Interaction of spironolactone with ACE inhibitors or angiotensin receptor blockers: analysis of 44 cases

Wrenger, Eike; Müller, R; Moesenthin, Michael; Welte, Tobias; Frölich, Jürgen C.; Neumann, Klaus

doi:10.1136/bmj.327.7407.147

Cited by 108 publications

(65 citation statements)

References 19 publications

(13 reference statements)

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“…Third, the doses of spironolactone prescribed at discharge were not available in our dataset. Because evidence from case series indicates that the risk of hyperkalemia increases with higher spironolactone dose, 6,25 such data might identify a larger number of patients at risk for adverse outcomes. Third, we were unable to assess changes in spironolactone use after hospital discharge.…”

Section: Masoudi Et Al Spironolactone Prescription In Heart Failurementioning

confidence: 99%

“…25 Several subsequent case series have described patients with hyperkalemia requiring hospitalization, some of whom died. [5][6][7][8][9] Many patients in these series were elderly, in whom the serum creatinine value often overestimates true renal function. The results of our study raise significant concerns about the safety of current patterns of spironolactone prescription in community-based populations, particularly among older patients with noncardiovascular comorbidities.…”

Section: Masoudi Et Al Spironolactone Prescription In Heart Failurementioning

confidence: 99%

“…Because of the potential risks of spironolactone therapy, concerns have been raised about the application of the trial results in case reports and series from single centers. [2][3][4][5][6][7][8][9] More recently, a study from Canada reported simultaneous increases in spironolactone prescriptions and hospitalizations for hyperkalemia after the publication of RALES. 10 Although that study could not determine whether that observation resulted from spironolactone use in patients at high risk for hyperkalemia in clinical practice, it suggests the possibility of inappropriate use or inadequate monitoring of spironolactone in the community.…”

mentioning

confidence: 99%

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Adoption of Spironolactone Therapy for Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction in the United States, 1998–2001

et al. 2005

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Background-Concerns have been raised about the appropriateness of spironolactone use in some patients with heart failure. We studied the adoption of spironolactone therapy after publication of the Randomized Aldactone Evaluation Study (RALES) in national cohorts of older patients hospitalized for heart failure. Methods and Results-This is a study of serial cross-sectional samples of Medicare beneficiaries Ն65 years old discharged after hospitalization for the primary diagnosis of heart failure and with left ventricular systolic dysfunction. The first sample was discharged before (April 1998 to March 1999) and the second sample after (July 2000 to June 2001, nϭ9468) publication of RALES in September 1999. We assessed spironolactone prescriptions at hospital discharge in patient groups defined by enrollment criteria for the trial. Using multivariable logistic regression, we identified factors independently associated with prescriptions not meeting these criteria. Spironolactone use increased Ͼ7-fold (3.0% to 21.3% PϽ0.0001) after RALES. Of patients meeting enrollment criteria, 24.1% received spironolactone, as compared with 17.4% of those not meeting the criteria. Of all prescriptions after RALES, 30.9% were provided to patients not meeting enrollment criteria. Spironolactone was prescribed to 22.8% of patients with a serum potassium value Ն5.0 mmol/L, to 14.1% with a serum creatinine value Ն2.5 mg/dL, and to 17.3% with severe renal dysfunction (estimated glomerular filtration rate Ͻ30 mL · min Ϫ1 · 1.73 m Ϫ2 ). In multivariable analyses, factors associated with prescriptions not meeting enrollment criteria included advanced age, noncardiovascular comorbidities, discharge to skilled nursing facilities, and care provided by physicians without board certification. Conclusions-Spironolactone prescriptions increased markedly after the publication of RALES, and many treated patients were at risk for hyperkalemia. Simultaneously, many patients who might have benefited were not treated. These findings demonstrate the importance of balancing efforts to enhance use among appropriate patients and minimizing use in patients at risk for adverse events.

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Section: Masoudi Et Al Spironolactone Prescription In Heart Failurementioning

confidence: 99%

Section: Masoudi Et Al Spironolactone Prescription In Heart Failurementioning

confidence: 99%

mentioning

confidence: 99%

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Adoption of Spironolactone Therapy for Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction in the United States, 1998–2001

et al. 2005

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“…Common cardiovascular agents such as angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and potassium-sparing diuretics all impart a risk of hyperkalemia (2,6 -10). Many studies have suggested an augmented risk of hyperkalemia associated with simultaneous use of two or more of these agents (11)(12)(13)(14)(15). However, there may also be significant risks associated with other combinations of common, hyperkalemiainducing medications such as beta adrenergic receptor blockers (␤-blockers) and trimethoprim-sulfamethoxazole antibiotics (TMP-SMX).…”

mentioning

confidence: 99%

Beta-Blockers, Trimethoprim-Sulfamethoxazole, and the Risk of Hyperkalemia Requiring Hospitalization in the Elderly

Weir¹,

Juurlink²,

Gomes³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:The simultaneous use of beta adrenergic receptor blockers (␤-blockers) and trimethoprimsulfamethoxazole (TMP-SMX) may confer a high risk of hyperkalemia.Design, setting, participants, & measurements: Two nested case-control studies were conducted to examine the association between hospitalization for hyperkalemia and the use of TMP-SMX in older patients receiving ␤-blockers. Linked health administrative records from Ontario, Canada, were used to assemble a cohort of 299,749 ␤-blockers users, aged 66 years or older and capture data regarding medication use and hospital admissions for hyperkalemia.Results: Over the study period from 1994 to 2008, 189 patients in this cohort were hospitalized for hyperkalemia within 14 days of receiving a study antibiotic. Compared with amoxicillin, the use of TMP-SMX was associated with a substantially greater risk of hyperkalemia requiring hospital admission (adjusted odds ratio, 5.1; 95% confidence interval [CI], 2.8 to 9.4). No such risk was identified with ciprofloxacin, norfloxacin, or nitrofurantoin. When dosing was considered, the association was greater at higher doses of TMP-SMX. When the primary analysis was repeated in a cohort of non-␤-blocker users, the risk of hyperkalemia comparing TMP-SMX to amoxicillin was not significantly different from that found among ␤-blocker users.Conclusions: Although TMP-SMX is associated with an increased risk of hyperkalemia in older adults, these findings show no added risk when used in combination with ␤-blockers.

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“…14 Opasnost od hiperkalijemije je još veća ukoliko se istovremeno daju diuretici koji štede kalijum. 15 Primena NSAIL je udružena sa retencijom tečnosti koja može dovesti do pogoršanja znakova i simptoma HSI. 16 Takođe je utvrđeno da NSAIL mogu uticati na sistem renin-angiotenzin-aldosteron i da njihova zajednička primena sa ACEi može potencirati ova neželjena dejstva, pogotovo u bolesnika sa HBI.…”

Section: Lekovi U Lečenju Hsi Kod Bolesnika Sa Hbiunclassified

Concept and therapeutic approach to cardiorenal insufficiency

Otašević¹

2012

Srce i krvni sudovi

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Interaction of spironolactone with ACE inhibitors or angiotensin receptor blockers: analysis of 44 cases

Cited by 108 publications

References 19 publications

Adoption of Spironolactone Therapy for Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction in the United States, 1998–2001

Adoption of Spironolactone Therapy for Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction in the United States, 1998–2001

Beta-Blockers, Trimethoprim-Sulfamethoxazole, and the Risk of Hyperkalemia Requiring Hospitalization in the Elderly

Concept and therapeutic approach to cardiorenal insufficiency

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