Question to general practitioner Maarten: Replacement of Prenolol
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.
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Dear Martin,
My blood pressure is on average 135/68 and heart rate 55. What can you recommend as a replacement for prenolol 100 mg? Measure my blood pressure about every 15 days. I have stents in my left upper and lower leg as well as in the chest. About 3 years ago and no problems since.
Regards,
R.
******
Dear R,
You can try it with, for example, nebivolol 5mg (Nebilet). Probably the pharmacy has to order it.
- Start with a quarter tablet of Nebivolol and reduce the Prenolol to 75 mg.
- If after a week blood pressure and pulse remain good, reduce Prenolol to 50 mg.
- After a week increase Prenolol 25 mg plus possibly Nebilet to half a tablet (2,5 mg).
- After a week stop Prenolol and if necessary increase Nebilet to 3/4 tablet (3.75 mg).
- Possibly Nebilet 5 mg.
That is a total of 3-4 weeks. It may be that 1.25 mg Nebilet is ultimately sufficient. If this does not work, there are many other possibilities.
Take the blood pressure pills in the evening.
A good blood pressure is between 150/115 systolic (first reading on the meter) and 75/90 diastolic. Pulse between 60 and 70. The guidelines go lower, but that's to sell more pills. These guidelines are drawn up by the industry, which pays some well-known doctors to put their names under it.
Do report to your doctor that you have changed your medication, even if it works well.
Sincerely,
Dr. Maarten
Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information (see list at the top of the page).