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Medical Forum / General / Pharmacy / May 2006

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cozaar versus lisinopril

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lasryl@bellsouth.net - 26 Apr 2006 13:20 GMT
Lisinopril was perscribed to help modereate my secondary polycythemia
which started 6 months after my kidney transplant.   It helped control
the hematocrit levels but caused me to have high potassium
levels........to control the potassium I have had to stop eating many
foods that are important for obvious reasons.   After questioniong my
Dr  he said....oh yes, I will perscribe cozaar.  It will help control
the potassium.

After researching, I find cozaar has the same potential for elevating
the potassium levels in the body as lisinopril,  and it costs 3 times
as much.

I havent started the cozaar yet, so dont know its effect.   Does anyone
know if cozaar is the correct alternative for lisinopril and its
characteristics of potassium retention in the body ?
Dr. Wayne Simon - 27 Apr 2006 05:14 GMT
> Lisinopril was perscribed to help modereate my secondary polycythemia
> which started 6 months after my kidney transplant.   It helped control
[quoted text clipped - 11 lines]
> know if cozaar is the correct alternative for lisinopril and its
> characteristics of potassium retention in the body ?

Is the polycythemia elevating your blood pressure? Not quite sure of the
mechanism of how and ACE inhibitor or an ARB like cozaar significantly
decreases hematocrit.

lisinopril seems to be worse in most patients than cozaar when it comes to
elevating potassium  in other words lisinopril in most patients seems to
elevate potassium more.  But potassium levels  which are from the vascular
volume is extracellular and is dependent on many things including
circulating insulin levels,   pH of the blood,   renal function,   and of
course potassium is effected by the renin, angiotensin system  or the
mineralocorticoids effects of your adrenal cortex.     Of course intake of
potassium contributes as well.
turbinedave - 28 Apr 2006 15:03 GMT
The potassium retention did not begin until being placed on lisinopril.
And yes, the blood pressure med is perscribed due to moderate
hypertension.  The change to lisinopril was made due to  elevated
hematocrit levels  of  58 to 60 at which time I underwent a theraputic
phlebotomy.
The theory, as I understand it is that there is some negative effect on
hematocrit levels induced by the lisinopril.  Or maybe the relaxation
of the blood vessels is one means to  keep the thicker blood flowing.
I am on a very restricted Potassium diet - self imposed.. otherwise it
changes drastically in the  one week period between bloodwork.

My goal now is to understand the potassium retention caused by the
blood press med, and find a med if possible that does not have that
charactestic.  I am told the polycythemia will control itself after a
year or so, that its quite common in kidney transplants where the
patients kidneys were left intact, and the new one "plumbed in"    I
understand that now the three kidneys are each generating  EPO,
resulting in increased hematocrit.

Its unfortunate I am unable to have a good dialog with my transplant
doctor(s), where I can have a Q and A session.  I get one question
answered and then he is gone.  I research the answer and that leads to
another question.   Thats why I am posting questions here.

I find that the pre transplant care and patient relations with the
transplant team is very close, but post transplant you are left to your
intuition and desire to get to the facts.  Many times I have been given
medical instruction that contradicts previous instruction.  If I wasnt
alert and questioning everything, I might have suffered some ill
efects.  And I am with a transplant unit that is one of the best in the
US.

Thank you for the reply
mrbrklyn - 12 May 2006 21:05 GMT
> My goal now is to understand the potassium retention caused by the
> blood press med, and find a med if possible that does not have that
> charactestic.

The use of Lisinopril of Lorastan for hypertension is only part of the
reason for its use in your case.  The drugs has protective properties of
the kidneys.

Ruben
mrbrklyn - 12 May 2006 21:05 GMT
> Of course intake of
> potassium contributes as well.

Dieing blood cells will cause high K+ levels as well.

Ruben
mrbrklyn - 12 May 2006 20:59 GMT
On Wed, 26 Apr 2006 05:20:14 -0700, lasryl scribble the following note:

> polycythemia

Why is cozaar or Lisinopril being used in polycythemia?

ruben
 
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