlorothiazide,

This answer was rated:

My mother is 83 years old. She is on hydrochlorothiazide, labetalol, carvediol, and lisinopril for hypertensin. Her physician added cardediol about 3 months ao. She has been dizzy, weak bp 140/ 40 since that time. Physician states she needs both labetolol and cardediol even though they both have beta blocker effect. He tells her she needs to stay on the carvediol. Am i missing something here. It seems to me the carcediol is what is making her sick. The BP was 140 to 150 over 90 prior. To the carvediol
Anthony Bray, MD : Hello!
Anthony Bray, MD : The 2 drugs labetalol and carvedilol ( Coreg) are both Alpha/ beta blockers ...
Anthony Bray, MD : they are the same class . I see no legitimate rationale for using these two together!!
Anthony Bray, MD : now the class itselfAlpha/beta blocker does have good properties in that it balances reducing vascular resistance if the arteries as well as gently lowers heart rate and the contraction of the heart...
Customer: So is is something that is not common to do with elderly pts
Anthony Bray, MD : Coreg does have an excellent study showing a 40 % reduction in death due to heart failure...
Anthony Bray, MD : so I am not downing this class in general...
Anthony Bray, MD : I do advise that she needs only ONE medicine if this class and her resting BP average should be in range if 100-135/ 60 - 85 for good control...
Anthony Bray, MD : right it makes no sense to use these two drugs together... One or the other may definitely have benefits though....
Anthony Bray, MD : I do not criticize either medicine alone but she does not need to be on both of these together ...
Anthony Bray, MD : The diastolic of 40 is too low... She needs monitoring over time though...
Anthony Bray, MD : we do not advise making too much if any single BP reading... It is the seated resting average that is significant to watch over time...
Customer: Asumming her bp is not under good control before the carvediol, besides mazimizing the doses of the other drugs she is on what would be the fourth class of drugs to put her on. Also, would just using the carvediol instead of the labetelol be an option? My mom is tough, healthy and has had a significant downgrade in her functioning since starting the carvediol
Anthony Bray, MD : we would not want to endanger her to make her pass out though!! Also blood flow to key organs such as kidneys may not be adequate if prolonged low diastolic of 40....
Anthony Bray, MD : Yes it may be an option to use only carvedilol or only labetalol ... The dose of either may be adjusted to her best benefit...
Anthony Bray, MD : It may have been an option to keep her first three meds and increase dose of HCTZ to 50 mg ( if she had been on most common dose of 25mg...)
Customer: Actually I M a pediatric GI specialist but dont use these meds in my pts. I only know enough to be dangerous and dont want to second guess her family doc. After much discussion with her though, she decided to hold her carvediol and began to feel better in 24 hours but then she saw her doc 2 days later who told her she needed to be back on the carvediol as well as the labetolol because those drugs work together. That really did not sound right to me. My mom though is very compliant and will do what her doc says. She was driving and walking all over the farm 3 months ago but is now too dizzy and weak to do either. She may need to change docs but they are hard to find where she lives.
Anthony Bray, MD : it may be option to stop lisinopril( ACE inhibitor) and place her on A2 blocker( Benicar/ losartan/ Irbesartan/ others) often I have found the A2 blockers to be similar in effect if ACE inhibitor but usually a bit more potent...
Anthony Bray, MD : she basically needs a milder adjustment from140-150/ 90 but without pushing her diastolic so low!!!
Customer: Can you use the lisinopril and losartan together
Anthony Bray, MD : I agree... It sounds concerning to me that her primary care doctor would insist that she needs both of these alpha/ beta class drugs at same time ... I see no rationale for this at all!! This would concern me as well if my mother's doctor was going down this path. I feel unfortunately that changing doctors may be in order?? As you know we hate to be critical of colleagues but two alpha/ beta blockers does not make sense here... Especially with her low diastolic and dizziness for her doctor to insist that she needs to remain on same seems really out of place...
Customer: In the adult world are there standard protocols that practices following when adjusting BP meds. For example a very basic protocol that a pt a
Anthony Bray, MD : I have to also throw in the possibility of a breakdown in communication??
Anthony Bray, MD : might her doctor have meant to switch to carvedilol instead of adding ?? Are the meds being confused??
Customer: A pt can call in to give reports regarding response to changes in the meds. I do think that communication is a problem. My mom oly gets an answering machine when she calls and then makes an appt but has to wait for weeks to be seen.
Customer: I suspect that there is a breakdown somewhere. I just wanted to talk to an unbiased person about my suspicions that the medications were really not quite right. When my mom was in the clinic the doc had her med list in front of him and really was not happy that my mom held the carvediol. S
Anthony Bray, MD : No there is not a standardized adjustment protocol per se... Part of the reason is that the choices if BP medications so often may depend on a variety of factors such as secondary benefits( tachy arrhythmias / heart disease/ CHF/ COPD/ migraine headaches/ renal disease/ hyperlipidemia/ diabetes)
Anthony Bray, MD : i would advise that she get her own BP cuff if not already owning one( I prefer the wrist type cuffs from the pharmacy options) checkBp random times once a day seated AFTER10 minutes rest...
Anthony Bray, MD : this should be recorded and shared with her doctor...
Anthony Bray, MD : she should always make list of all meds and supplements to take with her to doctor...
Anthony Bray, MD : if she is willing to let you accompany her then you would help serve her as potent advocate!!
Customer: Thanks for your honest response. I dont want to be critical toward her doc but feel that good communication and action in regards ***** ***** effects is in order. Also, That i wasnt missing something in regards ***** ***** between the labetalol and the carvediol. I really want to go with her to the doc but i live 800 miles away!! I will do my best though to be her advocate. This is new to us as she has always had good health. Thanks for the advice.
Anthony Bray, MD : I see... Yes this situation seems odd to me... I like the medicine carvedilol too but would not combine this with labetalol !!
Customer: Thanks
Anthony Bray, MD : Basically the combination places her on two drugs that block alpha receptors... This decreases peripheral vascular resistance... This is dropping her diastolic pressure too low and making her dizzy... It could make her faint!!
Anthony Bray, MD and 8 other Medical Specialists are ready to help you