This article is a transcribed edited summary of a video Bob and Brad recorded in November of 2020. For the original video go to https://www.youtube.com/watch?v=ohNxx2HSkik&t=48s
Brad: Hi, Brad Heineck, physical therapist.
Chris: Hi, I’m Chris the pharmacist.
Brad: Today we’re going to talk about Losartan, for high blood pressure, what are the side effects and the risks that you need to know. Chris is going to go through this in detail and answer all your questions. So, I’m going to pretend that I just came from the doctor. The doctor said, you got high blood pressure, hypertension. I’m already like, oh no. He says, “You’re going to have to take this medication.” He went through some of the rigor on how to take it, but I was so kind of nervous that I forgot. I’m going to go to the pharmacist and figure out if I can get this squared out and feel more comfortable about it. Now, I didn’t know this until a few years ago, Chris is a pharmacist and I’ve known him for years, but I actually went to where he distributes his medications. He does an outstanding job on making his customers feel like they’re knowledgeable about the product, that medication they are going to take. So that’s the approach we are going to take. So, Chris can you talk a little bit about how people come for Losartan?
Chris: I sure can.
Brad: They are a little nervous sometimes, they are mad or what is this?
Chris: I think there are a lot of emotions. Anytime somebody tells you that something’s wrong with you, I think we somehow naturally kind of get a defensive mechanism. We are like, oh my gosh, this is awful. I think a lot of times when you’re not feeling well, or in the case like Losartan, which is a medication for blood pressure. I’ll be it can be used for a couple other things too.
Brad: Is Losartan the name of it or is that a generic name?
Chris: Generic name is Losartan, brand name is Cozaar. It’s the first angiotensin receptor blocker that was out on the market, ARB for short.
Brad: So, what does that mean?
Chris: That’s how it works. It’s just all these drugs have their own little categories. They can have calcium channel blockers.
Brad: Does that work with the heart directly?
Chris: Actually, indirectly. It’s going to work on the blood vessels itself. If you were to come up and I’d say, Hi Brad, looks like a prescription for Losartan today. It looks like it’s going to be a 50-milligram tablet daily. Did your doctor spend a little time talking to you about the medication?
Brad: Yeah, but I can’t remember anything he said.
Chris: You probably went through a lot. It’s a lot to hear and a lot to process. Why your doctor chose this, he didn’t like how he saw your blood pressure developing. So, he thought it was probably a little elevated in all likelihood. Does that sound like something you guys may have talked about?
Brad: Yeah. He said something about maybe it would raised my risk for a stroke or something like that which was pretty scary.
Chris: Well, actually it’s going to help to prevent strokes, by lowering the blood pressure. High blood pressure can increase your risk for a stroke so by lowering it.. What it does in your body is it’s going to relax the vessels in your heart and all around your heart, so the heart doesn’t have to work so hard.
Brad: So, when you say vessels, you mean like arteries?
Chris: Yes, arteries, arterials.
Brad: So, they get relaxed and they get bigger?
Chris: Yes, they have little receptors. So, if you think of it as a hose, so when its wide open, water is flowing right through that garden hose. When it gets cramped down, it comes through a lot harder but there’s a lot more resistance to squeeze that water through that tiny hole.
Brad: So, the pressure goes up?
Chris: Yes. If you think of your heart is the pump, it has to work a lot harder to get that water through the, well, in this case your blood through your body.
Brad: So, it just relaxes the vessels, allows the blood to flow more easily so the less pressure for the heart and then the blood pressure goes down.
Chris: Yes. Heart’s not working so hard anymore.
Brad: That’s not so bad. So, I just take it twice a day?
Chris: Well, no, your doctors got you taking this once a day. Actually, the newer study is showing it might be better to take blood pressure medication, most blood pressure medication, at bedtime. Diuretics you have to take in the morning, that’s a different discussion. But we’ll talk about for this one, probably going to do better at night. Actually, maybe a 50% reduction in heart attack and stroke, but you’re taking your blood pressure at the same time every day at night. The big thing to make any medication work well is to take it consistently. It’s important for you to take it at the same time every day or within a small window. If you’re taking it at bedtime, just take it approximately the same time every day. That’s critical for you.
Brad: Okay. Do I need to take it with food?
Chris: This one doesn’t matter, which is good.
Brad: So, just water?
Chris: Yes, a big glass of water, so like 6-8 ounces of water. Some people don’t like to drink a
lot before bed, but you do want to be hydrated.
Brad: What if I, you know, I have a beer?
Chris: Well, that’s a good point that you bring up. Being from Wisconsin you know, there’s a lot of people that drink a beer before bed.
Brad: Well, Saturday night football, before you go to bed.
Chris: Exactly, and so blood pressure, when you have a beer or a glass of wine, it is going to naturally bring your blood pressure down, so you could get lightheaded or dizzy, which kind of leads us into some of the side effects with Losartan.
Brad: So, I’ll get lightheaded and dizzy from the alcohol?
Chris: The alcohol and the drug. It’s the combination of the two together. Your blood pressure’s here and you can bring it down even further. Say you’re sitting down and watching the game; you took your medication because you have an hour to go before bed and then you stood up too quickly. All of a sudden you get really lightheaded or dizzy. That’s called orthostasis. It’s a fancy term that just says you’re dizzy. Some people can be so severe though, you could hit your head on the coffee table.
Brad: So, you get so dizzy you fall.
Chris: Yes. You want to be really careful about that. As we age, sometimes our muscles don’t work as well as one another. This is probably a lot more in detail than what I would give to a patient, but it’s something to be aware of. We don’t want you to take a tumble because you could get hurt. We have to be careful with that. It’s the first five days while you’re on drugs like Losartan, it takes your body about that long to start to begin to see that blood pressure lowering. Then it takes about 3-6 weeks for that maximum response to occur. You might have to go back and see your doctor to see how things are going and maybe they’ll adjust as necessary.
Brad: So, I’ve got a lot of things going on here. I feel a little bit better about it now, but there’s some things, the side-effects. I’ve heard there’s some side effects that may not be good for this.
Chris: All drugs have a ton of side effects.
Brad: You’re not making me feel good Chris.
Chris: I know. Basically, we want to focus on the major three. Most side effects in general from all medications, very very uncommon across the board. Everyone is going to have a story. Well, my uncle took this, and it was horrible. It can happen. We have genetic predisposition, so certain drugs our race can dictate what drug is actually better for us versus others.
Brad: So, we need to really depend on our doctor.
Chris: Your doctor did the homework. He prescribed this for a very specific reason. Unfortunately, anytime we get a new prescription, you don’t know what that first dose until you try it. Sometimes it takes our bodies a few days to get used to it. We want to be really mindful of that. So, in case of the blood pressure medication, like I said, takes about 5 days to start to kick in, 3-6 weeks for that next response. What we’re going to see is your blood pressure is up here and it’s going to gradually come down. It’s not going to come down like you’re coming off a cliff. If it did that, you could have some pretty serious problems and that orthostasis we mentioned earlier.
Brad: But you’re going to feel some symptoms. Lightheaded, dizziness.
Chris: You are. So, lightheaded and dizziness are the primary things that I always warn people about. So how do you prevent it? Well, when you get out of bed in the morning, don’t just jump out of bed and walk across the room. Just sit up slowly. That’s one thing that I find very important. Let’s say you wanted to tie your shoes and you just popped right back up, stand up slowly for the first couple of days. Your body will naturally adjust. After about the first five days, you just take a little bit easier then. After that, the side effects really become inconsequential with this drug. The one thing that we want to watch for and if this is the only drug, you’re on, it’s not going to be a big issue. But sometimes people that have blood pressure issues may take multiple medications. This is a drug that is known to raise our potassium levels and potassium, you know, this is going to be a sidebar here. For the most part, we have to make sure that we aren’t eating more potassium than we should. A normal healthy diet where you are having some bananas, cantaloupe, potatoes, broccoli, those types of things are certainly fine, you just don’t want to overdo it.
Brad: Those are foods that are high in potassium?
Chris: High in potassium. Oranges, orange juice, those types of things. You know, you don’t want to have tons of it, but I still think it’s important to have a wide variety of food in your diet. When you heard me say diet, diet’s very very important when people have blood pressure issues. One of the coolest things that most patients aren’t aware of when they hear the bad news that they have hypertension, we can get you off these medications with lifestyle changes in a lot of cases. So, if you’re willing to put the work in and exercise and you’re willing to put the work in and eat a healthy balanced diet and you’re willing to get some good rest and hydrate well, we may be able to naturally get off of the blood pressure medicine. Losing weight, even if it’s just like 10 pounds, might be enough depending upon where that level is, you know, genetic factors withstanding. Again, your doctor would probably tell you this, but again, it’s pretty overwhelming to hear that you have hypertension. Do you think you’re going to have a stroke? Do you think you’re going to have a heart attack? Do you think you’re going to die? It can be a terrifying experience for a lot of patients.
Brad: So, the biggest side effect I have to worry about is monitor that I’m not getting lightheaded or dizzy and if that’s not happening, I trust my doctor. He gave me the right one in combination with the other medications I’m taking. Also, another pharmacist, you will be aware of the other medications that patient’s taking.
Chris: Yes, we are going to be looking at that exclusively.
Brad: So, you double check it?
Chris: Yes, we are anal retentive to a fault. We’re going to sit there and look at that profile and make sure that there’s nothing cross-reactivity type-wise because people could come in for Losartan and there could be another drug like Lisinopril. This is a total sidebar again. We see, why are you getting this today? Oh, I have a cough. What’s a primary side effect of that drug? Well, discontinue that and we’ll start this because too much together, all that potassium problem could be an issue, lightheaded, dizziness. There’s a lot of things going on.
Brad: So, between the physician and the pharmacist, you guys double check with each other to make sure you’re both on the same page.
Chris: Oh yes, there’s phone calls, faxing, emails, we communicate pretty readily with the nurse staff. Usually, we end up with the nurse staff. They double check with the doctor and relay back to us. But we’re looking for those things very hard. Actually it’s 90% of my job.
Brad: Well, I feel a lot better so I can take it, I know the side effects and if I want to take the effort and change my diet, my exercise and my liquid intake, water, you’re saying I can get rid of these.
Chris: It’s very possible. You have to put the work in. It might take a little bit of time, but you know, working with your doctor and knowing that you’ve got a plan to work ahead, I mean you can live a healthier lifestyle. I will point out, all drugs do have side effects, even the positive effects of the drug are a side effect. We just learned that that was the good part of it. So, if something bad happens, let’s say, you’re losing consciousness, you’re really dizzy, you don’t feel right, you’re nauseous, just thinking your heart’s racing. Just something’s, I mean, when we take many different medications, you know, if it’s weird, reach out to your pharmacist, reach out to your doctor, right away. If you don’t feel right, it could be a possibility that there’s something going on. And the other thing we didn’t touch on, if you’re pregnant or thinking of getting pregnant, Losartan is not a good drug for you.
Brad: Oh, that’s good to know.
Chris: It’s teratogenic. Anybody at childbearing age, it’s important to have probably a backup plan if we’re trying to avoid pregnancy. Or, you know, maybe we have to try and find a different medication if that’s the family planning is in the future.
Brad: Okay, well good. I feel a lot better about it now, Chris. And hopefully, that’s the same experience you will feel after you see your doctor, your pharmacist. I didn’t realize it, but that is one of the jobs of the pharmacist, is to help you understand what you’re taking.
Chris: Yes, that’s what we hope to do for everybody.
Brad: That’s right. Very good, can you do anything for a broken heart, Chris?
Chris: I can fix a lot of broken things, but I can’t fix a broken heart, I’m sorry.
Brad: Well, then you’re not going to be able to help Bob and I on that quest.
Chris: HAHA, have a great day guys!
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