Yesterday I began a critical review of my current health situation, with a view to improve my future results by making some new decisions based on the current facts and trends.
Current Symptoms
Here is a recap of the situation as I see it now. I am taking the symptoms I listed yesterday and discussing each of them in the context of my current method of dealing with them, and/or discussing the cause of each of them as best I can, given that I’m not a doctor or scientist trained in this.
Photo by Markus Spiske temporausch.com on Pexels.com
Frequent urination – especially at night, interrupting my sleep.
The whole issue of urination and bladder control is interconnected with so many of my other underlying issues so it’s probably a good place to start.
Problems with urination are a little bit like the canary in a mine that warns of trouble. One of my earliest indicators that I had a problem, (and it might be diabetes) was having a need to urinate frequently, both during the day and at night. This started in my thirties, almost thirty-five years ago.
Diagnoses of the problems with my urination were complicated by a discovery, in my thirties, that I suffer from a relatively mild form of spina bifida, which despite it not being debilitating does have some significant neurological effects on my lower body, including sexual response and bladder control. This wasn’t great news to hear when I was only in my thirties, but everything the doctor told me about the possible side effects of spinal bifida occulta has surfaced from time to time since then.
Like many other men with any problems with their genitals and urinary systems, including urination or sexual performance, I generally tried to ignore the problem as much as possible. After discussing the potential effects of the problem with my lower spinal column with the back specialist I tended to ascribe any problems to the back and nervous system, including periodic difficulties with both urination and sexual performance.
In the spring of 1985, when I was 32 years old, I also exacerbated the problem, by choosing to undergo a vasectomy, without understanding in advance that the operation could have unintended side effects. Unlike what I had expected, the operation resulted in swelling of my prostate and my testes and an infection in my urethra and bladder. For more than a year I suffered severe pain from both urination and sexual expression, and my soreness persisted for several years before fading away completely. A prescription was given to me to reduce the swelling of my prostate, but it took some time to take effect, and as it was significantly swollen, there were physical effects on both sexual function and urination.
As one might expect, given the pain, there were also emotional effects and a significant impact on my intimate life, in ways I would not have normally expected.
My reasons for having a vasectomy still seem as valid today, as they were at the time, however, part of the decision to go for it turned out to be less true than it is in most cases. My medical results included significant pain, reduced enjoyment of life, and a much higher level of anxiety about the whole subject than was probably warranted.
The argument for having a vasectomy is that it is generally considered a relatively benign surgical procedure, done in the doctor’s office as a day surgery. For a woman to have sterilization surgery is much more invasive, not to mention that it results in huge hormonal changes. My wife and I both thought a vasectomy would be less problematic, and we were probably right, despite how frustrating and painful it turned out to be.
It continues today, as so I suppose I’m used to it. However, continuing declines in muscles and nerves is also contributing to further problems, which require a certain fastidiousness to avoid embarrassment because of weakness in bladder control. It’s not promising for the future, because if it continues to decline I can see a future including adult diapers. It may be already as bad as it is going to get, at least that’s my current hope.
So my problems with sexual function and urination really started then, and it was only somewhat later that I realized that my need to urinate more frequently as I was getting old might have a relationship to diabetes.
Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.
I’m not sure that I’m doing this analysis in the right order, but this is the order I listed my symptoms yesterday, so I will follow this list and get to the underlying stuff as it comes.
I have a lot of trouble sleeping through the night. I have a CPAP machine to help me deal with my sleep apnea, with which I have been having problems. The problems with the CPAP machine aren’t really with the machine itself, but with on again off again sinusitis that makes it almost impossible to sleep with the device forcing me to breath through my nose. So when I’m congested I don’t put it on. So it doesn’t do anything if I don’t use it.
So one of the new decisions I’m making as I do this analysis is to start using the damned CPAP every night possible. When I was using it, it did improve my blood sugars and I suppose it improved my sleep, although I didn’t feel much more rested then that I do now. In other words I’m still exhausted most days, regardless of the CPAP.
The problem with cramping in my legs and feet is another thing that wakes me up in the middle of the night fairly frequently, although not every night. When it first started up a few months ago, I asked a doctor and she advised me to use Magnesium and Calcium together to help. I started taking them every day, and my cramps in my calf muscles has been reduced to once or twice a month, instead of every night. However, this remedy has not improved the cramping in the arches of my feet, or the muscles in my toes.
Other body pain and neuropathic pain are also problematic in getting a decent night’s sleep. Arthritis and rotator cup problems wake me at various times in the night, and make it difficult to get back to sleep. Neuropathic pain which is merely irritating during daylight hours seems far more painful when I am at rest. Ergo, more interrupted sleep and more pain.
Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes.
I am taking Gabapentin, an anti-seizure medication which has shown to help with neuropathic pain. It may be providing me with some relief from the neuropathic pain, but the benefits are still uncertain to me. Would the neuropathic pain be worse if I were to wean off of Gabapentin, due to the numerou side effects cited in the literature?
Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.
Various types of chronic pain plague my waking moments, including arthritis in my hands, shoulders, hips and legs. Tendonitis has my hands bound up with pain. Inflation combines with ongoing pain.
Persistent breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed. Sometimes exacerbated by emotional stress or conflict. Of all my symptoms my breathing problems are the most intrusive, making ordinary activities difficult or impossible. I am currently taking three separate inhalers to remediate the asthma and borderline COPD. All of them have side effects which make my sinus and throat problems worse, and while they help me breathe, they make my singing voice harsh.
Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue).
Addressing these symptoms is something I haven’t really been able to address, yet.
To close the blog for the day, I’ve decided to stop here and pick it again tomorrow or Friday. All of this thinking is making my head hurt, but I realize that I haven’t really given enough thought to the role of the many drugs in my system, and how their many potential side effects may be effecting me.
There can be no time more suitable than the present to make
better choices for my future health and well-being. New choices mean reviewing and carefully
considering alternatives not previously pursued, or if previously pursued,
inadequately. In some respects, this
analysis reflects a continuing and necessary re-evaluation based of my current
state of health, not as a snapshot, as it were, but rather as a streaming and
changing set of conclusions and actions based on them. However, this analysis is specifically about
now and the immediate future, with a clear understanding that nothing is ever
completely settled in these issues, and there is new information available on
an ongoing basis.
More simply put – This self-analysis is about resetting how
I go about living my life with due consideration to what I have learned about the
conditions and diseases that currently plague me. How to do better and improve my health for
the future – this is my object.
Much of what will be expressed here rests on certain
persisting patterns of behavior which require significant modification. In other words, I must change if there is to
be any real improvement in my health reality. And based on what I know about
achieving anything of consequence in my life, it will need to be outlined in a
program of specific steps, which depend upon my own actions rather than on
others. My physicians can only provide
me with information and treatment within what I’m willing or able to do
myself. My partner, as supportive as she
has tried to be over the years, is not responsible for any part of this,
despite my tendency to try to lay responsibility at her door particularly for
my dietary habits and lack of blood sugar control.
Frequent urination – especially at night,
interrupting my sleep.
Poor sleep – several things wake me up at night,
variously including frequent urination, frequent cramps in my feet and calves, pain
my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and
difficulties breathing.
Chronic pain during waking hours – moderate to severe
pain in my feet, neuropathic pain as well as mechanical distress, including
pain caused by walking on supersensitive soles of my feet, as well as my
toes. Also… periodic moderate pain in my
back and shoulders, and more serious pain in my lower back and hips when
walking more that 1,000 to 2,000 steps.
Periodic breathing problems – mild to severe
asthma on a continuing basis, almost always somewhat symptomatic but much worse
when exercising or physically stressed.
Sometimes exacerbated by emotional stress or conflict.
Chronic physical exhaustion and fatigue – comes and
goes during the day but is worse during periods of relative inactivity (sense
of exhaustion) and during periods of exercise (weakness and muscle fatigue)
Dizziness upon standing – it is sometimes acute
and sometimes minor
Mental fatigue and a sense of a loss of acuity
and sharpness – I am finding it difficult to concentrate on mental tasks which
require the application of my intellectual skills and professional skills. I still feel capable of creative work for
relatively brief periods, but fatigue quickly overtakes me, and I must put
things aside, while I attempt to recover my energies and focus.
Forgetfulness and feelings of anxiety regarding
memory
Visual deficiencies – lately I can only read or
work on the computer for a certain period before my eyes begin to become less
effective, making it necessary for me to interrupt my work or reading, and brake
completely from work that require visual acuity. Eye fatigue contributes to my overall sense
of fatigue and exhaustion. Note: I probably need new glasses, something
I will discuss with my ophthalmologist on Friday when I next visit her.
Rain Coast Review Blog author
Conditions and/or diseases
Diabetes
Slightly elevated cholesterol
Sleep apnea
Asthma and bronchitis (borderline COPD)
Diabetic Neuropathy
Evidence of diabetic damage to my eyes
Fatty liver
Obese
Arthritis in hips, hands, shoulders, lower back
Tendonitis in hands and wrists
Eczema
High and low blood pressure
Allergies to a broad band of common allergens
including pollens, animal dander, dust and others. Anaphylactic reaction to Cipro and Penicillin
I have had recent visits with my family doctor, my Endocrinologist
and my Respirologist (Pulmonologist), plus an upcoming CT Scan in early June at
Burnaby General, and an eye exam this Friday.
I’m clearly a heavy draw on the medical system with all these frequent
appointments to deal with various ailments.
Clearly I’d like to see less of them, and they would like to see less of
me. All we have to do to accomplish this
feat is to improve my health sufficiently so that they wouldn’t need to see me
so often.
Diabetes blood sugar and neuropathy management
Endocrinologist
My most recent visit with my Endocrinologist, as usual, thorough,
with a significant discussion about changing my medications, in particularly,
moving to two different types of insulin every day, with a long acting insulin
injected in the morning with design purpose of bringing my premeal and fasting
insulin down to ideally 7.0mml or below and then having me take fast acting
insulin with each meal, dividing up the insulin between the meals, more or less
based on the prorated amount of food being ingesting at each meal.
In order to manage this much more intensive insulin regime,
it will be necessary for me to check my Blood sugar levels first thing each
morning, as well as 2 hours after each meal.
The goal of the fast-acting insulin is to return my blood sugars to
10mml or below within the two hours.
In order to maintain such a frequent reading of my blood
sugar levels, I need to have a new form of monitor with a patch blood reader
that sends the information to a monitoring device, either my iPhone or one that
comes with the patch. I submitted the
request to Blue Cross two weeks ago and am currently awaiting approval. Note: I
should follow up with them before Friday to make sure they are working on this.
The Endocrinologist wrote me prescriptions for the insulin
and the device, as well as had his assistant prepare the forms for Blue
Cross. Once I have approval, I will need
to deliver these forms to the Pharmacy for processing.
The Endocrinologist and I had a fairly long conversation
regarding various aspects of my diabetes including the need for me to have my
eyes re-examined, thus an appointment this Friday with Chui Luca, my Ophthalmologist. We also discussed my weight gain since being
diagnosed with diabetes with him expressing some thought that while weight loss
would be desirable many type two diabetics in my circumstances find it very
difficult to lose weight while taking insulin.
Not only does insulin contribute to weight gains, but so do Jentadueto
and Invokana my other diabetes treatment medications.
In addition, gabapentin, which has been prescribed for my
neuropathy due to diabetes, also leads to weight gain along with other symptoms
I am experiencing.
The more common side effects
of gabapentin include:
abnormal eye movements that are continuous,
uncontrolled, back-and-forth, or rolling
clumsiness or unsteadiness
constipation
diarrhea
difficulty speaking
drowsiness or tiredness
dry mouth
nausea
vomiting
Talk with your doctor about
precautions you can take for side effects from gabapentin:
Ask your doctor for advice on diet and
exercise to help manage your weight if you are concerned about possible weight
gain from gabapentin.
Don’t drive or operate heavy machinery until
you know you can function normally while taking gabapentin.
Talk to your pharmacist about
over-the-counter medications that can help relieve some of the more common
digestive system side effects.
Gabapentin side effects may
make you want to stop taking the drug. However, don’t stop taking it without
first talking to your doctor.
Stopping gabapentin suddenly
can cause serious problems, such as withdrawal symptoms or the return of
seizures. Your doctor will help you stop taking the drug safely.
Medically reviewed by Lindsay Slowiczek, PharmD on December 20,
2016 — Written by University of Illinois-Chicago, Drug Information Group
Other diabetes
Medications
In addition to the two new forms of insulin, and the
gabapentin for treatment of the diabetic Neuropathy I also take two other
diabetes medicines.
Jentadueto
2.5/1,000 MGs – taken twice daily prior to morning and evenings
meals.
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
08/28/2017
Jentadueto (linagliptin and
metformin hydrochloride) is a combination of two 2 oral antihyperglycemic drugs
indicated as an adjunct to diet and exercise to improve glycemic control in
adults with type 2 diabetes mellitus when treatment with both linagliptin and
metformin is appropriate. Common side effects of Jentadueto are:
cough,
sore
throat,
sinus
pain,
stuffy
nose,
upset
stomach,
weight
gain,
pancreatitis,
diarrhea,
and
low blood
sugar (hypoglycemia).
Get medical help immediately
if you have severe side effects of lactic acidosis (symptoms include muscle
pain or weakness, numb or cold feeling in your arms and legs, trouble
breathing, dizziness, lightheadedness, tiredness, weakness, stomach pain,
nausea with vomiting, or slow or uneven heart rate.
Jenadueto is available in the
following strengths: tablets containing 2.5 mg linagliptin and 500 mg metformin
hydrochloride or 850 mg metformin hydrochloride or 1000 mg metformin
hydrochloride. The maximum recommended dose is 2.5 mg linagliptin/1000 mg
metformin twice daily. Jenadueto should be taken daily with meals, with gradual
dose escalation to reduce the gastrointestinal side effects due to metformin.
Invokana
300 MG – taken once daily prior to the morning meal.
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
11/12/2018
Invokana (canagliflozin) is a
sodium-glucose co-transporter 2 (SGLT2) inhibitor used to control blood sugar
in people with type 2 diabetes mellitus, in addition to diet and exercise.
Common side effects of Invokana include:
urinary
tract infections,
increased
urination,
yeast
infections,
vaginal
itching,
thirst,
constipation,
nausea,
fatigue,
weakness,
skin
sensitivity to sunlight,
hypersensitivity
reactions (including skin redness, rash, itching, hives, and swelling),
bone
fractures, and
kidney
problems.
The recommended starting dose
of Invokana is 100 mg once daily, taken before the first meal of the day. Doses
may be increased to 300 mg in patients who are able to tolerate Invokana at 100
mg doses. Invokana may interact with rifampin or digoxin. Tell your doctor all
medications you use.
Asthma and Bronchitis Medications and treatments
After spending 10 days in the hospital in 2016 with severe
pneumonia, when I was discharged my Respirologist at Centrio Medical Centre diagnosed
me with COPD and prescribed three different inhalers to treat the disease.
Spiriva 2.5 mg
Spiriva 2.5 mg – two puffs with morning medications
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList 2/12/2018
Spiriva HandiHaler
(tiotropium bromide) Inhalation Powder is an anticholinergic drug used to
prevent bronchospasm (narrowing of the airways in the lungs) in people with
bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease). Common side
effects of Spiriva HandiHaler include:
Tell your doctor if you have
any serious side effects of Spiriva HandiHaler including:
difficult
or painful urination, or
fast
heartbeat.
The recommended dose of
Spiriva HandiHaler is two inhalations of the powder contents of one Spiriva
capsule, ONCE DAILY, with the HandiHaler device. Spiriva may interact with
atropine, belladonna, cimetidine, clidinium, dicyclomine, glycopyrrolate,
hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, or
scopolamine. Tell your doctor all medications you use. During pregnancy,
Spiriva should be used only when prescribed.
Symbicort
Symbicort 200 mg – two puffs with
morning medications and two puffs with dinner medications
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
1/22/2018
Symbicort (budesonide and
formoterol fumarate dihydrate) is a combination of a steroid and a long-acting
bronchodilator used to prevent bronchospasm in people with asthma or chronic
obstructive pulmonary disease (COPD). Common side effects of Symbicort include:
headache,
throat
irritation,
nausea,
vomiting,
stomach
upset,
diarrhea,
back pain,
stuffy
nose,
muscle or
joint pain, or
changes in
your voice.
Tell your doctor if you
experience unlikely but serious side effects of Symbicort including:
white
patches on tongue or in mouth,
signs of
infection (such as fever, persistent sore throat),
mental/mood
changes (such as nervousness),
trouble
sleeping,
vision
problems (such as blurred vision),
increased
thirst or urination,
muscle
cramps, or
shaking
(tremors).
For patients 12 years of age
and older, the dosage of Symbicort is 2 inhalations twice daily (morning and
evening, approximately 12 hours apart). Symbicort may interact with
antibiotics, antifungal medication, MAO inhibitor, antidepressants,
beta-blockers, or diuretics (water pills). Tell your doctor all medications you
are taking. During pregnancy, Symbicort should be used only when prescribed.
Budesonide passes into breast milk. It is unknown if formoterol passes into
breast milk. Consult your doctor before breastfeeding.
Salbutamol
Salbutamol 100ug – two puffs as required
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
2/7/2019
Ventolin HFA (albuterol
sulfate inhalation aerosol) is a bronchodilator used to treat or prevent
bronchospasm in people with reversible obstructive airway disease. Ventolin HFA
is also used to prevent exercise-induced bronchospasm. Ventolin HFA is
available in generic form. Common side effects of Ventolin HFA include:
nervousness,
shaking
(tremor),
palpitations,
headache,
mouth/throat
dryness or irritation,
cough,
hoarseness,
sore
throat,
runny or
stuffy nose,
nausea,
vomiting,
dizziness,
sleep
problems (insomnia),
muscle
pain,
changes in
taste, or
diarrhea.
Seek medical help immediately
if you have rare but serious side effects of Ventolin HFA, including:
chest pain
or
irregular
heartbeat.
The dose of Ventolin HFA for
adults and children for treatment of acute episodes of bronchospasm or
prevention of symptoms associated with bronchospasm is 2 inhalations repeated
every 4 to 6 hours. More frequent administration or a larger number of
inhalations is not recommended. For exercise-induced bronchospasm, the dose is
2 inhalations 15 to 30 minutes before exercise. Ventolin HFA may adversely
interact with diuretics (water pills), digoxin, beta-blockers, antidepressants,
MAO inhibitors, or other bronchodilators. Tell your doctor all medications you
are taking. During pregnancy, Ventolin HFA should be used only when clearly
needed. Discuss the risks and benefits with your doctor. It is unknown if this
medication passes into breast milk. Consult your doctor before breastfeeding.
Other Medications Prescribed or recommended
Tecta 40 MG
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
10/24/2018
Protonix Delayed-Release Oral
Suspension and Delayed-Release Tablets (pantoprazole sodium) is a proton pump
inhibitor (PPI) used for short-term treatment (less than 10 days) of
gastroesophageal reflux disease (GERD) and a history of erosive esophagitis in
adult patients.
Common side effects of
Protonix include
injection
site reactions (redness, pain, swelling),
headache,
nausea,
vomiting,
abdominal
or stomach pain,
diarrhea,
gas,
dizziness,
joint
pain,
weight
changes,
drowsiness,
tired
feeling, or
sleep
problems (insomnia).
The recommended adult dose of
Protonix is 40 mg once daily. Protonix may interact with atazanavir,
nelfinavir, ampicillin, blood thinners, digoxin, diuretics (water pills),
ketoconazole, iron, or methotrexate. Tell your doctor all medications and
supplements you use. Protonix is not expected to be harmful to a fetus. Tell
your doctor if you are pregnant or plan to become pregnant during treatment
with Protonix. Protonix passes into breast milk and may harm a nursing baby.
Consult your doctor before breastfeeding.
APO-atorvastatin 40 mg
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
4/23/2019
Lipitor (atorvastatin) is a
statin used for the treatment of elevated total cholesterol, LDL,
triglycerides, and to elevate HDL cholesterol. Side effects of Lipitor include:
constipation,
diarrhea,
nausea,
fatigue,
gas,
heartburn,
headache,
and
mild
muscle pain.
Contact your doctor if you
experience serious side effects of Lipitor including:
muscle
wasting and muscle breakdown (rhabdomyolysis),
confusion
or memory problems,
fever,
dark
urine,
increased
thirst or hunger,
drowsiness,
loss of
appetite, or
yellowing
of the skin or eyes (jaundice).
The recommended dose of
Lipitor is 10-80 mg daily. Erythromycin (E-Mycin), ketoconazole (Nizoral),
itraconazole (Sporanox), cyclosporine (Sandimmune), indinavir (Crixivan) and
ritonavir (Norvir) decrease elimination of Lipitor. Lipitor increases the
effect of warfarin (Coumadin) and cholestyramine (Questran) decreases the
absorption of Lipitor. Lipitor should not be taken during pregnancy because the
developing fetus requires cholesterol for development, and Lipitor reduces the
production of cholesterol. Lipitor passes into breast milk and could harm a
nursing baby. Breastfeeding while taking Lipitor is not recommended.
Ramapril 10 MG
Ramipril side effects
Ramipril oral capsule doesn’t
cause drowsiness. However, it can cause other side effects.
More common side effects
If these effects are mild,
they may go away within a few days or a couple of weeks. If they’re more severe
or don’t go away, talk to your doctor or pharmacist. The more common side
effects that occur with ramipril include:
dizziness
or faintness due to low blood pressure
cough
dizziness
chest pain
nausea
vomiting
diarrhea
weakness
or tiredness
Serious
side effects
Call your doctor right away if
you have any of these serious side effects. Call 911 if your symptoms feel
life-threatening or if you think you’re having a medical emergency. Serious
side effects and their symptoms can include the following:
low blood
pressure. This is more common when you’re starting the drug or increasing
doses. Symptoms include:
dizziness
lightheadedness
allergic
or hypersensitivity reaction (angioedema). Symptoms include:
swelling
of your face, lips, tongue, or throat
trouble
breathing
stomach
pain with or without nausea and vomiting
liver
problems (jaundice). Symptoms include:
yellowing
of your skin or the whites of your eyes
stomach
pain
fatigue
swelling
(edema). Symptoms include:
swelling
of your feet, legs, or hands
low white
blood cell count. Symptoms include:
sore
throat
fever
purple
spot on your skin caused by internal bleeding (purpura)
fast or
abnormal heart rate or palpitations. Symptoms include:
feeling
like your heart is fluttering
high
potassium levels. Symptoms include:
weakness
arrhythmia
(irregular heart rate)
worse
kidney function. Symptoms include:
nausea and
vomiting
decreased
urine output when urinating
fatigue
loss of
appetite
Disclaimer: Our goal is to
provide you with the most relevant and current information. However, because
drugs affect each person differently, we cannot guarantee that this information
includes all possible side effects. This information is not a substitute for
medical advice. Always discuss possible side effects with a healthcare provider
who knows your medical history.
Senior dosage (ages 65 years
and older)
As you age, your kidneys may
not work as well as they used to. This can cause your body to process drugs
more slowly. As a result, more of this drug may stay in your body for a longer
time. This increases your risk of side effects. Your doctor may start you on a
lowered dose or a different schedule. This can help keep levels of this drug
from building up too much in your body.
Special considerations
Kidney problems: 1.25 mg once
per day. Your doctor may increase your dose to 5 mg taken once per day if
needed for blood pressure control.
Renal artery stenosis or
dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your
doctor may change your dose as needed.
Dosage to reduce the risk of
heart attack, stroke, or death
Adult dosage (ages 18–64
years)
2.5 mg taken by mouth once
per day for 1 week. Then 5 mg taken once per day for 3 weeks. Your doctor will
increase your dose as tolerated to 10 mg taken once per day.
