Concerned

[desiderata]

I'm getting more and more concerned that my psychotropic meds consisting of Effexor Adderall, Xanax, and Wellbutrin are having an adverse effect on my body. After a knee injury and a subsequent check up to see if I was fit for duty I was deemed unfit due to an elevated blood pressure of 190/126. I see a primary doctor to control my bp and take Lisinopril to keep it in check. I sometimes think all the meds in me can cancel other meds out or just make matters worse.

 

[Daniel E.]

Yes, I would think all/any of them except the Xanax could raise blood pressure to some degree at least.

I would be most concerned with Adderall.

 

[David Baxter PhD]

Have you spoken to your doctor and/or pharmacist about your concerns?

Note that discontinuing any of those meds abruptly could make things worse for you.

Try a drug-interaction checker:

Drug Interactions Checker - Check Your Brand and Generic Drugs - RxList

Drug Interaction Checker - Find Interactions Between Medications - WebMD

 

[Daniel E.]

You may also want to start keeping a log of your blood pressure if you haven't already.

For many, the best way to get a good reading is to take it at home in a relaxed state.

deemed unfit due to an elevated blood pressure of 190/126.

Also, that reading is in the realm of a "hypertensive emergency":

The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120 mmHg or systolic blood pressure greater than or equal to 180 mmHg...

Many factors and causes are contributory in hypertensive crises. One main cause is the discontinuation of antihypertensive medications. Other common causes of hypertensive crises are autonomic hyperactivity, collagen-vascular diseases, drug use (particularly stimulants, especially cocaine and amphetamines and their substituted analogues), glomerulonephritis, head trauma, neoplasias, preeclampsia and eclampsia, and renovascular hypertension.

During a hypertensive emergency uncontrolled blood pressure leads to progressive or impending end-organ dysfunction. Therefore, it is important to lower the blood pressure aggressively.

Hypertensive emergency - Wikipedia

 

[Daniel E.]

Note that discontinuing any of those meds abruptly could make things worse for you.

And, looking at your previous threads, you have been on Adderall (at least on-and-off) since at least August 2010. So you would think your doctor(s) should have noticed any major effects on blood pressure by now (?)

 

[forgetmenot]

All meds have an affect on ones body, the organs blood pressure etc. I do think you need to talk with your doctor and have him or her monitor your blood pressure for 24hours to see a true reading of what is happening. I hope that your doctor can adjust your meds accordingly to help keep your blood pressure stable.

 

[GaryQ]

After editing before posting I realised that this is a dang long post and apologize but on certain subjects I'm quite sensitive as to making sure information is as complete, yet simply presented and as informative as possible. IF you survive reading through it all you'll have a very good understanding of why.

First I'm no doctor and these are simply personal observations, from personal medical history, having the whole arterial "kit and caboodle" including, but definitely not simply limited to, high BP, coronary and peripheral artery disease and necrosis (death) of heart muscle tissue from 3 heart attacks. The first one being in 2001. Add to that an alphabet soup of neuropsychiatric and psychological issues like TS+, ADHD, OCD, etc. And the different attempts over the years to keep some of this under control.

I agree with the previous comment posted: Definitely, Never stop any med cold turkey without first getting medical advice. If allergic reaction that advice might come from the ER. Others reasons are usually discussed with preferably your primary care provider (Doc, psychiatrist or another doctor if they don't seem competent in the present matter - trust me, it happens and when it does it's not easy dealing with some professional egos when one or all of them are wrong. Been there regarding Clonidine and it was months of fighting with my GP, Cardiologist and a psychiatrist which I literally had to dump)
​

And yes, as David posted, That's definitely a really dangerously BP reading!

(even if it was just a temporary brief spike)

Why you ask? OK, Let me explain a bit of what I've learned about it all

A vague analogy is that Arteries are like long skinny balloons, and in some aspects like the inner rubber tube of a bicycle tire, (the balloon will have a specific breaking point (you blow it up and at a certain point it pops depending on how deteriorated each one is that popping pressure decreases accordingly) a tire innertube on the other hand has a bit of a gap where the inside walls will form cracks each time it is slightly overinflated and each successive crack or weakening of the previous cracks will sooner or later cause it to rupture. If it is overinflated beyond a certain pressure it will also blow up like a balloon.

Now, when the heart pumps out blood (Systolic blood pressure, the highest of the two numbers) it's like blowing air into a tire or balloon to a certain pressure. Then, a bit like letting some, or a lot, but not all, of the air out of the tire or balloon, When the heart stops pumping fresh blood out of the heart there is a resting pressure (Diastolic blood pressure, the lower number) Think of it as inflating a balloon or bicycle tire and then letting out a certain amount then blowing it up again and this anywhere from about 60 to 100 times per second (pulse of the average person at rest, can go lower and way higher under certain conditions) ​

Tires have a recommended max inflation pressure printed on them. Then according to the vehicle weight the recommended inflation pressure is used (example my car: tires have a maximum inflation printed on them of 35PSI and the manufacturer recommends an inflation of only 32 PSI.)

We don't have recommended and maximum pressure ratings printed on us but we have learned that the recommended pressure is about 100 to 120 for systolic pressure and maximum safe rating of 140. Above 140 you are considered to have high blood pressure. It can go higher but the higher it goes the greater the risk of us damaging or literally "blowing an artery" like a blowout on a tire.

Now "another fun little fact" is that the human body has a protective mechanism that can both save and take lives doing the exact same thing. "Coagulation" Coagulation is one of the mechanisms used to stop bleeding that can also cause thrombosis (the formation of a blood clot inside a vessel) examples are strokes, heart attacks and other little nasties like embolisms. Platelets in out blood get to work immediately when they detect a ruptured blood vessel to try and stop the bleeding internally or externally. Then Tada! we stop bleeding unless it's a really serious rupture/cut! Now here's the catch 22: They are both really smart (they get to work the moment they encounter a ruptured blood vessel) and really dumb (They can't tell the difference between simple plaque, a crack in an arterial wall or a ruptured blood vessel) Over time (for the majority of us) our arteries start to harden from cholesterol buildup (plaque which is not flexible) on the inner walls to some degree or another and each time the inner wall of the artery is subjected to a systolic blood pressure that is beyond it's current cracking point a crack is formed usually where there is hardening of plaque buildup. Now in these arteries that have just cracked flows the same platelets and they see a crack as a ruptured blood vessel and they want to save our lives and get to work clotting to stop what they are convinced is a ruptured blood vessel. And Tada! A blot clot has started to form. it fills the crack and usually stops and stays there when it thinks it has accomplished it's task. Sometimes the clotting doesn't stop when it should and a large blood clot forms. Then when the blood pressure is too high the crack can get bigger and more clotting continues. Then the clot which is weaker than the plaque can break off and flow through the system and stop somewhere smaller and block an artery or a vein.

When a clot blocks, partially or totally, an artery and prevents sufficient oxygen from reaching the cells it supplies, all these cells will most likely die sooner from lack of oxygen if something is not done to remedy the situation before it's too late.

In the brain arteries this is a stroke.
In the coronary arteries this is a heart attack (Myocardial Infarction).
In a lung it's a pulmonary embolism.
In any organ, failure of that organ is possible (kidneys, lungs, etc.)
In a limb loss/amputation of that limb is possible.

Now think of our arterial system as a tree with the trunk as the aorta and from there about 20 other major arteries exist like big branches with many smaller branches that have smaller branches and on and on. The closer the relationship to aorta the artery in question is the higher the risk of almost immediate death. Since too many cells are supplied blood and especially oxygen from this branch.

Now when an artery or vein that is weakened (can be from plaque/clot buildup or an aneurism, which is like a balloon formed at a weakened spot of a blood vessel) is exposed to an extremely high blood pressure it can literally pop like a tire blowout. This result is internal bleeding and depending on the blood vessel and it's location, death or severe organ damage can occur and rapidly. An ruptured aorta aneurism is almost certain immediate death.

So to make this story a little longer someone who has been diagnosed as having high blood pressure usually has some level of hardening of the arteries and the direct result of this is a vulnerable blood vessel system. Any spike in blood pressure, even temporary, can cause anything from a tiny almost undetectable heart attack or stroke to severe organ damage or death.

Adderall is an amphetamine which is a stimulant:
Normal warnings like at Drugs.com state:
"You may not be able to use Adderall if you have: high blood pressure, heart disease or Coronary artery disease."

Here is a very important and often neglected fact I would like to emphasize:
What they don't mention, and many docs don't take into account seriously, is that if you are taking any medication to keep your blood pressure under control that does not mean that you don't have high blood pressure . It only means you have high blood pressure and take meds to lower it. If you need meds to lower high blood pressure it also means you have an underlying issue that is causing the elevated blood pressure and hence the need to take meds for it. It's the same thing as someone that is diabetic: Even if you keep your glucose levels under control with meds or insulin, YOU STILL HAVE DIABETES! NO, you can't scoff down a nag of sugar because your diabetes in under control with meds. So, same thing if you have high blood pressure and taking meds, it's still there, just under control. YOU STILL HAVE HIGH BLOOD PRESSURE! So takeing anything that normally by default causes elevated blood pressure and heart rate is risky and dangerous. IF you have high BP you should really try to avoid taking any form of stimulants, be it street drugs or prescribed, especially from the amphetamine family! It's like "speed" and methamphetamine: (AKA: Meth, Crystal Meth) elevated Heart rate and blood pressure and spikes are pretty common. The higher the dosage and combined with other meds it can increase substantially.

There are other alternatives to amphetamines for ADHD. These should be the first option and technically only options for someone with high BP, cardiac or other arterial and vascular issues. Sometimes, like in my case, you just have to live with certain conditions because the meds that might help you can also kill you.

Finally: Monitoring blood pressure:
Although the recommendation is to monitor it at rest regularly if you are having issues, I can tell you with certainty that unless you are in very serious condition you'll rarely have a stroke or heart attack at rest. If under stress or effort you feel uncomfortable it is wise to monitor both pulse and BP at this crucial moment because that's when the damage starts. It can take up to 2 and even more days after the damage caused by a stressful event for a heart attack to actually occur. Personal example: Driving from Winnipeg, Manitoba to Quebec in the winter of 2009 I drove non stop except for a bladder, gas and Tim Horton's coffee, till around 3:30am just a couple km from Nipigon, Ontario with a temperature around -35C I got a blow out (tire at that point, not artery LOL) and replaced it myself with the donut spare (I'll spare you the details of the 2 OPP cars that came speeding towards me from both directions and scared the living daylights out of me mistaking me for someone that had just done a robbery. I showed them I had just finished changing my blown out tire, they checked my ID and let me go) then drove to and slept in my car at Canadian Tire in Nipigon till they opened to get a new winter tire installed. Then back on my way I went. 2 or 3 days later (think it was 3 but my memory is failing me on the exact timeframe) anyway, while at my sister's in Sorel, Quebec I knew I was having a heart attack again (my second one) which was confirmed at the hospital. Cardiologist traced all my activities with me back to that point and he was convinced beyond a doubt that this was the triggering event that cause the blockage. After telling him that that didn't make sense because that was days ago and that although I felt bad physically at that moment in the brutal cold changing the wheel by hand I had been tired since which seemed normal after a long drive but OK after that till I started feeling it at my sister's. That's when he advised me that it can take days after the triggering event before the actual damage happens. I learned a bit more about cardiology that day

 

[Daniel E.]

On the positive side:

A large retrospective cohort study in adults (aged 25-64 years) did not show an increased risk of MI, stroke, or sudden cardiac death with use of ADHD medications.

FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults

 

[GaryQ]

On the positive side:

Well, not really...

from the article itself:

FDA recommendations for the use of medications to treat ADHD have not changed. Healthcare professionals should continue to take special note that:​

• Stimulant products and atomoxetine should generally not be used in patients with serious heart problems, or for whom an increase in blood pressure or heart rate would be problematic.

• Patients treated with ADHD medications should be periodically monitored for changes in heart rate or blood pressure.

​

The studies in question were not targeting "at risk" people but "risk of" for those taking it.
Someone that would be at risk should not be taking it as per FDA recommendations.
​

And hopefully most docs are following FDA recommendations that have not changed.
Now if the studies were focused on the at risk group it would be different and probably lacking the availability of a large study group.

 

[desiderata]

Thanks to all for your insight and feedback. I went to my PCP today and my bp is right in range. Both sides of my health care doctors mental/physical are on the same page and want whats best for me. It's up to us to find and balance the mind/body systems.

 

[forgetmenot]

I am glad your health team are working TOGETHER with you to help keep you well sometimes that is a hard task to do . Glad your BP is right in range now.