My cousin Doll, who is over 80, had a heart attack with angina two years ago. She bruises badly with the slightest knock or scratch and also has vertigo. Here is her prescription-drug list: moxonidine, for high blood pressure; Isotard, a nitrate drug for angina; atenolol, a beta-blocker; bendrofluazide, a diuretic; valsartan, an angiotensin-II inhibitor; aspirin, to thin the blood; nicorandil, a potassium-channel activator, for angina; atrovastatin, a lipid-lowering drug; sulphasalazine, an anti-inflammatory. - PP, Grand-Over-Sands, Cumbria

My 86 year old mother is taking: digoxin, a cardiac glycoside (or digitalis) for atrial fibrillation; an ACE inhibitor, a diuretic, a drug like Zantac for stomach acid, a paracetamol/codeine pain reliever and an NSAID for arthritis; naftidrofuryl oxalate, for poor circulation in the legs, and aspirin. Could this cocktail be aggravating her loss of memory and lack of appetite? - LL, Northampton

WDDTY replies: At a recent meeting of the European Society of Hypertension, the drug interactions for antihypertensives were highlighted (www.eshonline.org/education/esh2002/transcriptions/vanzwieten.htm). Although ACE inhibitors and diuretics can work synergistically, they can also work antagonistically and raise blood pressure.

Remember, a diuretic slows down water loss, the effect of which is to retain all the various drugs longer, and make drugs like ACE and angiotensin-II inhibitors stronger or more toxic. Diuretics can also cause low levels of potassium in the body, which will increase the toxic effects of digoxin and other cardiac glycosides, and increase cardiac arrhythmias.

Nicorandil can cause dizziness, but so can ACE inhibitors.

NSAIDS inhibit the effect of most antihypertensives, particularly diuretics, because they retain sodium and water, which will cause blood pressure to rise. All drugs that work on the central nervous system (like moxonidine) will have an effect on all other drugs in the body.

Take a brown bag of all the prescribed drugs to the doctor. Insist that he look up the drug interactions of each drug, and look up the website above. Ask if the women can be put on one or, at most, two heart drugs and work out non-drug dietary or supplement alternatives for the rest, such as Ginkgo biloba to improve circulation. For help with arthritis, see our Arthritis Manual and, for reflux, try digestive enzymes (see WDDTY vol 8 no 1).