Anton C, Cox A R, Watson R D S, Ferner R E
West Midlands Centre for Adverse Drug Reaction Reporting and Cardiology Department, City Hospital, Birmingham, UK.
J Clin Pharm Ther. 2003 Aug;28(4):285-7. doi: 10.1046/j.1365-2710.2003.00491.x.
Spironolactone is increasingly being used in the treatment of heart failure. However, it has been associated with cases of hyperkalaemia. The common use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-2 receptor (AT2) antagonists in heart failure increases the risk of hyperkalaemia.
To identify the risk of spironolactone withdrawal, hyperkalaemia and severe hyperkalaemia in patients prescribed spironolactone together with either an ACE inhibitor or an AT2 antagonist.
Retrospective identification and analysis of patients co-prescribed an ACE inhibitor or an AT2 antagonist with spironolactone. Patients' records were linked to their biochemical results and the doses of spironolactone, ACE inhibitor and AT2 antagonists received by them.
We found that a higher proportion of patients in our cohort stopped taking spironolactone compared with the Randomised Aldactone Evaluation Study and a higher proportion developed hyperkalaemia, a predicted adverse effect of spironolactone combination with an ACE inhibitor or an AT2 antagonist. Patients with diabetes mellitus and those with a haematocrit below 0.36, were more likely to develop hyperkalaemia than those without these traits.
Spironolactone is a common cause of hyperkalaemia when used in combination with either an ACE inhibitor or an AT2 antagonist. This reinforces the need for care when extrapolating the results of clinical trials to daily clinical practice.
螺内酯越来越多地用于治疗心力衰竭。然而，它与高钾血症病例有关。心力衰竭患者中常用的血管紧张素转换酶（ACE）抑制剂和血管紧张素2受体（AT2）拮抗剂会增加高钾血症的风险。
确定同时开具螺内酯与ACE抑制剂或AT2拮抗剂的患者停用螺内酯、发生高钾血症和严重高钾血症的风险。
回顾性识别和分析同时开具ACE抑制剂或AT2拮抗剂与螺内酯的患者。将患者记录与其生化结果以及他们接受的螺内酯、ACE抑制剂和AT2拮抗剂剂量相关联。
我们发现，与随机醛固酮评估研究相比，我们队列中更高比例的患者停止服用螺内酯，并且更高比例的患者发生了高钾血症，这是螺内酯与ACE抑制剂或AT2拮抗剂联合使用的一种预测不良反应。糖尿病患者和血细胞比容低于0.36的患者比没有这些特征的患者更有可能发生高钾血症。
螺内酯与ACE抑制剂或AT2拮抗剂联合使用时是高钾血症的常见原因。这强化了在将临床试验结果外推至日常临床实践时需要谨慎的必要性。
