Side Effects of Benicar

[HiCaliber]

A close family member was recently given Benicar for hypertension. On the second day he obviously began having a manic episode - breaking out in a sweat, agitated, tremoring, trouble driving w/o drifting over the lane, argumentative, etc. The doc gave him 40 mgs - I had him cut it into quarters so he only took 10 mgs.

I'm really upset - he of course loved it and was furious that I took it away. Has anyone else experinced any mania effects from Benicar? Betablockers give him terrible depression. Many meds seem to influence his mood even when they're not designed to do it. He also takes Lamictal which has helped some to even out his mood. I find that doctors just don't care about the mental and behavioral effects of the treatments they prescribe. Although I've searched the web I haven't found this as a side effect yet. :confused: Perhaps it just lowered his blood pressure too fast and that caused the mania. Dunno ... looking for insights. Thanks, everyone!

[dreamz]

I want some information about this benicar…..i take it because I have hypertension problem. I have read on http://www.drugdelivery.ca/s33930-s-BENICAR.aspx
That this medicine should not be in case of pregnancy….Is this true?

[houghchrst]

I hope you get some help soon. I am bipolar II and have trouble taking a lot of meds. some make me severely depressed, some make me manic and when I mention it to the doctors that prescribed it and tell them I have stopped taking it they act like I am stupid. I too looked for that as a side effect and couldn't find it. Maybe someone else can. Maybe it was a reaction to mixing it with the Lamictal.

As for pregnancy, here is a link for you.
http://www.rxlist.com/cgi/generic/benicar_wcp.htm

[mrsdoubtfyre]

This question is very intriguing...so I did some looking around.

From pharmacology statements about Benicar...
this fact suggests strongly that it does not directly affect bipolar:
The volume of distribution of olmesartan is approximately 17 L. Olmesartan is highly bound to plasma proteins (99%) and does not penetrate red blood cells. The protein binding is constant at plasma olmesartan concentrations well above the range achieved with recommended doses.

In rats, olmesartan crossed the blood-brain barrier poorly, if at all. Olmesartan passed across the placental barrier in rats and was distributed to the fetus. Olmesartan was distributed to milk at low levels in rats.
from http://www.rxlist.com/cgi/generic/benicar_cp.htm

What this means is that it is not lipofilic. New research into ACE inhibitors (which this is not-- Benicar is a ARB..) suggest certain ACE inhibitors prevent Alzheimer's by crossing the blood brain barrier and preventing certain inflammatory changes. For example Vasotec does not, but Zestril does.
So I thought at first that Benicar might cross the BBB, but it appears not.

But looking at the symptoms listed here for the reaction, I wonder if the 40mg dose was just too high. When one has hypertension, and is given a drug that is too strong, then there can be a sudden drop in blood pressure, which then if extreme, would activate stress responses. Adrenalin (epinephrine) may be triggered, and that could explain the sweating, and irritability. One way to tell would have been to take a pulse. Rapid/and weak suggests this reaction. If severe enough, cortisol might then be triggered, and this can have mood effects in some people.
Many blood pressure drugs elicit responses like this. Commonly reactive tachycardia may occur with calcium channel blockers (like Procardia, or Verapamil) for example.

The trends in hypertension control today suggest, using modest doses of different drugs in combo to get a good response, rather than one big dose of one agent. There are several families of drugs now..
betablockers
ACE inhibitors
ARBs
diuretics
calcium channel blockers
vasodilators (hydralazine)

ACE inhibitors and diuretics are considered first line now. It is odd that he would be started on an ARB in high dose like that. Sounds to me like the drug salesperson has visited and offered incentives! JMO (Benicar is heavily sampled, that I have seen).

[HiCaliber]

I'm really "sticking to my guns" in a manner of speaking about meds triggering mania even though healthcare does not admit it. Now then, I would hardly say that everyone or even most people are going to have that reaction but I've noticed that in my family member's case it does. Agreed that it may be the end product of a chain of reactions or a combo effect rather than direct but it's still a bad sign and a bad outcome.

He had been on MANY blood pressure meds - all of the classifications mentioned in this thread - and NONE really helped his blood pressure. They did make him mean and crazy though and a big THUMBS DOWN to the so-and-sos who prescribe them. :mad:

A cardiologist finally ran tests for hyperaldosteronism and despite the lab's best efforts to screw up the test, he did turn up w/elevated aldosterone. He's been on treatment now for over a year - takes spironolactone - and blood pressure is excellent. No other blood pressure meds.

[HiCaliber]

The same family member I've already mentioned in this thread has multiple sclerosis. He started on Tysabri a few months ago and after about 2 or 3 treatments began to manic again. Wild, mean, angry and threatening. I complained to the doctor who did not want to take him off and would not lower the dose.:rolleyes: I was close to telling the FDA. The MS doctor swore up and down that the Tysabri does not do it but I know full well that no one has ever studied the issue even though the rate of manic depression is twice as high among MS patients. (another major fact that is not popular but hey, I don't think most people *choose* to be bipolar) It's easy to claim a med does not have a given side effect when you close your eyes to it. :rolleyes: The family member was put on Depakote which had it's own side effects but the "every-few-minutes" of mood swings from crying to screaming were greatly reduced. I'm told that's a mood disorder - not classic bipolar 2 as bipolars allegedly have several months of "normal" behavior.

We've brought the Lamictal down from 400 mgs a day to 100 mgs a day w/depakote of 1500 mgs a day in place now. Hoping to get rid of Lamictal as the whole effect seems to change when combined w/depakote. Lamictal seems to act as a stimulant now. Also, the Depakote has made the MS symptoms worse . :(

Still steaming as no doctor out there knows enough about these multiple serious health issues and their treatments together in one patient to give an authoritative response - and shouldn't because it has not been researched. Probably many people with the milder forms of mood disorders are not recognized anyway. I feel that my life is revolving around fighting doctors who don't know what they're doing. :eek:

[twilson]

Mood changes are listed as a side effect for Benicar-HCT on MayClinic, and the 40mg does seem like a high dose to start on. 20mg is recommended starting dose. I wonder as one of the other writers did whether there could also be some sort of drug interaction with the Lamictal? Lamictal can also increase the effect of some other meds as well as alcohol and I have read it should not be taken with Depakote, which you said they were also on.