Reduced sodium levels after 2 weeks on Ramipril followed by a week on Losartan

It can be a side effect from either medicine (albeit an uncommon one). Unless your sodium levels are dangerously low (and at a level which would lead to signs and symptoms) then active correction is not needed. Sodium supplements should be avoided due to the risk of increasing your blood pressure.

Tarun (hospital pharmacist)

Tarun

Thank you. I did wonder about sodium supplements and the risk to blood pressure especially as I'm having difficulty getting my BP down to normal. I have a sole kidney and CKD3. Do you know what would be a "dangerously low" reading of sodium and what the signs and symptoms would be, please?

There is no fixed agreed reference that defines what is determined as mild, moderate or severe. However any level below 120 would be certainly regarded as severe that could require hospital admission. If you have severely low sodium, you would not be sitting typing on an internet forum - signs can include drowsiness, confusion, reduced consciousness levels as well as affecting your hydration. However I would stress that this is an uncommon effect of ACE inhibitors - if you are having periodic measurements of your kidney function (which would include sodium and potassium levels) you can be reassured.

Tarun

Many thanks again for your helpful reply. My sodium reading at present is 133, (so not sounding too serious at the moment) and, yes, I will be monitored with another blood test next week, this time for a renal consultant. It may be that the few weeks on Ramipril caused the problem, as now after 10 days on Losartan the nausea has stopped, although still have the cramping calf muscles, and the swollen ankles - the latter probably courtesy of the Diltiazem which I am taking alongside Losartan. As Diltiazem is a Calcium Channel Blocker, it can cause swollen ankles though they don't seem to be as bad as when I was started on Amlodipine, another CCB. I am crossing everything that the Diltiazem and Losartan combination works, and with minimal side effects, otherwise I will be exhausting all the BP meds! Unfortunately, there is no research into BP drugs for those with one kidney and CKD3.

Thank you again - I'm most grateful for your help.

MrsO

That sodium level doesn't sound horrendously low to be honest. Different laboratories across the countries will have different reference ranges for "normal" blood sodium levels as they base it on local population characteristics (which of course will vary across the country). For example in worcestershire, our normal range is 133-146. Another trust or region might use 134 or 135 as the lower end - there is so much variation and like I said I doubt your level would be anything to worry about !

Tarun - you're so kind to have explained all this so clearly and concisely, and I'm very grateful....thank you!

I think your renal consultant may want to keep you on the losartan as much as possible because of the benefits of this type of drug in chronic kidney disease, so s/he may not bat an eyelid at a slightly low sodium ! Happy to help !

Thanks again, Tarun - I know what to expect now at my next renal appointment!