Detailed query on high BP and rapid pulse issues, and some m

I am 44 years old. After many years of normal blood pressure and pulse, I am suddenly experiencing both high blood pressure (130/90 and higher) and rapid pulse (90 to 100). I am speaking with my physician, and with several other doctors I see, but they are very busy and I'm not always sure they are on top of things. So I want to use this space to discuss some medication changes, and see if anyone can tell me if the meds may be related to the problems I'm having.

First, I've been on a lot of psychotropic meds over the years. I also take Melatonin, 1 Mg, to help me get to sleep, and Zantac (150 mg, twice daily) for stomach acid.

About 1.5 years ago, following surgery for a benign tumor, I had a bad

Serzone (can't recall the dose)
Zyprexa (1.25 mg, once per day, at night)
Depakote (250 mg twice daily)

Remeron (also called Mirtazapine) (15 mg x 3 pills, once a day, at night)
Desipramine (50 mg once daily, in morning)
Zyprexa (1.25 mg, once per day, at night)
Depakote (250 mg twice daily)

Now, sometime after this change was made -- and I'm not sure exactly when -- my doctor started to observe the high blood pressure during office visits.

The psychiatrist thinks the Remeron is unlikely to cause high blood pressure or fast pulse, but the Desipramine could be the culprit. So recently he switched me from the Desipramine to Nortriptyline (50 mg at night), since he thought the latter drug was less likely to cause fast pulse or high blood pressure. However, the change made no difference in my symptoms. We have lowered the dose of Nortriptyline to 25 mg, still with no noticeable difference in symptoms. One option is to stop taking the Nortriptyline for a few weeks, and see what the effects are, if any. However, before doing that, there is another medical factor involved.

I need a lot of sleep. I saw a sleep doctor, and they did two overnight sleep studies. They noticed a urinate a lot at night, and suggested that might be the cause of needing a lot of sleep, so they sent me to a urologist. (It's like, trying to solve one problem just leads to another.) The urologist put me on Flomax (0.4 mg), and more recently switched me to Uroxatral (10 mg). Now, the thing is, I'm not sure exactly when this rapid pulse problem showed up, but I think, maybe, it roughly coincides with when I started on these medicines that are supposed to address my urinary frequency. So the next question is: Can Flomax or Uroxatral cause rapid pulse problems? (The high blood pressure definitely preceded both the Flomax and
Uroxatral, so the latter two medicines are not under suspicion there.)

Next medicine: The doctor put me on HCTZ for the high blood pressure.
It does not seem to have helped much, if at all, with the high blood pressure; and I'm wondering if that medicine itself could have caused the rapid pulse problems I'm having.

Finally, the doctor put me on Toprol-XL, last week, for both the high blood pressure and pulse problems. So far, based on my home monitoring device, it seems to be lower my blood pressure somewhat.
But my pulse remains stubbornly rapid, and it's scaring me a bit.

In case you've lost count, I'm currently on:

Toprol-XL (50 mg in the a.m.)
HCTZ (12.5 Mg in a.m.)
(both meant to address the high blood pressure, and I think the rapid pulse)

Remeron (also called Mirtazapine) (15 mg x 3 pills, once a day, at night)
Nortriptyline (50 mg, at night)
Zyprexa (1.25 mg, once per day, at night)
Depakote (250 mg at night, 125 mg in the a.m.)
(all to relieve depression and anxiety)

Uroxatral 10 mg at night (Flomax, until very recently)
(for urinary frequency)

Melatonin, 1 Mg
Zantac (150 mg, twice daily) for stomach acid (been on both for ages, can't imagine they are causing the problem)

Does anyone out there in medical land have enough experience with these medicines to know which, if any, might be causing the problem?
Of course, it could also be that the blood pressure and rapid pulse problems are unrelated to my meds, and are happening for other reasons. But I'm not that old. I don't smoke, don't drink, don't use drugs. I've put on a little weight since starting the Remeron (it does induce hunger), going from 160 lbs to 175 lbs, but I'm hardly obese. I don't exercise as much as I should, but I'm not short on breath, either.

So, supposing it is the medicines, can anyone pinpoint which ones it might be. I'm reluctant to get off the Nortriptyline (and actually, would prefer to get back on the Desipramine, since I was getting real good benefits from that). On the other hand, I lived with the urinary frequency for years, and the Flomax (and then the Uroxatral) have not provided terribly much improvement anyway, so I'm perfectly prepared to ditch that, if that might be causing the problems (at least with the rapid pulse). Any suggestions or insights?

Finally, let me add, I won't make any changes without consulting with my physicians. I just want whatever added information people can provide.

This was my Flowmax experience. You will find others with similar problems if you do a Google search on Flowmax or look at the Flowmax thread on sci.med.prostate.bph
Sorry I originally posted the reply to the next thread.
Derek.
After starting Flowmax and Proscar last Tuesday my BP was lower than usual the next morning and eventually went as low as 106/58 but my normally drug induced pulse rate of under 50 was up to 61. By evening the headache began and by Sunday my BP was much higher than normal all day. I woke up early
Monday morning with my heart pounding and checked my BP and pulse getting a reading of 214/85 and a pulse of 112. Alarmed my wife phoned the doctor who came round to check me out. He said that my BP was still as high but heart sounded all right and that my pulse had gone to 90. He had never heard of such a reaction before but to stop taking the medication.

I did a Google search and found others who had a similar problem with Alpha
Blockers:-

"I have had bph problems for quite a while now. I have tried Cordura and it really made me dizzy. I have tried Hytrin which I may have to go back too. I was only taking 2 mgs a day, but it was helping a little.
The problem was it was making my heart beat pretty rapidlyt at times and I decided to discontinue it".

Also:-

warning of the dangers of alpha-blocker drugs. The article, by Sidney Wolfe,

M.D., cautioned that these drugs can significantly increase the chance of

heart attack or stroke. The article specifically named Cardura, Hytrin and

Flomax, all of which belong to the alpha-blocker family. Although, I had

been taking Flomax for the last two years and Proscar for more than five

years, I reluctantly decided to discontinue the Flomax out of concern that I

might increase my risk of stroke"

Also:-----

" I was having dizzy spells, weakness and after very little exertion, my pulse rate would go sky

high. I normally have low blood pressure and that might have been some of

the problem. The fact that there are increased cases of congestive heart

failure and stroke are enough to make you think twice or more about taking

it".

When I posted my problem on a cardiac NG I got this reply from a Doctor:-

" I would wonder about the Flomax interacting with the verapamil by

lowering levels of the latter. This would raise both your heart rate

and your BP"

Derek.