Trimethoprim-Induced Hyperkalemia: An Analysis of Reported Cases

Abstract

Background: Trimethoprim has been recently implicated in the development of hyperkalemia when administered at standard doses to immunocompetent patients. However, many clinicians are unaware of this potentially dangerous adverse effect. Objective: To review reported cases of trimethoprim-induced hyperkalemia in immunocompetent patients and identify predisposing factors, treatment, and outcome. Methods: A MEDLINE literature search was performed using the key words ‘trimethoprim’ and ‘hyperkalemia’. All English-language case reports and bibliographies of immunocompetent patients with trimethoprim-induced hyperkalemia were reviewed. Results: Nine cases were identified. The mean patient age was 77.6 years, and the mean duration of therapy was 10.2 days. Seven patients received standard oral dosages of trimethoprim-sulfamethoxazole for common infections, and 2 patients were concurrently receiving angiotensin-converting enzyme inhibitors. The mean pretreatment levels of creatinine and potassium were 1.01 mg/dl and 4.55 mmol/l, respectively. The mean peak serum potassium level was 7.0 mmol/l. No deaths attributable to hyperkalemia occurred. Conclusions: Hyperkalemia due to trimethoprim typically affects elderly patients administered standard oral dosages, even in the presence of a normal serum creatinine level. Concurrent angiotensin-converting enzyme inhibitor therapy may increase the risk of hyperkalemia. The prognosis is favorable with standard therapy for hyperkalemia and withdrawal of trimethoprim.

Renal Effect of Lopinavir/Ritonavir and Sulfamethoxazole/Trimethoprim in Albino Rats

“…[18] In this study treatment with SMX/TMP had no effect on potassium level which disagrees with some reports [19]. This difference in report could be associated with variation in dose because most reported cases of SMX/TMP induced hyperkalemia were associated with higher doses.…”

Renal Insufficiency in Concert with Renin-angiotensin-aldosterone Inhibition Is a Major Risk Factor for Hyperkalemia Associated with Low-dose Trimethoprim-sulfamethoxazole in Adults

“…65 years) and potassiumsparing diuretics are risk factors for hyperkalemia with highdose TMP-SMX (17,18,20,27), our study shows that this is not the case for hyperkalemia associated with low-dose TMP-SMX. Our results showed that in patients with renal insufficiency, ACEi/ARB use may be a risk factor for hyperkalemia associated with low-dose TMP-SMX.…”

Ronda clínica y epidemiológica: club de revistas

“…Otros trabajos han ido en la misma dirección: Alappan y asociados describieron en un estudio de casos y controles que la concentración de potasio sérico aumentaba de 4,30 ± 0,36 mmol/L a 4,66 ± 0,45 mmol/L tras 5 días de tratamiento en comparación con el grupo control (9), y el de Marinella quien, además de describir este aumento del riesgo en pacientes ancianos con creatinina sérica normal, documentó la posibilidad de que dicho aumento fuera potenciado por el consumo de IECA (10). Los mismos autores del presente estudio han encontrado que en pacientes hospitalizados y en tratamiento con TMP-SMX más IECA o BRA hay un aumento del riesgo de hiperkalemia, con un OR ajustado de 6,7 (IC 95% = 4,5-10,0) (11), mientras que en pacientes tratados con espironolactona y TMP-SMX la admisión hospitalaria por hiperkalemia aumenta (OR = 11,0; IC 95% = 6,8-17,8), presuntamente por una reducción de la kaliuresis de un 40% (12).…”