Oh, my very first rant!!!!

[Jean]

Went to see my neph a week ago and during the visit mentioned I had upchucked a couple of times. Why, he says? Well, I dont know!!!! So, he tells me to go to Sams Club and get some Prilosec and if that did not stop the upchucking, I should see my primary and have a scope done. Okay, so, I got the Prilosec like a good little patient and started to take it right away. Today, while watching TV, I heard a commercial on Plavix, which I have taken for 2.5 years and of which my kidney Dr. is well aware, since he also knows I had a heart attack and the ad says, " Do not take Prilosec if you use Plavix as it will cause the Plavix to not work as well. "HELLO?. Lets just let me have another clot break off and hit my heart or brain, but, boy I wont be upchucking. Goody!!!! I feel so much better now!!!!






TOPIC MOVED to appropriate section - Bajanne, Moderator

[monrein]

I hope you're going to call him and teach him a thing or two.   

[looneytunes]

Jean....mention the word "malpractice" and see how his face changes....

[Rerun]

That is so frustrating!  They are all idiots and we PAY them to stay in business! 

               

Even if you call him he will be "Oh, they have to say that... go ahead and take it" at which you say "Put that in writing for my lawyer".

[totosidney]

OK. Calm down. We need these sobs, even if it is likely they will kill us. The M word will not make him a better doc. My suggestion: Always shop at the same pharmacy. Always get the product insert. If you don't want to read the insert, ask the pharmacist if it is ok to take this over-the-counter med with your other stuff. BTW, that diagnosis(?) seems completely off the cuff.  best wishes..Sid

[Stoday]

I've had a similar thing happen only last month.

I always read the leaflet, which is as well. My neph prescribed Calcium Acetate which should not be taken with digoxin. When I pointed out that there was a problem he said "I haven't heard of that" and did nothing. I checked with a pharmacist who said I should leave 2 hours before taking one after the other.

[Bajanne]

That has happened to me a couple times in my lifetime.  The doctor prescribes something.  I buy it, go home and read the little sheet and find that I should not be taking it with some other medication that he had prescribed before.  One of the occasions I had even asked the doctor if it would be alright to take the second medication with the one I was taking before and he had said it would be okay.  That is not what the paper said!!
That is why one of the main encouragements in IHD is to be your own advocate.  Don't leave things up to the 'professionals'!

[Jean]

Boy, amen to that!!!! And that is what I am always preaching to my friends. Did I do it myself? NO!!!! At any rate, went to see my friendly and awesome pharmacist today and he started shaking his head no, as soon as I started talking. So, the only thing you can take for heartburn, if you take Plavix, is Pepcid AC. You learn something new every day, but, I really did not want to have to learn this, at this point. I am thinking of changing nephs anyways as last time I asked him about nocturnal dialysis and he said it was too soon for me to worry about that and I did not need tubes and things hanging out of my body. Tells me, he will give me all the information I need when it is time, and I will make an informed decision. Thanks so much to all of the friends at IHD for all the knowledge they have given me.

[Quickfeet]

You have to watch them every second.

[KICKSTART]

I dont know why but this is a common thing ! If i look at all the tablets i take nearly all of them say DO NOT take if you have kidney problems , yet these are the very tablets used to treat all our annoying problems that go with kidney failure.

[kevno]

Kickstart we do not have Kidney Problems. We have no bloody kidneys 

Now I always double check what ever I am given now. At least ask another Neph, if you can get any sence out of one 

Over the years been put in ICU 3 times overdosed on Morphine, renal patients can not get rid of morphine so it just builds up in you system. Only thing is i did not know I was being given morphine. I was out of it after operations. 
Once a neph stopped atenolo, its a beta blocker. Nearly had a heart attack!  It needs to be stopped over a few weeks not straight away like he did.

Plus may more too many to mention.

[EnglishBelle]

Oh Kevno, I too have just had atenolol stopped, instantly and now my bp is up to 140/90 and my pulse is never under 100 (even after a good nights sleep or 3hrs dialysis). I am concerned, my GP is concerned but the unit staff do not seem to care, for in the four months on dialysis, I have yet to see a nephrologist. I was transfered from my Neph to a new one, just because I fall under his "time" slot, as I start dialysis at 7am. Yet to see the guy.

[KICKSTART]

Kickstart we do not have Kidney Problems. We have no bloody kidneys 

Now I always double check what ever I am given now. At least ask another Neph, if you can get any sence out of one 

Over the years been put in ICU 3 times overdosed on Morphine, renal patients can not get rid of morphine so it just builds up in you system. Only thing is i did not know I was being given morphine. I was out of it after operations. 
Once a neph stopped atenolo, its a beta blocker. Nearly had a heart attack!  It needs to be stopped over a few weeks not straight away like he did.

Plus may more too many to mention.

I also think everyone is different !  I still have an extremely high resistance to sedatives , in fact last time i needed them i was told i need a bucketfull ! and as for holding onto meds , well within an hour of being sedated , i was up and about , eating drinking and the doc was so suprised that he agreed to let me go home ! I have also had atenolol  stopped but suffered no effects. Maybe you where just unlucky?

[MooseMom]

I believe that if you have a chronic illness like CKD, you just have to assume that you will need to educate yourself thoroughly before you take any new med.  I don't even leave the pharmacy before looking at the patient info sheet and asking the pharmacist if I have a question. 

[RightSide]

That has happened to me a couple times in my lifetime.  The doctor prescribes something.  I buy it, go home and read the little sheet and find that I should not be taking it with some other medication that he had prescribed before.  One of the occasions I had even asked the doctor if it would be alright to take the second medication with the one I was taking before and he had said it would be okay.  That is not what the paper said!!
That is why one of the main encouragements in IHD is to be your own advocate.  Don't leave things up to the 'professionals'!

An even trickier problem is when one of your doctors prescribes one med to treat one condition (say kidney disease), and another doctor prescribes another med to treat another condition--and the two meds interact badly with each other.  No doctor is an expert on all the meds that exist today.

The website "Drug Interactions Checker",

http://www.drugs.com/drug_interactions.html

enables you to search for drug interactions of the meds you take.

For example, for "Prilosec AND Plavix," it says this:

MAJOR INTERACTION: 
GENERALLY AVOID: Coadministration with proton pump inhibitors (PPIs) may reduce the cardioprotective effects of clopidogrel. The proposed mechanism is PPI inhibition of the CYP450 2C19-mediated metabolic bioactivation of clopidogrel. This is consistent with studies that reported decreased effectiveness of clopidogrel and poorer clinical outcome in patients who have common genetic polymorphisms of CYP450 2C19 resulting in reduced or absent enzyme activity. In a population-based nested case-control study among patients aged 66 years or older who started clopidogrel after treatment of acute myocardial infarction, concomitant use of PPIs was associated with a significantly increased short-term risk of reinfarction. No association was found with more distant exposure to PPIs or with current exposure to H2-receptor antagonists. In a stratified analysis of the type of PPIs used, pantoprazole was not associated with recurrent myocardial infarction among patients receiving clopidogrel. However, the number of patients receiving pantoprazole in the study was relatively small. Compared with no treatment, the other proton pump inhibitors (lansoprazole, omeprazole, rabeprazole) were collectively associated with a 40% increase in the risk of recurrent myocardial infarction within 90 days of initial hospital discharge. In the Clopidogrel Medco Outcomes Study, a retrospective analysis of 16,690 patients taking clopidogrel for a full year following coronary stenting revealed that patients who also took a PPI (esomeprazole, lansoprazole, omeprazole, or pantoprazole) for an average of nine months experienced a 50% increase in the combined risk of hospitalization for heart attack, stroke, unstable angina, or repeat revascularization. Specifically, use of a PPI was associated with a 70% increase in the risk of heart attack or unstable angina, a 48% increase in the risk of stroke or stroke-like symptoms, and a 35% increase in the need for a repeat coronary procedure. The event rates for the individual PPIs are esomeprazole 24.9%, lansoprazole 24.3%, omeprazole 25.1%, and pantoprazole 29.2%, compared to 17.9% for the no-PPI control group. In a study of 105 consecutive high-risk coronary angioplasty patients receiving aspirin and clopidogrel, PPI users had a significantly lower antiplatelet response to clopidogrel than nonusers as measured by the VASP (vasodilator-stimulated phosphoprotein) phosphorylation assay, which provides an index of platelet reactivity to clopidogrel. No significant differences in antiplatelet response were found for users of statins, ACE inhibitors, angiotensin II receptor antagonists, and beta-blockers compared to nonusers. A subsequent study conducted by the same investigators reported similar results when omeprazole (20 mg/day) or placebo was given for seven days to 140 coronary artery stent patients receiving aspirin and clopidogrel. In contrast, a study of 300 consecutive patients with coronary artery disease undergoing PCI found that esomeprazole or pantoprazole use did not impair the response to clopidogrel as measured by VASP assay or ADP-induced platelet aggregometry. Another study also found no effect of lansoprazole on the pharmacokinetics or pharmacodynamics of clopidogrel, and that increasing gastric pH did not influence platelet inhibition by clopidogrel. The interaction has not been studied with dexlansoprazole. According to the product labeling, dexlansoprazole is unlikely to inhibit CYP450 2C19 based on data from in vitro studies. However, it is a substrate of the isoenzyme, thus competitive inhibition could occur.

MANAGEMENT: Until further data are available, the use of proton pump inhibitors should preferably be avoided in patients treated with clopidogrel. PPIs should only be considered in high-risk patients such as those receiving dual antiplatelet therapy, those with a history of gastrointestinal bleeding or ulcers, and those receiving concomitant anticoagulant therapy, and then only after thorough assessment of risks versus benefits. If gastroprotection is necessary, H2-receptor antagonists or antacids should be prescribed whenever possible.


Great website!!!

[billybags]

I must admit our local GP,  lovely young woman, always gets in touch with our neph before she prescribes any thing for my husband. I must admit it is a nightmare with all these pills and every one says "do not take if you have kidney problems". If my husbands restless leg is bothering him and it mostly does I will say "ok if you take a gabapartin you can not take a paracetamol or an indigestion tablet" is your leg that bad? I think we all have to change into a pharmacist or a renal doctor at times.It is good that we read the pamphlets that come with the meds and ok they try to cover most eventualities but some times you think "no these are not for me" whether the doc says they are or not. Keep on top of it people.

[FineWhine]

My PKD kidney specialist told me I didn't have to be on a kidney diet, for crying out loud! I went to a dietitian myself and started a low protein diet about 10 years ago, still not on dialysis! GFR 11. Anyway, last summer the specialist tells me I HAVE to be seen by their nutritionist, waste of my time. Found out they had accreditation problems and this was a requirement. Been shopping for a new transplant hosp ever since, and have been seeing a great neph locally.