Need to switch ARB II

Background: 47 y/o male, non-smoker, weight normal, non-drinker, try to eat healthy and get moderate exercise.  Since 2002, have been taking 75mg/day of Cozaar and 12.5mg/day of HCTZ to control hypertension.  Seems to keep things under control and no noticeable side affects.  History of hypertension in my mother and in my father's father (who died from a stroke in 1979).  Tried an ultra low-salt diet and it did not help; still try to avoid sodium and potassium, though, just to be on the safe side.

Additional medications: 1000mg/day Niaspan to control cholesterol.  Started in 2006 and have had good results, LDL number had been creeping upward and is now level.  Within the last six weeks started taking levothyroxine after having problems with fatigue and decreased libido.  Doctor prescribed it after blood test confirmed that my TSH level was abnormally high.  Will have that re-tested soon and adjust levothyroxine as needed.

One last detail: Taking a nutritional supplement for "kidney health."  Looks like snake oil to me, but it has a measurable impact.  Before I started taking it two years ago, the level of protein in my urine was abnormally high. Now it is in range.  I started with one pill of it a day and the protein number improved.  Going to two a day improved it some more. Tried 3 a day and saw small improvement, currently on 2 a day.

All other blood and kidney test results are normal, although there is usually a tiny amount of occult blood in each urine test.  I have the tests done every six months.

So other than the recent fatigue/libido problems, I feel fine.  I take all this stuff just to make my numbers be correct.

Here is my question: I am changing insurance companies on January 1, 2009.  The new company does not cover Cozaar.  My choices are: Avapro, Benicar, and Diovan.  Any suggestions as to which of those is most similar to Cozaar?  Also, any suggestions on an equivalent dosage for any of them to match the results I get from 75mg/day of Cozaar?

[Lee Kirksey, MD]

The choices provided by the new insurance company are all in the same class of medication as Cozaar is.  They all work well and often times what your doctor will recommend is the one they have the most experience and comfort level with.  I like them all,  with Diovan and your dose will probably be about 80 to 160mg. Your PCP will adjust this There are no drug interactions between diovan, niaspan and levothyroxine.

As you probably know, each of these agents can potentially be associated with diminished libido

I encourage you to continue your healthy regimen. Include exercise, diet, stress management and appropriate screening for comorbid disorders. To learn more about an 8 step program to Optimal Health, read my new book Your Guide to Optimal Health at www.personalwellnesswheel.com

Good luck