Greetings, Dr. Roach Both my spouse and I have low blood sodium levels, typically around 132, but occasionally lower. It never makes it to 135. Since salt is necessary for cell upkeep, this is concerning. Our doctor is concerned when it drops as low as 129. Every other metabolic metric is within the typical range.
Two potential offenders come to mind. In addition to not using a lot of extra salt in her cooking, my wife and I never consume fast food. However, we both have labile hypertension, which can lead to stressful events (like elections) causing our systolic pressure to reach 170 mm Hg.
We both take clonidine, with one of us taking losartan and the other taking olmesartan as supplements. Since clonidine dehydrates us, we question if it or the other drugs are causing our blood sodium levels to drop. Do you think our low sodium levels are more likely to be caused by our diet or our medications? — T.D.
ANSWER: The medications are probably the cause, not the diet. Under a relatively broad range of water and sodium consumption, a healthy kidney can regulate sodium. Low sodium levels, however, can occasionally be brought on by clonidine and angiotensin receptor blockers (ARBs), such as losartan and olmesartan. The most likely drugs to lower sodium are diuretics like HCTZ and chlorthalidone, but other medications you are taking may also do so, most likely by influencing the hormone known as antidiuretic hormone or by causing the kidney to excrete more salt.
As a blood pressure medication, clonidine is a bit of an odd option. It isn’t a first-line medication. The standard first-line therapy for high blood pressure include calcium blockers, ACE inhibitors, ARBs, and diuretics. I’m not aware of any other reason why your doctor would have prescribed clonidine.
High blood pressure specialists often recommend a prescription that blocks the hormone aldosterone (spironolactone and eplerenone do this) for patients who still have high blood pressure when taking these drugs.
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Greetings, Dr. Roach Taking Adderall for years has helped me, a 72-year-old lady, deal with attention deficit hyperactivity disorder (ADHD). A CT angiography recently revealed that I have nonobstructive coronary artery disease. Should I quit taking Adderall? — V.P.
ANSWER: The outcomes of the studies intended to address this question have been inconsistent. However, after reviewing numerous research on the topic, it appears that stimulants like amphetamine/dexamphetamine (Adderall) may slightly raise the risk of heart attack and mortality.
Compared to a person not using Adderall, one study found a 3% absolute higher risk of having a serious heart attack (within a few years), with the risk being highest when the stimulant is first started.
Plaque in the blood vessels supplying the heart muscle is present in nonobstructive coronary artery disease, but it is not substantial enough to block blood flow. Although this is preferable to obstructive CAD, there are still calcium and cholesterol deposits in the coronary arteries that could burst and cause a heart attack. The risk of a heart attack is significantly higher for someone with known blockages than for someone without. Therefore, Adderall is much more of a concern in your situation.
I wouldn’t feel comfortable giving an elderly person with known coronary heart disease an Adderall prescription. Your doctor should give continuing this drug serious thought. Since they are probably less dangerous, I suggest a nonstimulant agent like guanfacine or clonidine, which is frequently used as a blood pressure medication.
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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