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Heart Medicine & Supplements

Here is some important information about your medication and supplements.

Bile acid resins

Types of medications: Colestipol (Colestid)-powder, Cholestyramine (Questran) powder, Colesevelam HCL (Welchol) capsule

Instructions for powders

  • Take at meal times (breakfast and evening meal) with plenty of liquid
  • Powders come packaged in small packets or in a canister with a scoop.
  • Mix 8 oz liquid with 2 scoops of powder. Thin, slightly sweet liquids work best, like sugar-free Kool-Aid, Tang, or apple juice.
  • Shake for 30 seconds and refrigerate.
  • Re-shake or stir before drinking at meal time. If taken properly, most patients experience more regularity, rather than constipation.

Possible medication interaction: Other medications should be taken one hour before or at least two hours after taking powders. The powders can interfere with your body’s ability to absorb certain medicines, such as thyroid replacement, diuretics, digoxin, anticoagulants (Coumadin or warfarin), and others.

Instructions for capsules

  • Take 6-7 capsules once a day with a meal OR 3 capsules with breakfast or lunch and 3-4 capsules with your evening meal
  • Drink at least 8 oz of liquid with the capsules

Possible medication interaction: You can take the pills at the same time that you take your other medications.

Possible side effects

Most people have no side effects. Side effects which may occur are limited and minor.

  • Larger stools
  • Belching
  • Constipation
  • Gas
  • Stomach “fullness”
  • Stomach discomfort

If you get constipated, increase the amount of fluid that you drink and add fiber to your diet.

Buproprion SR

Instructions

  • Set a date to stop smoking
  • Begin Buproprion SR one week (7 – 10 days) before your quit date.

Buproprion SR is not recommended if you:

  • Have a seizure disorder
  • Currently have or have had an eating disorder
  • Are currently taking medication for depression
  • Are pregnant, thinking about becoming pregnant, or are breast feeding

How to take Buproprion SR

  1. Take one 150 mg tablet in the morning for three days
  • Never take an extra dose of Buproprion SR. If you forget to take a dose don’t take a “catch-up” dose.
  • Buproprion SR and nicotine patches, gum, and/or lozenges can be used at the same time

Possible side effects

  • The most common side effects include: dry mouth, difficulty sleeping, shakiness, and skin rash.
  • Note: These side effects tend to be mild and disappear within the first two weeks
  • Rare incidence of seizures.

Chantix

Instructions

  • Set a date to stop smoking
  • Begin Chantix one week prior to stop date
  • Take after eating with a full glass of water
  • There should be no need to take nicotine replacement products such as the nicotine patch or gum with Chantix

Possible side effects

  • Nausea, gas, constipation
  • Trouble sleeping or abnormal dreams
  • Headache
  • Agitation

Dosing

The recommended dose of Chantix is 1 mg twice daily following a 1-week titration as follows:

DAY DOSE
1-3 0.5mg once daily
4-7 0.5mg twice daily
8-end    1mg twice daily

If you can't tolerate the side effects of CHANTIX, you may have the dose lowered temporarily or permanently.

Don’t skip doses or double doses if a pill is missed

Treatment is for 12 weeks, but may be extended another 12 weeks for those who have successfully stopped smoking to further increase the likelihood of long-term abstinence.

DASH diet for hypertension

Daily nutrient goals used in the DASH studies

  • Total Fat - 27% of calories
  • Sodium 2,300 mg (1500 mg will lower bp even more)
  • Saturated fat 6% of calories
  • Potassium 4,700 mg Protein 18% of calories
  • Calcium 1,250 mg
  • Carbohydrate 55% of calories
  • Magnesium 500 mg
  • Cholesterol 150 mg
  • Fiber 30 g

How to adopt the DASH eating plan

  • If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.
  • Gradually increase your use of fat-free milk and milk products (such as nonfat yogurt) to three servings a day.
  • Read the Nutrition Facts label on margarines and salad dressings to choose those lowest in saturated fat and trans fat.
  • Limit lean meats to 6 ounces a day—all that's needed. Have only 3 ounces at a meal, which is about the size of a deck of cards.
  • If you now eat large portions of meats, cut them back gradually—by a half or a third at each meal.
  • Include two or more vegetarian-style (meatless) meals each week.
  • Increase servings of vegetables, brown rice, whole wheat pasta, and cooked dry beans in meals.
  • Try these snacks ideas: unsalted rice cakes; nuts mixed with raisins; graham crackers; fat-free and low-fat yogurt and frozen yogurt; popcorn with no salt or butter added; raw vegetables.
  • Use fresh, frozen, or low-sodium canned vegetables and fruits.

Tips to reduce salt and sodium

  • Choose low- or reduced-sodium, or no-salt-added versions of foods and condiments when available.
  • Choose fresh, frozen, or canned (low-sodium or no-salt-added) vegetables.
  • Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types.
  • Choose breakfast cereals that are lower in sodium.
  • Limit cured foods (such as bacon and ham); foods packed in brine (such as pickles, pickled vegetables, olives, and sauerkraut); and condiments (such as mustard, horseradish, ketchup, and barbecue sauce). Limit even lower sodium versions of soy sauce and teriyaki sauce. Treat these condiments sparingly as you do table salt.
  • Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.
  • Choose “convenience” foods that are lower in sodium. Cut back on frozen dinners, mixed dishes such as pizza, packaged mixes, canned soups or broths, and salad dressings—these often have a lot of sodium.
  • Rinse canned foods, such as tuna and canned beans, to remove some of the sodium.
  • Use spices instead of salt. In cooking and at the table, flavor foods with herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends. Start by cutting salt in half.

Avoiding salt when eating out

Ask how foods are prepared. Ask that they be prepared without added salt, MSG, or salt-containing ingredients. Most restaurants are willing to accommodate requests.

  • Know the terms that indicate high sodium content: pickled, cured, smoked, soy sauce, broth.
  • Move the salt shaker away.
  • Limit condiments, such as mustard, ketchup, pickles, and sauces with salt-containing ingredients.
  • Choose fruit or vegetables, instead of salty snack foods.

Fibric acid derivatives

Types of medication

  • Gemfibrozil (Lopid)
  • Fenofibrate (Tricor or Lofibra)

Instructions

Remember: These medicines are not a substitute for a heart healthy diet! They will work best only if you are choosing foods that are low in saturated fat.

Avoid heavy alcohol use (no more than 1 drink per day).

Possible side effects

  • May increase the effect of the “blood thinner” warfarin (Coumadin).
  • May cause upset stomach or diarrhea. These effects are minor and usually disappear over time. However, discuss these symptoms with your doctor if they continue more than one week.
  • May cause anemia and low white blood cell count
  • May cause muscle pains in less than 1 out of 100 people. (Report new muscle pains to your doctor; special tests may be needed.)
  • Muscle side effects may be more common if used with a statin 

Fish oil supplements

Instructions

Always take fish oil capsules with meals. To reduce burping, store the capsules in the refrigerator or freezer and swallow them cold.

Side effects

The following side effects may occur while you take fish oil capsules. Most of these side effects are mild and will decrease overtime. They are rare in patients who take low doses of fish oils.

  • Gas (belching, flatulence)
  • Abdominal discomfort
  • Loose stools
  • Weight gain (10 calories / capsule)
  • Easy bruising or bleeding

Safety information

Cod liver oil is not recommended because it is lower in omega-3 fatty acids and large doses may provide too much vitamin A.

Some types of fish may be contaminated with mercury and PCBs, but when fish oil supplements are prepared, these dangerous elements are removed.

Examples of fish oil supplements

  • Omacor (prescription only)
  • Walgreen's Finest Natural Omega-3 Fish Oil
  • Carlson Super Omega-3
  • Costco Kirkland Enteric Coated Fish Oil
  • Nordic Naturals Ultimate Omega

Niaspan (vitamin B3 or niacin)

Instructions

  • Start with a low dose (usually 500 mg), once per day at bedtime. Gradually increase as instructed.
  • Always take with food or skim milk.
  • Always take full dose aspirin (325 mg) prior to taking Niacin, unless told otherwise:

Regular aspirin, not enteric-coated, works best.
Ibuprofen (Motrin, Advil - 200 mg) or Naproxen
(Aleve – 220 mg) may also be acceptable.

  • Avoid heavy alcohol use (no more than 1 regular drink per day).
  • Avoid spicy foods or hot drinks like coffee or tea immediately before or after taking Niaspan, since they may aggravate the flushing symptoms.
  • Do not skip doses, since flushing can recur if a dose is missed.
  • If you develop a rash or blurred vision, stop the medication and call your doctor.
  • Remember: Niaspan is not a substitute for a heart healthy diet! It will work best only if you are choosing foods to reduce your cholesterol.
  • Treatment is usually long-term. When your cholesterol levels are at goal, you will still need to take your medicine. If you stop taking it, your cholesterol will rise again.

Common side effects

Flushing and itching may occur. Flushing is a brief reddening of the skin, which occurs when the blood vessels in your skin open wider. It usually happen while you are asleep, so many people don’t notice. This is the main advantage of Niaspan compared to other types of niacin.

Remember, if you flush, it means that the medicine is in your blood and is working!

The flushing usually goes away within a week.

Less common side effects

  • Nausea
  • Increased blood sugar
  • Blurred vision
  • Liver inflammation or liver test abnormalities
  • Stomach pain (ulcer)
  • Allergic response
  • Gout (rare)
  • Skin changes (rare)
  • Muscle aches

Niaspan schedule – take at bedtime

Week Dose
Week 1 500 mg
Week 2 500 mg
Week 3 500 mg
Week 4 500 mg
Week 5    1000 mg
Week 6 1000 mg
Week 7 1000 mg
Week 8 1000 mg
Week 9 1500 mg
Week 10 1500 mg
Week 11   1500 mg
Week 12 1500 mg
Week 13 2000 mg

Follow Up

Laboratory tests should be done 6-8 weeks after any major change in your dose and about 2 times per year when you are on a steady dose of niacin.

Over-the-counter forms of niacin

Types of over-the-counter preparations

No-flush niacin (inositol hexaniacinate)
  • Also called “zero-flush” or “flush-free”
  • Does not contain niacin, but gets broken down to niacin in the body but at much lower levels than other forms of niacin
  • Effects on lipids are not as well studied as other forms of niacin
  • Patients do not have flushing with inositol hexaniacinate
  • Most expensive form of over the counter niacin
  • Doses of 2000-3000 mg daily are needed to be effective and then only works well in about half of patients so close monitoring of effect is needed
Sustained-release
  • Also called “controlled-release” or “timed-release”
  • Cause less flushing than immediate release preparations
  • Several formulations have been shown to be more likely to cause liver
  • Toxicity than the immediate release
  • Examples: Slo-Niacin and Enduracin
Immediate release
  • Also called “crystalline” or “plain” niacin
  • Absorbed within 1 hour of ingestion
  • Used safely for > 40 years
  • Least expensive form of niacin
  • Usually more flushing than above forms and must take 3 times a day; flushing can be reduced by taking after meals, taking an 81 mg aspirin 30 minutes prior to niacin, and avoiding hot drinks, spicy foods, and alcohol with niacin

Red yeast rice

Cautions

  • Patients taking other cholesterol-lowering medications should consult a healthcare provider before taking red yeast rice-containing products.
  • Red yeast rice contains the HMG-CoA reductase inhibitor mevinolin; therefore should not be taken at the same time as prescription HMG-CoA reductase inhibitors (statins) as this may result in excessive levels of this cholesterol-lowering substance.
  • Due to the presence of mevinolin in red yeast rice, users should consider undergoing periodic monitoring of liver function.
  • Individuals with a history of liver disease and pregnant or lactating women should consult their healthcare provider prior to taking this product.

Contraindications

  • Red Yeast Rice is contraindicated in individuals with a hypersensitivity or allergy to rice or yeast.

Possible side effects

  • Heartburn, abdominal discomfort or bloating
  • Dizziness
  • Headache
  • Body aches or stiffness
  • This supplement is generally well tolerated.
  • If you develop severe muscle pain, tenderness or weakness, especially if associated with flu-like symptoms, stop red yeast rice and call your healthcare provider as soon as possible.

Instructions

  • Avoid grapefruit juice or excessive alcohol while taking red yeast rice.
  • Dosage: Each tablet contains 600 mg of Red Yeast Rice. Take 2 tablets (1200mg) twice a day.

Where to buy

Cholestene™ by High Performance Formulas is recommended and available at:

Since the FDA does not regulate nutritional supplements, other formulations of red yeast rice may or may not be as effective as the High Performance Formulas brand.

Statins

Type Of Medications:

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Lovastatin (Mevacor)
  • Pravastatin (Pravachol)
  • Rosuvastatin(Crestor)
  • Simvastatin (Zocor)

Instructions

  • Remember: These medicines are not a substitute for a heart healthy diet! They are only about half as effective on a high saturated fat diet.
  • If you are taking only one pill each day, it is usually most effective if you take it in the evening, with your meal or at bedtime
  • Treatment is usually long-term. When your cholesterol reaches a healthy level, you will still need to take your medication. If you stop taking it, your cholesterol will rise again
  • Do not drink more than 8 oz. of grapefruit juice within 8 hours of taking a statin medication.

Possible side effects

Side effects with this medication are rare—less than 3 out of 100 people taking these medications will have any of these side effects.

However, if you experience any of these symptoms, report them to your doctor.

  • Severe muscle soreness or weakness (rare)
  • Nausea or abdominal discomfort
  • Liver irritation (uncommon)
  • Rash
  • General fatigue (tiredness)
  • Insomnia

Follow-up

Liver function tests will be checked at six weeks after beginning or changing therapy and then yearly.

Starting an exercise program

DAY   ACTIVITY
1    Timed walk with a watch. Walk until you have to stop for any reason (fatigue, short of breath, pain, boredom). Record the time.
2 Rest
3 Walk half the time of day 1
Walk half the time of day 1
5 Rest
6 Walk same time as day 3 plus 2-5 minutes
7 +    Add 2-5 minutes every third day of exercise taking no more than two days off per week.

When you are walking 30-45 minutes per day, five or more days per week, you now have a regular exercise program.

It's okay to substitute biking (outdoors or stationary), elliptical trainer or swimming so long as you time your sessions, start slowly and steadily increase your times.

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