Posted by ed_uk2010 on November 11, 2013, at 15:45:40
In reply to Re: coreg, posted by joef on November 7, 2013, at 22:10:02
> thank you ..it seems that maybe celexa or Lexapro might be safer.....although he was not worried about cymbalta
Duloxetine (Cymbalta) can sometimes increase heart rate and occasionally BP. It is therefore not an ideal choice in pts with heart disease, but may be OK when combined with a beta blocker.
Citalopram (Celexa) and escitalopram (Lexapro) are rarely associated with cardiac arrhythmias. There are therefore not ideal in heart disease either.
Sertraline (Zoloft) is not generally associated with changes in heart rate, BP or cardiac rhythm. It has few drug interactions and is a good choice in pts with heart disease.
All SSRIs and SNRIs increase the risk of gastric bleeding when taken in combination with anti-platelets (especially multiple anti-platelets, as used in stent pts). Common anti-platelets are ASA (aspirin), clopidogrel (Plavix), ticagrelor (Brilinta) and prasugrel (Effient). When your doc does a CBC, a decrease in hemoglobin levels may be due to small amounts of blood being lost into the stomach over a period of time. Proton pump inhibitors such as omeprazole (Prilosec) are sometimes prescribed to decrease the risk of gastric bleeding. Unfortunately, PPIs may decrease the effectiveness of clopidogrel (Plavix). As far as I know, PPIs do not interact with ASA, ticagrelor or prasugrel. Prasugrel and ticagrelor are more potent than clopidogrel however, and the bleeding risk is higher.
Hope this information is useful.
poster:ed_uk2010
thread:1053947
URL: http://www.dr-bob.org/babble/20131025/msgs/1054153.html