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Q
My aunt is in her 80's, yet vibrant and alert. She has spinal stenosis and hypertension and is being treated with the following med regimine: Procardia, Tenormin, Baby ASA, Prednisone, Centrum vitamin, Fosamax, Tylenol prn and Restoril. She complains of feeling "exhausted and dopey" by late afternoon. Could this be a result of Procardia and Tenormin of someone of her age? Would elimination or timing of one or both be of benefit? Surgery has not been recommended but wondering if it is more of a decision because of age and managed care? Welcome your input.
A
Procardia (nifedipine) is a calcium channel blocker used to treat, among other cardiac conditions, hypertension. Its commonest side-effects are due to vasodilation - these include hypotension, flushing, edema, headaches, dizziness and depression.

Tenormin (atenolol) is a beta-blocker and like nifedipine, used to treat hypertension. Individuals with decreased renal function (at 80+, your aunt is most likely in this group) will excrete it more slowly with consequent increase in blood levels - this leading possibly to increased incidence and severity of side-effects. At high doses these include, among others, insomnia and depression.

It would indeed be appropriate to look at possible change in dosage, amount of each dose and timing, elimination of one or both with possible substitution with an ACE-inhibitor.

Another possible candidate might be the Restoril (temazepam) although if it's given at bedtime, shouldn't be around by next afternoon.

You don't mention any dosages, but where this is extremely important is in the use of prednisone which in long-term use may be involved. I would guess your aunt is on a dose which may produce osteoporosis since she has been prescribed Fosamax (alendronate).

Nothing else you mention is likely to be involved.

Best wishes to you and your aunt.

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