A really interesting side effect of a medication I'm taking: Vivid dreams.

Recently I began taking blood pressure medication when I realized that my blood pressure was out of control.

(It would be better, I think, to exercise, but it's difficult with my intense work load and, well, winter, although I did get the chance to do some wonderful weight lifting recently using snow weights.)

After a rather long and pleasant discussion with my long term physician, in which we weighed the merits of various approaches to medication, we decided to try an ACE inhibitor that was relatively inexpensive (generic), and a compound I understood fairly well, the peptide/peptidomimetic lisinopril. (I had actually synthesized many similar molecules in the lab when I was a kid.) Lisinopril is an ACE inhibitor and for various reasons, we thought it would be a cool approach and might work well.

A side effect of lisinopril is, however, coughing, and I'm afraid I got that one pretty bad. As I am already an insomniac - and have always been one - and the coughing was worse at night, making my insomnia even worse, as well as making things at work difficult, where I am often required to engage in long phone conferences, and often find myself speaking to groups.

Also, it was only marginally effective, much to my disappointment.

So I went back to the doctor and we discussed our approach and decided to move to angiotensin II inhibitors, and settled on losartan (Cozaar) which is still under patent by Merck, and costs a little more.

It seems a little more effective. I have a bad cold as a result of snow shovelling for long hours - which was, in fact, good exercise in any case - so I'm still coughing, but I have noticed that since beginning to take losartan, that I have begun to have very, very, very, very, very vivid dreams, usually about war or dire poverty, but often involving strange juxtapositions in temporal periods and locations. For instance, the other night I dreamt of my long dead aunt and uncle - who I loved very much - huddled with large numbers of civil war soldiers and refugees in the suburban Long Island house where I grew up, which somehow had become attached to the family church I used to attend when I was a boy. There was no sign of my parents, but with all these soldiers and relatives around, who should come by but my wife, dressed in a very sexy night gown she used to wear when we were first lovers; she was young and very beautiful.

I had to warn her not to step on a soldier since it was dark, and I went to turn on a light, but had difficulty because they were all brass antiques with strange unworkable switches.

Very bizarre. I very seldom dream anymore, and seldom sleep all that much either - a long night of sleeping would involve four hours - but I can only attribute this sort of thing to losartan.

When I look at the structure of losartan, I don't see any features that suggest a kind of neurotransmitter effect, although if one stretches one's imagination one could imagine a certain relationship to a diazepam, particularly in the biphenyl portion which has a tetrazole carboxylic acid isostere. You fiddle around with it could just imagine a stereochemical relationship to a diazepam sort of bird.

No such effects are reported in the typical literature associated with losartan.

Anyway. The dreams are kind of interesting, and it was certainly fun to see my wife in that sexy nightgown again, even if it was in the presence of wounded confederate officers.

that are out of this world. That is, when I sleep. I will ask my doctor about the lisinopril and see if he won't put me on something else. I can handle the dreams but I can go 36 hours with sleep and it is killing me. I can't take Norvasc because it makes my feet and legs swell to the point I can't get shoes on. Thanks for posting this.

About 30% of the population, unevenly distributed for reasons that are not entirely understood among African Americans, have refractory hypertension.

Interestingly, a drug that addressed this population set was omapatrilat, which made it through phase III clinical trials but was pulled just before the NDA for angioedema events leading to constricted airways.

I'm not sure that this was a wise choice from a risk/benefit standpoint, given an large and serious unmet medical need, coupled with with a relatively low risk of the side effect. Maybe a black box warning would have been more appropriate. High blood pressure is a very serious syndrome, with very serious risks and we may have saved more lives than we would have lost with approval.

For full disclosure, I was involved in the manufacture of some intermediates for that compound at the time.

strange how medication differs with different people. I actually take 3 types of pills. Can't remember the last one or rather can't pronounce it let alone spell it. One must be a diuretic. I go constantly. I am still alive because of them. When mine was first discovered my BP was off the chart. I've been on BP medicine for 13 years.

Sorry it doesn't work for you (meds are so iffy for each of us). I don't sleep much at all (3-5 hours per night, max), but I was like that before the Lisinopril. As for the swelling, is it just water weight? I take a Lisinopril/HCTZ split (the HCTZ is a diuretic). The HCTZ took care of the swelling and extra weight I had, unless I drink soda for a week, which I never do anymore.

I know nothing about atenolol though.

The type of dreams that are so troubling that no matter how tired you are, you get up and find something to do because you don't want to go back to sleep.

When I complained to the doctor about the dreams he directed me to quit taking the Lisinopril and had the nurse draw some blood to send to the lab (this is at the very end of the business day.)

The next morning I got a panicked call from the doctor's nurse directing me to not bother bathing or brushing my teeth, but instead to immediately go to the pharmacy and get a prescription (if I understand correctly, basically some water softener resin) and swallow it before even paying for it.

Apparently, the Lisinopril had driven my potassium level so high that it's normally fatal. The possibility of high potassium levels is a known risk, but it doesn't usually happen so quickly.

I was unaware of the pyschopharmacology of potassium, but I have checked the literature and discovered that this is a well known symptom of potassium imbalance.

I will follow it up.

Thanks again.

I pray that potassium levels (or for that matter, anything potentially sinister) are not the cause of your dreams. Wouldn't it be nice to continue to have such wonderful dreams.

However, if my dreams had been pleasant rather than so horrible I probably would not have been so quick to complain to the doctor. In which case the results could have been much more dire.

Best wishes.

It works beautifully for insomnia.

but it gives me freaky dreams...vivid, intense dreams.

woman i work with had to switch to something else because her cough was awful.
I take something else with the lisiopril but i can not ever remember the name.
I get them both at costco
90 day supply just over 20 bucks.
I can live with that
literally

Weight workouts without cardio exercise can actually raise your BP even further. It happened to my step-brother.

Maybe it's that you're sleeping more deeply, or now that your body is healing itself your biochemistry has changed.

can you describe something about the time course, in terms of how quickly it acts and what the half life is like?

I'm trying to titrate the dosage/timing so that I take the lowest dose that accomplishes what's needed. So far I have not noticed any of those side effects (cough or dreams).

Very interesting, thanks for posting!

:hi:

would be precisely that, that they are averages for a genetically diverse population, which is the purpose of clinical trials, to assure that the probability of an adverse reaction is acceptably low for a broad section of the population. (One may debate this point of acceptability, which is something of a loaded question even under the best of circumstances, by the way.)

However a report on the data associated with statistical averages need not, and does not, have general utility. There are many things that can effect pharmacokinetics, including medical conditions, medical history, genetics, diet, other medications etc, etc.

Regrettably I am neither competent nor licensed to give medical advice, and were I, I would not be either ethical nor wise to give it here like this.

Here is what I am doing to determine the utility and approach to my medication. I bought a blood pressure machine in a drug store and monitor my pressure. This gives me absolute measurement of the effects of my medications, and also my habits, good and bad. I keep records of these measurements and discuss them with my physician.

The role of genetics and individual populations is very much a factor in hypertension. Actually there are genetic subsets of people who have completely refractory hypertension, notably African Americans, particularly males.

It is interesting that this subset, from my understanding, was responsive to omipatrilat, but the FDA made a decision to not approve that compound because it was associated, again with a particular subset of genetics that was significantly represented in the population, with angioedema which in a few cases, in phase III clinical trials, resulted in airway constriction that required the insertion of breathing tubes. I do not believe that there were any deaths connected with this syndrome, but the FDA ruled the drug non-approvable. This may have been a classic in risk/benefit analysis in which a greater benefit was rejected because of a smaller risk, but I am not a statistician either and my impression is therefore non-professional.

The drug may have been approvable, and may have saved lives, if accompanied by biomarker analysis to determine susceptibility to angioedema. That's not what happened though.

(Similar types of distributions of disease suseptibility or unusual reactions are found in other populations, for instance, the high incidence of melanoma in Northern Europeans, Tay Sachs in people of Italian and Jewish heritage and the well understood incidence of sickle cell anemia in African and Southern European populations. It may not be chacterized as a "disease" but lactose intolerance is a feature of Asian populations which is why one never has cheese Sushi or lo mein with sour cream sauce.)

I have not yet determined, via the use of a blood pressure machine, how refractory my own hypertension is. It's not looking great. Lisinopril was not particularly effective, and Cozaar seems only marginally better.

My genetic heritage involves a sort of heathen, violent tribe of barbarians and vulgarians who often set out, to steal a phrase from the old National Lampoon, on lemming like adventures from their (probably stolen) homeland in Northern Europe, sacking and destroying other country's cities during which large numbers of them are killed, much to the improvement of the world in general.