Criteria for getting off of drugs

[JOHN2393]

Age: 45
Sex: M
Height: 5'10"
Weight: 195lbs

I've been on the following medication since Jan 13.

Morning:
1 x 81mg aspirin
0.5 x 5mg lisinopril
1 x 90mg Brilinta
0.5 x 25mg Metoprolol Tartrate

Evening:
1 x 90mg Brilinta
0.5 x 25mg Metoprolol Tartrate

I had a heart attack on Jan 11 (NSTEMI) and a stent was put in to fix a 90% blockage in LAD.

I quit coffee and any drink with caffeine. I quit smoking. I ate pretty healthy before my heart attack, but now it's even more healthy. I exercise at least 30 minutes (on Elliptical) every day.

For each of the above-mentioned drugs I would like to know which medical conditions have to be met before a patient can be weaned off of the drug? There must be certain criteria and I would like to know what those criteria are or where to find literature that will describe such criteria.

Pre-conditions:
- diagnosed with fatty liver in 2000 based on slightly elevated AST and ALT.
- High BP in 2017

In Jan 2017 I was diagnosed with hyperlipidemia and hypertension based on the following lab test results:

Test #1
NON HDL CHOLESTEROL 193 mg/dL (calc)
CHOL/HDLC RATIO 7.9 (calc)
LDL-CHOLESTEROL 151 mg/dL (calc)
TRIGLYCERIDES 209 mg/dL
HDL CHOLESTEROL 28 mg/dL
CHOLESTEROL, TOTAL 221 mg/dL

Test #2
NON HDL CHOLESTEROL 197 mg/dL (calc)
CHOL/HDLC RATIO 8.3 (calc)
LDL-CHOLESTEROL 151 mg/dL (calc)
TRIGLYCERIDES 230 mg/dL
HDL CHOLESTEROL 27 mg/dL
CHOLESTEROL, TOTAL 224 mg/dL

Blood pressure measurements:
124/80, 150/110

ALT measurements:
61 U/L, 65 U/L, 59 U/L

[2210485]

The literature you are looking for is this:

http://circ.ahajournals.org/content/early/2016/03/28/CIR.0000000000000404

That is the AHA/ACC/ESC consensus update on DAPT (Aspirin/Brilinta)

This document is created as the result of a meeting between all the cardiologists, cardiothoracic surgeons, hematologists etc. In the world. Its basically the law.

[JOHN2393]

Are there similar documents (guidelines, recommendations) regarding criteria for weaning patients off of lisinopril, metoprolol tartrate and aspirin ? What are the pre- and post conditions? By "pre-conditions" I mean which conditions must be met while on medication to start weaning a patient off of the drugs. And by "post-conditions" I mean which conditions must be met *after* a patient has been weaned off of the drugs?

[JOHN2393]

Thank you for the document link by the way! I'm printing it out now and plan to read it carefully.

[2210485]

Reading,the document would be best.

I am familiar with the theory, however in practice that document and others like it (google for the previous AHA/ACC "consensus statements") are the gold standard.

Basically if something happends to you, and you take the doctor to court.. That document I linked will be the "evidence" used in the case.

On paper these documents are only "recommendations" but the truth is, these are minimum standards that protect a physician. They constitute every aspect of care that is generally accepted as "fact" by the medical community.

This may not be EXACTLY what you're looking for, but what it can do for you is give you an idea of whether or not a decision is risky enough to constitute malpractice.

[2210485]

Thay said, I am not familiar enough with the most precise and uo to date information off the top of my head to share any information about this that I can confidently say falls in line with the present standards.

If you want specific criteria, seek out the source directly.

[2210485]

Brilinta is there to help prevent another heart attack.

When people have heart attacks we typically implant stents, which are metal scaffolds to open the artery.

Your heart, like most of your body isn't particuarly fond of having foreign objects inside of it. It will respond to this like an injury, by trying to form a clot or a "scab" if you will; over the top. This would cause another heart attack in the stent.

Brilinta is a blood thinner, aka anti-platelet that prevents this from happening. Without this medicine you would die.

Typically after about 1 year of having the stent scar tissue, or endothelium forms over the surface, when this occurs you can consider transitioning off brilinta. However being on it longer is a good precaution to avoid another heart attack.

Aspirin is there to help make the brilinta more potent. Going off either will increase your risk for another heart attack.

Both Lisinopril and Metoprolol help to reduce blood pressure. This helps reduce the workload of the heart and also reduces your risk of stroke. The doses of both these medicines for you is very small, if you get good control off these medicines as it is then removing them is a bad idea.

Blood pressure has a rebound effect. So removong the lower dose of meds could put you in a situation where a higher dose is required in the future.

In short all of your meds are lifesaving. I would not advise pulling them.

None of them have any sort of serious adverse effects in the long term. Aspirin and brilints can cause problems with ulcers and bleeding.

Lisinopril and metoprolol both modify your bodies natural hormonal and nervous system mechanics to achieve an effect. Their mechanisms of action are discreet.

[JOHN2393]

Thank you for your detailed answer. I appreciate it. I haven't made up my mind about whether or not I'm going to stay on these drugs. I will definitely stay on them for at least 1 year, but I also want to understand what the guidelines and recommendations are for each of these drugs given the facts/data available for my particular case. I don't believe in the "one shoe fits all" philosophy so I need to understand if I need to be on these meds for the rest of my life regardless of the level (or lack of) adverse effects.