Well, here we are again. Having stabilised my condition I thought it would be quite some time before I had a need to write another instalment, but it seems my GP just can’t resist the urge to screw things up.
I take the now fine but previously extremely troublesome beta-blocker, Nebivolol, at the rate of 1.25mg twice a day – as the 2.5mg tablet is scored, this is simple enough. Now, though, in a spirit of penny-pinching, my GP wants to prescribe 5mg tablets, that I can cut up – completely ignoring the fact that cutting up an unscored tablet (scored for breaking in half, not for quarters), accurately is almost impossible, even with a tablet splitter, as they tend to crumble. This does not save money, it creates waste. It also makes an accurate dose almost impossible.
The best indicator possible that I’ve got it right, by the way, is my BP (127/63), and heart rate (77). Neither have ever been that good. When I started Nebivolol (this time round), and my reason for doing so, my BP was about 20% higher, and my heart rate 125bpm. That’s better than it’s been in decades, and I really do NOT need a penny-pinching pill-peddler fucking with that. The more I see of doctors, at any level, the more my contempt at their lack of in-depth knowledge and propensity for bullshit increases.
Almost in the same breath, though, he wants to prescribe a vitamin D and calcium supplement, which I don’t want, didn’t ask for, and certainly don’t need. In my case I already take vitamin D3 (the bioavailability of basic D is minimal), and I get ample calcium from my diet.
There’s a booklet from the people peddling the supplement which, pretty much from the outset, gets it wrong, by claiming that the effect of sunlight on skin produces vitamin D. It does not, it produces D3, which I’ve been taking for years anyway. Yep, I know it’s based on the assumption that most patients wouldn’t know the difference, and they might be right, but it’s still inexcusable.
So, on the one hand, my GP wants to screw up my heart meds for the sake of saving a few coppers , while at the same time wanting to spend money on a supplement which I don’t need, don’t want, and didn’t ask for.
You really couldn’t make this shit up!
This is my reply:-
Re: Medication change – Nebivolol 2.5mg
As previously advised, I do not take Nebivolol 2.5mg once a day, I take half a tablet every 12 hours. (When I wrote to you previously on this subject, I got the numbers wrong.) At that time I started with 0.625mg every 12 hours, increasing to 1.25mg every 12 hours,** which is my current dose. This effectively controls my tendency to tachycardia and my BP.
**This is because in some people, and I am clearly one of them, Nebivolol can have an extremely short half-life, with the result that I am effectively unmedicated for a large part of the day, as evidenced by the fact that my heart rate rises in the evening, and becomes erratic, if I take just 2.5mg in the morning, while taking 1.25mg every 12 hours keeps me stable. (BP127/63, pulse 77, at noon today.)
The 2.5mg tablet is scored, so clearly intended to be accurately split in half. Cutting up a 5mg unscored tablet (scored for breaking in half, not for quarters), accurately is almost impossible, even with a tablet splitter, a crude device at best, as they tend to crumble. This creates waste as I know from experience that Nebivolol tablets often do not cut cleanly if not scored. It also makes an accurate dose almost impossible, which I really do not need.
Ronald W. Graves.
PS Regarding the proposed vitamin D/calcium supplementation, I have been supplementing with D3 (cholecalciferol), for some years, as I’m housebound (5000 i.u. per day, the lower end of internationally-recognised guidelines from the Vitamin D Council), the bioavailablity of D3 being superior to D and D2, and my diet contains ample calcium from dairy products (milk, yoghurt, cheese), eggs, pulses, sardines, greens, and home-made bread. I have no need, therefore, to take up this offer.
Perhaps the saving can be applied to my Nebivolol, as I see no logic in complicating my life, and potentially compromising my health, to save a little money, while being willing to spend money on a supplement I don’t need and didn’t ask for.