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Drugs and Diving - Blood Pressure

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I would like to know if adalat and perindopril are ok to dive with, also are any diuretics acceptable?

A - Yes. Yes, maybe.

Alright I'll expand on the brief answer. The first 2 are drugs used most commonly for high blood pressure. For any budding pharmacists out there, they are a calcium antagonist and an angiotensin converting enzyme inhibitor, respectively. They lower BP by dilating blood vessels and blocking an enzyme that causes blood pressure to rise via fluid balance. So the key thing here is that if your blood pressure is controlled by these meds, then you should be fine to dive. You will need a dive medical as well as the doc needs to do an ECG of your heart to check for any abnormalities that long term high BP can cause, notably left ventricular hypertrophy. If you have this then diving could cause problems.

Now to diuretics. They do what they say. Cause diuresis, medical for peeing. The theory is that if you pee out all thisfluid, there's less in the system, so your BP decreases. The only problem with diving here is that you can dehydrate a tad on these tablets, so increasing the risk of DCS. I think best leave these alone if you want to dive a lot.

Q - I am a 47 year old male diver and dive regularly throughout the year I take 2.5mg of Tritace (Ramipril) & 20mg Lipitor (Atorvastatin) each day, I am fairly fit and workout 3 or 4 times a week (weight training) and I have never smoked. I am considering starting to use a supplement to assist with my weight training its called Pro Test and to quote the sales pitch it "boosts natural hormone production, increases muscle gains, increases strength, lowers oestrogen & stimulates lutienizing hormone production. It contains Tribulus terrestris, Protodioscine, concentrated extract of the herb Avena Sativa & Diindolylmethene, it describes itself as an "endocrine support system offering natural testosterone elevation!!!"

I don't know if this is all rubbish but a number of people including instructors at the gym I use say it is quite effective at building up muscle and strength, I am not a hardcore bodybuilder or anything but I just like to keep fit and have a good physique (a bit vain I guess!) and at my age a bit of help would be welcome! But I don't want it to affect my diving so I would value your opinion.

A - The first bit about the blood pressure pills and cholesterol lowering meds is fine. If your BP is under control then you are OK to dive.

For more info on diving and blood pressure, please go to the e-med site and click on "longer articles" on the dive pages.
As for the muscle bulking supplements.

Hmmm

The reality is that we don't dope test yet in diving, and I am sure that anything sold probably is fairly benign so it should be fine with diving. My only reservation is that history has proven that these supplements don't often either contain or say what they will do on the tin.

Be careful you don't grow breasts and have your nads disappear.

Q - I am a diving instructor with the B.S.A.C. and yesterday a friend's wife asked if she could learn to dive, and to cut a long story short… she has slightly high blood pressure and takes 'AMLODIPINE' to control it. Does this exclude her from diving? She and I would be grateful for a quick reply. I explained if it does, then she should see a qualified diving doctor for another solution, but at the present time I can't see the point in her paying for a diving medical just to be told "you can't dive".

A - Amlodipine will probably be fine but I think `sartan would be better. Either way I suggest she should be fine to undergo pool training now but would need a check up before she hits the Big Blue. The doc will make sure all is well with the BP, but a little tip before she goes, don't rush to the surgery and arrive late and hassled as the BP will be sky high, get there early and chill in the waiting room with an old copy of Readers Digest to keep the pressure low before the doc gets out his sphygmanometer. That's a blood pressure cuff to the rest of us.

Q - I would like some advice on the suitability of medication I have been prescribed for high blood pressure. This is purely for my own peace of mind. The brand name of the medication is Diovan; the chemical name is Valsartan. The prescribed dose is 80mg.

A - Well you can rock the house there as you have got the right medication there in one. Anyone who has read my comments on blood pressure meds before will know that the `sartans are in my opinion the best ones to take. They are from a group called A2RI's. Don't ask what that's short for as it's too boring and why I spent most of my pharmacology lectures either asleep or in the pub, but believe me when I say that it's good stuff. Any diver though with high blood pressure, controlled or not will need to get a fit to dive cert before going in deep as the doctor has to check for "end organ damage". This is not where you may have scraped your love pump on a urinal but something more complex to do with eyes and kidneys. So get a check up, all well and off you can go.

Q - My husband and I did a try-dive during 'Learn to Dive' week and really enjoyed it and we are now thinking about joining our local dive club, however I would appreciate your opinion as to whether it would be OK for my husband to take up diving as a hobby as he is on medication since he received a kidney transplant in late 1999.

He currently takes -
1000mg of Mycophenolate Motefil three times daily,
2mg Tacrolimus twice daily
5mg Amlodipine once daily
3mg Prednisolone once daily
1mg Doxazosin once daily
100mg Metoprolol Tartrate twice daily


He is in good health and is not overweight - your advice on this matter would be much appreciated.

A - A successful kidney transplant where the donor kidney has taken, the blood urea and electrolyte balance is all fine and the side effects of the medication are not causing any debilitation is no bar to diving.

However looking at the meds he is on, one rears its ugly head. Metoprolol.

This is a beta blocker and as mentioned before can cause fluid on the lungs if the dive were to turn strenuous.

Now here's the rub. The metoprolol is to keep his blood pressure down, vital after this sort of operation. In non-renal transplant divers there are other choices of BP tablet, but this may not be the case if he's got someone else's kidney. I think the best option is to go back to the specialist, see if there's another alternate to metoprolol that is not yet another beta blocker, e.g a calcium antagonist and if that's the case then switch. But if his specialist says it can only be metoprolol then I think that he may have to steer clear of sub aqua pursuits.

And finally whilst on the subject of Try Dives, I have just done a medical on a young girl keen to learn to dive after a similar initial experience. Only she was very nearly put off it for life after her session. Why? Well they only went and took her cave diving didn't they after a 20 minute pool session. Makes you realise where all the cowboys have gone.

Q - Earlier this year you found I had a prostate problem during a general medical. As per your recommendation I am now getting drugs via the NHS to reduce it and everything seems to be getting better. My question is that the drug, Omnic MR Capsules (400micrograms once daily), is an alpha blocker. The results of this is I occasionally get dizzy if I stand up too quickly and my heart races if I do any anaerobic exercise. Although these symptoms are easing, and I have been diving with no problems, I am a bit worried whether I should be diving with this drug or not. I am an Instructor so want to be sure so that I am not putting anyone else at risk. Your advice would be appreciated.

A - An alpha blocker as well as being a drug that can reduce the size of the prostate, is also a blood pressure lowering medication.
Divers are allowed to dive on these as it is a common problem and the medicines widely taken.

It may take a while to get used to the side effects of this drop in pressure as your prostate shrinks, but things will level out later.

You need to get a pressure check to compare standing versus lying to see if there is too much of a drop. If there is then it may be worth trying another med, or even going for the prostate reducing operation.

Q - I am a diver who takes medication for mild hypertension. My prescription is 2mg of Perindopril daily. This medication has been fine for the last 3 years while I have been taking it, controlling my blood pressure well. There is a but, I now seem to have developed a dry cough, which I understand is a common side effect of this particular medication. I have had this for a number of months.
I recently visited my GP to discuss this with him who took my BP. This was 140/96, which is a little higher than it normally is. My GP stated he would like me to return in the New Year to check it again, and that maybe I should consider a change of medication, 1. to control the BP better and 2. to get rid of the cough.

Now I have got that all out of the way I will get to the point, I have read that a drug called Sartan is available, which is very good for divers. Could ou advise me if this is the case, and further which other drugs are available that may be worth considering changing to, that could be suitable as an option, should they be required.

A - You've heard the right thing. Perindopril is an ACE inhibitor. It lowers the BP by blocking an enzyme called angiotensin converting enzyme. Its good but does have this side effect of a dry cough. And there is a low risk that you could spit your reg if you were hacking away underwater. So go for a 'sartan. That's the suffix for this group of newer anti-hypertensives. They block the angiotensin receptor itself, not the enzyme, and currently do not seem to cause this cough. A couple are called losartan and candesartan.

So try one of these to start with, your GP should be happy to give them to you but they are pricey in comparison to other meds.

Lets hope you handed over the requisite whisky and fags to your doc at Christmas to keep him onside!

(other dive medical questions)



   


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