“What causes these unusual changes in blood pressure?”

Good day,

Medications causing drowsiness. 90 yrs old, multiple drug therapy due to multiple medical ailments are some of the reasons for drowsiness and drug side effects. Ranitidine has been taken off the market? Amlodipine takes awhile to clear from the body, it is a good med.

This is a very complex question & not sure I can answer it fully here. There are a few things I could suggest. 1) level out her insulin- Lantus id a long acting insulin and supplies the bodies basal insulin. It should not be given "as needed" but if she needs insulin, it should be given daily. You said she also get Novolin-Is this Novolin regular or Novolin fast acting (Novolog) or Novolin NPH? NPH & Lantus should not be given together. Lantus & Novolin regular can be but it is not the best. If she is taking Novolog, it would be better is she were taking Levemir than Lantus as her basal insulin but that is not a big deal. The best regimen would Novolog or Humalog with meals & Lantus, Basaglar or Levemir at bedtime. Now as too the BP. I would need more data to understand what is going on here but I will make a couple of suggestions 1) amlodipine is a calcium CHANNEL BLOCKER & dilates the blood vessels going into the kidney increasing the load on the kidney. An ACE or ARM dilates the arteries coming out of the kidney & thus relieves pressure in the kidney. An ACE or ARB would be a better BP med for a person with diabetes than a calcium channel blocker. I would get it changed. Finally the memantine, gabapentin & donepezil all have sedative properties & the combination may be causing her sleepiness. I'd see if at least one of these could be eliminated or at least lower the doses. If I were you I would discuss these points with the Dr. & see if changes can be made. It's tough to get everything under control is us older people & it may take a consult with a specialist in older people (a geriatrician). Good luck.

Dear Patient: the inability to awaken Mom is likely due to damage to cerebral function possibly as a result of hypoglycemia (low sugar); the counter-regulatory response to hypoglycemia could be associated with a rise in blood pressure. It would be helpful to know what her sugar is when she cant be awakened as well as blood gases as she does have copd and could have ventilation problem. It would be useful to know her pulse rate, blood sugar and if she is clammy during episode. She is on multiple meds that can cause drowsiness such as gabapentin, nemantine and donazepril. If her blood sugars are not low during episodes she requires full neurological evaluation. If she is hypoglycemic her insulin regimen must be reevaluated and changed.

Respectfully

Marvin A. Leder, MD FACP FACE