Change from Diovan to Zestril
Andrew Chung
>
> Take it easy now, Dr. Chung:
>
> It is unfair and dangerous to carry out summary executions of your
> colleagues without having all the facts. Besides, it is grossly unethical.
> Please consider what it will do to the doctor/patient relationship with your
> correspondent.
> You might argue that your correspondent did bring up the $$$$ subject, but
> he was also rightly prepared to consider that may be Zestril was better than
> Diovan for him. Besides, he says he has no cough and I do not see him
> mention any allergic reaction.
> He wanted some information about the pros and the cons of Diovan against
> Zestril, although he seems already to know something about bradykinin or
> whatever.
> I do not think that you gave him the information he wanted.
> Besides,do we know whether Diovan is better than Zestril?
>
> The GP made a clinical decision: you have no evidence to the contrary.
>
> Xtal
>
> Original Message----->From: Andrew Chung <ach...@emory.edu>
> >Newsgroups: sci.med.cardiology>Date: Saturday, February 27, 1999 3:41 PM
> >Subject: Re: Zestril versus Diovan>>>>>>>>Kolaga Xiuhtecuhtli wrote:>>
> >>> My GP switched me from Diovan (valsartin?) to Zestril (linosospril?)
> >>> just recently. Diovan is a new Angiotensin Receptor Blocker and
> >>> Zestril is an (old-fashioned) ACE inhibitor.>>>
> >>> I'm wondering why she changed my meds. I got the word over the
> >>> phone from her receptionist. And coincidentally, this switch
> >>> occurred the day after I called to ask the doctor to write a
> >>> letter to my insurance company so that I would be approved to
> >>> receive the Diovan under my plan.>>>
> >>> This is day two of Zestril and I've got no complaints. Maybe
> >>> it's better than Diovan. After all, there's some business
> >>> about ACE inhibitors blocking the breakdown of bradykinin which
> >>> is a vasodilator. I seem to have a tad of a headache but maybe
> >>> that's because I decided to stop drinking coffee. But I haven't
> >>> developed a cough (yet), so maybe it's all OK.>>>
> >>> Now then, what is the professional opinion on ARB's versus
> >>> ACE-inhibitors?>>
> >>IMO, your GP was forced to change your medications because of $$$ and
> >>not because of clinical judgement. ACE inhibitors have a more worrisome
> >>side effect profile as compared to AT-1 receptor blockers. I would
> >>question the wisdom of deciding that the $$$ benefit outweigh the risk
> >>of either chronic cough or life-threatening allergic reaction.
> >>Insurance companies can get away with this because they are still pretty
> >>much protected by ERISA in the event the change injures you.>>>>>>-
First, I have seen firsthand changes in medications based solely on economic
considerations and Diovan to Zestril is a common one.
Second, Kolaga asked for a professional opinion of which is better, Diovan
versus Zestril and I provided that opinion. While we are on this topic, while
I think ARBs are better drugs, I wouldn't switch someone who is doing well on
ace-inhibitors to an ARB (risk of adverse rxn with any new medication >
benefit here).
Third, if you re-read the original post, I think you can infer that there are
already seeds of mistrust sown by the change in medications occurring *after*
a request for health insurance approval for the Diovan. Kolaga is a regular
participant in this NG and will likely indicate shortly whether he is now more
mistrustful of his doctor because of my comments. I suspect if anything that
he directing his mistrust more toward his health insurance company since he
has witnessed firsthand how they can influence his doctor's clinical decisions.
Fourth, you're right that it is dangerous (career-wise) for a doctor to slam HMOs.
--
Andrew Chung
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http://userwww.service.emory.edu/~achung
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Kolaga Xiuhtecuhtli
wrote:
[major snip]
>First, I have seen firsthand changes in medications based solely on economic
>considerations and Diovan to Zestril is a common one.
Here's the sequence of events. In mid-January of this year, my GP
handed me a lot of Diovan capsules. I took one and it "took the wind
out of my sails." Within the next week, I got a letter from our
prescription drug plan informing me that Diovan and 20 other
medications required "approval" in order to qualify.
I was angry at my employer for not providing me with a life-saving
medication based on it being "too expensive." I suppose my employer
is hoping I'll drop dead and not incur any more medical expenses.
But when I called the GP's office (I only talked to the receptionist)
asking for a letter to my employer's insurance company, it was the
next morning that the receptionist called back and told me to switch
to Zestril. My take on the situation is that insurance companies
can intimidate doctors.
I am hoping for the best. I'm hoping that maybe the doctor had
second thoughts and figured Zestril was better in my case if I
could tolerate it. I read my stress echo cardiogram results and it
says "mild septal hypertrophy."
To the point then, how does Zestril (linospril?) stack up as
a treatment for "mild septal hypertrophy"? What is current
opinion concerning the role of bradykinin in hypertension and
cardiac function?
After a month on Diovan, my BP was just about 140/80. After one
week on Zestril, my BP is about 126/76 or so. In the past
six weeks since this whole BP issue hit me, I've dieted and exercised
losing 12 to 15 pounds -- no more Burger King for lunch or milk and
cookies before bed. It's 30 minutes walking during lunch now and
lots of broccoli from now on.
Back to my point. What are the dangers of Zestril (ace inhibitor)?
Am I really at risk of this scary anaphlactic shock? If the
first pill doesn't kill the patient, is it safe thereafter?
I sure hate the thought of my co-workers giving me adrenaline
injections...
As for trusting my GP, it's a mixed bag. She ordered the stress
echo cardiogram which I think was a sign that she was being aggressive
in looking for target organ damage. I've got to keep telling myself
not to let my frustration and anger at my employer's insurance
plan flow over to anger at my GP. After all, she put me on Diovan
in the first place. Her judgement is probably aggressive and
conservative. Maybe the insurance plan says that I have to take
an ACE-inhibitor before I can be approved for Diovan.
>Second, Kolaga asked for a professional opinion of which is better, Diovan
>versus Zestril and I provided that opinion. While we are on this topic, while
>I think ARBs are better drugs, I wouldn't switch someone who is doing well on
>ace-inhibitors to an ARB (risk of adverse rxn with any new medication >
>benefit here).
>
>Third, if you re-read the original post, I think you can infer that there are
>already seeds of mistrust sown by the change in medications occurring *after*
>a request for health insurance approval for the Diovan. Kolaga is a regular
>participant in this NG and will likely indicate shortly whether he is now more
>mistrustful of his doctor because of my comments. I suspect if anything that
>he directing his mistrust more toward his health insurance company since he
>has witnessed firsthand how they can influence his doctor's clinical decisions.
>
>Fourth, you're right that it is dangerous (career-wise) for a doctor to slam HMOs.
"I do not believe that the same God who has endowed us with sense,
reason, and intellect has intended us to forgo their use." - Galileo
Andrew Chung
<snip>
> To the point then, how does Zestril (linospril?) stack up as
> a treatment for "mild septal hypertrophy"?
should be equally effective.
> What is current
> opinion concerning the role of bradykinin in hypertension and
> cardiac function?
Doesn't play a major role.
>
> After a month on Diovan, my BP was just about 140/80. After one
> week on Zestril, my BP is about 126/76 or so. In the past
> six weeks since this whole BP issue hit me, I've dieted and exercised
> losing 12 to 15 pounds -- no more Burger King for lunch or milk and
> cookies before bed. It's 30 minutes walking during lunch now and
> lots of broccoli from now on.
The lifestyle changes with weight loss probably played a bigger part in better
blood pressure than the change in medication.
>
> Back to my point. What are the dangers of Zestril (ace inhibitor)?
> Am I really at risk of this scary anaphlactic shock? If the
> first pill doesn't kill the patient, is it safe thereafter?
The worry occurs with initiating any new therapy.