Dr. Keith Roach
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 wouldn’t say it’s severe, but I never experienced ongoing constipation problems until I started taking these medications (more the amlodipine), which is why I’m hoping that there is a vasodilator without that particular side effect or another medication you can recommend. — M.D.C.
ANSWER: 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 favor 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 have been experiencing shortness of breath. I have been tested six ways to Sunday and aced every one, and I have also been seen by several specialists. They have basically given up.
I am a 73-year-old male 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, but I can’t test that theory, since I can’t stop taking it. I’m not sure what to do next. — M.H.
ANSWER: 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.
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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 or send mail to 628 Virginia Dr., Orlando, FL 32803.
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