Dear Dr. Roach: I’m 58 years old and was diagnosed with high blood pressure back in 2021. Since then, I’ve been prescribed atenolol, which slows down my heart rate. I was later prescribed 10 mg of amlodipine, which I’m told relaxes and dilates my blood vessels.
I never had ongoing constipation problems until I started taking these medications, which is why I’m hoping you can recommend another medication.
M.D.C.
Atenolol is more likely to cause constipation than amlodipine is, but constipation is certainly possible with either of these medicines. When a prescribed medicine causes a side effect, I usually try to find as close a medicine as possible to the one I am no longer prescribing. But sometimes closely related medicines have closely related side effects.
Drugs that end in “-pine” are a type of calcium channel blocker (felodipine, nifedipine and isradipine), so I would consider trying one of those first to see if that helped and didn’t have the constipation side effect.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) also work by relaxing small blood vessels and are unlikely to cause constipation. I favour those over other medications because the long-term safety and effectiveness data on them for treatment of high blood pressure is excellent.
I sometimes see people treated with hydralazine, a potent vasodilator. This medicine is more often used in people with heart disease (especially heart failure) than in people with high blood pressure and normal heart function. Drug-induced lupus is a major concern with hydralazine, so it is best used when other options aren’t indicated or working.
Dear Dr. Roach: For the past year, I’ve had shortness of breath. I’ve had multiple tests and have been seen by specialists. They have basically given up.
I am a 73-year-old man in decent condition. The only medication I take is apixaban, as I experience the occasional atrial fibrillation (AFib). I have recently read that apixaban can cause shortness of breath. I’m not sure what to do next.
M.H.
It’s always wise to consider drug effects when a new symptom appears, as medications are so often the culprit. If your doctors really thought it likely, they could try a different anticoagulation drug to see if that makes the symptom go away. In your case, I think it’s possible, but unlikely. In placebo trials, shortness of breath wasn’t reported by people taking apixaban.
I’m more concerned about your underlying AFib, the abnormal heart rhythm. AFib commonly causes a fast heart rate, fast enough to cause symptoms at times. If you haven’t already gotten one, a prolonged heart monitor will catch fast heart rates. If you keep a symptom log, it can signify if your heart rate correlates to the shortness of breath. If so, you may benefit from medication to keep your heart rate in the normal range. It is common to have shortness of breath without a cause, despite extensive evaluation.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu
