Usefulness of mineralocorticoid receptor antagonists, rather than angiotensin II receptor blockers, for the prevention and treatment of licorice‐induced pseudoaldosteronism

Abstract

Aim The influence of angiotensin II receptor blockers (ARB) on licorice‐induced pseudoaldosteronism remains unclear and the antihypertensive drug selection of prescribers, when they encounter hypokalemia and hypertension in licorice‐treated patients, has not been surveyed. Methods We examined the occurrence of hypokalemia, concomitant drugs, and treatment for hypokalemia and hypertension in 42, 26 and 27 patients prescribed the licorice‐containing traditional Japanese kampo medicines shakuyakukanzoto (SKT; containing 6 g licorice/day), rikkunshito (RKT; 1 g licorice/day), and goshajinkigan (GJG; without licorice), respectively. Results Seven (16.7%; P < 0.05) of 42 patients treated with SKT more than 4 weeks developed hypokalemia. This rate was significantly higher than that in the GJG group as a negative control. Only one (3.8%) of 26 patients treated with RKT developed hypokalemia. None of the five patients who received simultaneous SKT and mineralocorticoid receptor (MR) antagonists developed hypokalemia. In contrast, four (57.1%) of seven patients who developed hypokalemia were treated with simultaneous SKT and ARB. Conclusion MR antagonists may be useful for both the prevention and treatment of pseudoaldosteronism, while ARB may not be.

Remission inductive efficacy of the combination of ARB, MRA, and saireito for nephrotic syndrome of membranous nephropathy

“…ARBs were originally used in the present case and the previous case, and eplerenone and saireito were used in combination, although the order was opposite. Saireito contains licorice as an ingredient and eplerenone may suppress the licorice‐induced pseudoaldosteronism [14]. In addition, eplerenone may suppress aldosterone breakthrough in ARB.…”

“…licorice as an ingredient and eplerenone may suppress the licorice-induced pseudoaldosteronism [14]. In addition, may suppress aldosterone breakthrough in ARB.…”