People’s Pharmacy: Voltaren Gel can raise blood pressure dramatically

Q. My experience with Voltaren Gel was not good. At the time, my blood pressure was normally around 120/65. I take it most mornings now that I’m older and have some health issues.

Within a day or two of starting Voltaren, my blood pressure was about 155. I was a little concerned, so I took my blood pressure during the day, and it kept rising. When it reached 180, I went to the emergency room. It registered 190 at that time. I don’t know what the lower numbers were.

At the ER, they put me in a bed and after several hours, my blood pressure began to come down. They released me when it came down to 145. Later, I read that Voltaren can cause high blood pressure, so I never used it again.

A. One of the mysteries that we cannot answer is why some people react badly to topical diclofenac (Voltaren Gel) while others get pain relief with no complications. The official prescribing information for Voltaren Gel states that: “Hypertension can occur with NSAID treatment. Blood pressure should be monitored closely during treatment with Voltaren Gel.”

This suggests that some people absorb enough of this nonsteroidal anti-inflammatory drug through the skin to experience a systemic side effect as you did. Others have complained of digestive tract upset. The prescribing information warns that NSAIDs, including Voltaren Gel, can cause bleeding, ulceration and perforation of the stomach or intestines.

To learn more about managing joint pain without NSAIDs, you may want to read our “eGuide to Alternatives for Arthritis.” This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I’ve had trouble getting the authorized generic version of Toprol XL. I read that Melinta started distributing an AG, but I’ve had no luck getting it.

I emailed Melinta and a pharmacist responded that they stopped selling the AG version of Toprol XL as of Dec. 31. He suggested purchasing the brand name if I wanted a high-quality product.

A. Toprol is the brand name for the heart and blood pressure medicine metoprolol. A cardiologist colleague has raised questions about the quality of some generic forms of this beta blocker.

When we checked GoodRx.com, we discovered that brand name Toprol XL is available for about $1 a pill. That makes it reasonably affordable.

Q. After reading an article in the New York Times, I asked my dermatologist about low-dose oral minoxidil to reverse hair loss. My baby-fine hair has slowly thinned since my 50s.

I started with one-fourth pill (monitoring my blood pressure daily). After four months, I upped it to one-half pill. I’ve had no side effects, and my hair is somewhat thicker. It’s still not as thick as when I was young, though. After talking to my dermatologist, I’m increasing the dose to three-fourths pill, and I’ll watch for side effects.

Low-dose minoxidil is working for me, but it might not be for everyone. I decided to go slowly, as this is a regimen that you have to continue for life. If you stop, you lose the hair you’ve grown.

A. Minoxidil is better known as a topical medicine under the brand name Rogaine. It was first developed as a pill to treat high blood pressure. That dose was 10 to 40 milligrams daily, which unfortunately can produce serious side effects.

Some dermatologists have been experimenting with low-dose oral minoxidil (0.25 milligrams to 5 milligrams). As long as your dermatologist is monitoring your progress, this could be an interesting option.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”