ArcaMax

DEAR DR. ROACH: I am interested in knowing how long it might take for someone who discontinued all medications that have been taken for years to have serious or dire consequences? I started seeing a cardiologist five to six years ago, mainly as a preventive because of a family history of cardiac and stroke risk with both of my parents/grandparents. He determined that I had a slight atrial fibrillation and mildly obstructed carotids.

Subsequent annual testing has shown little to no progression. I take levothyroxine, Eliquis, verapamil and pravastatin. I've had it with pills. -- F.W.

ANSWER: In general, I recommend against stopping prescription medications without your doctor telling you to, and I hope to help you understand why.

Atrial fibrillation is a rhythm disturbance of the heart where the atria no longer function mechanically. Although this can affect the function of the heart, the biggest problems are the heart rate (which can sometimes be so fast that it causes symptoms or heart failure) and stroke risk. Verapamil is used to lower the blood pressure, but it also slows the heart. Your cardiologist might be using it for either or both of those reasons.

Eliquis is used to reduce stroke risk. With more information about you, I could give you a more personalized risk, but on average, about 5% of people with atrial fibrillation will get a stroke per year. This number goes down to about 1% if they are treated.

You mention you have some obstruction in the carotid arteries. These are the main arteries providing blood flow to the brain, and blockage of these can also lead to stroke. Pravastatin has been shown to reduce the risk of heart attack and death in people at a high risk. A rough guess is that for every 40 people at a higher risk who take pravastatin, 1 will not get a heart attack, stroke, or need to have an artery opened through surgery or a balloon.

Levothyroxine is used to treat low thyroid hormone levels. Very low thyroid hormone levels can cause many symptoms, including severe ones like comas. These are uncommon, but fatigue, low energy, depression, and weight gain are much more common.

So, if you were to stop taking your medication without seeking your doctor's advice, you might not notice anything for days or even weeks. But you would be putting yourself at an increased risk for cardiovascular disease, especially stroke, over the next months and years. If you've ever had a loved one who has had a bad stroke, I don't think you would want them to stop taking their meds.

DEAR DR. ROACH: I take 1,000 mg of metformin in the morning and 1,000 mg at night, and my A1C level is 7.2%. I am 80 years old. Is this dose too much? -- Anon.

ANSWER: A medicine is too much if it causes toxicity or does too much of what it is supposed to do. The major toxicity of metformin is gastrointestinal. The dose you are taking is enough to cause stomach upset, nausea, vomiting or diarrhea. If you aren't having any of these, it's not likely toxic to you. One notable exception is that people with kidney disease need to be careful with, or not take, metformin at all. A high creatinine level is a reason not to take metformin.

An A1C level of 7.2% is excellent, but many experts don't insist on an A1C this low in patients who are in their 80s, since it's usually over years or decades of having a high A1C level that causes damage. An A1C of 7.5% or even 8% might be reasonable for a person in their 80s.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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