Amir Omalhassan, Hassan Yahaya, Sarriff Azmi, Awaisu Ahmed, Abd Aziz Noorizan, Ismail Omar
Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia.
Pharm World Sci. 2009 Jun;31(3):387-93. doi: 10.1007/s11096-009-9288-x. Epub 2009 Mar 3.
To determine the incidence of and the risk factors associated with hyperkalemia, induced by ACEI-drug interactions among cardiac patients.
Five medical and cardiology wards of a tertiary care center in Malaysia.
Five hundred cardiac inpatients, who received ACEIs concomitantly with other interacting drugs.
This was a prospective cohort study of 500 patients with cardiovascular diseases admitted to Penang Hospital between January to August 2006, who received ACEIs concomitantly with other interacting drugs. ACEI-drug interactions of clinical significance were identified using available drug information resources. Drug Interaction Probability Scale (DIPS) was used to assess the causality of association between ACEI-drug interactions and the adverse outcome (hyperkalemia).
Hyperkalemia as an adverse clinical outcome of the interaction was identified from laboratory investigations.
Of the 489 patients included in the analysis, 48 (9.8%) had hyperkalemia thought to be associated with ACEI-drug interactions. Univariate analysis using binary logistic regression revealed that advanced age (60 years or more), and taking more than 15 medications were independent risk factors significantly associated with hyperkalemia. However, current and previous smoking history appeared to be a protective factor. Risk factors identified as predictors of hyperkalemia secondary to ACEI-drug interactions by multi-logistic regression were: advanced age (adjusted OR 2.3, CI 1.07-5.01); renal disease (adjusted OR 4.7, CI 2.37-9.39); hepatic disease (adjusted OR 5.2, CI 1.08-25.03); taking 15-20 medications (adjusted OR 4.4, CI 2.08-9.19); and taking 21-26 medications (adjusted OR 9.0, CI 1.64-49.74).
Cardiac patients receiving ACEIs concomitantly with potentially interacting drugs are at high risk of experiencing hyperkalemia. Old age, renal disease, hepatic disease, and receiving large number of medications are factors that may significantly increase their vulnerability towards this adverse outcome; thus, frequent monitoring is advocated.
确定心脏病患者中由ACEI药物相互作用诱发的高钾血症的发生率及相关危险因素。
马来西亚一家三级护理中心的五个内科和心脏病科病房。
500名同时接受ACEI与其他相互作用药物治疗的心脏病住院患者。
这是一项对2006年1月至8月间入住槟城医院的500例心血管疾病患者进行的前瞻性队列研究，这些患者同时接受ACEI与其他相互作用药物治疗。利用现有的药物信息资源确定具有临床意义的ACEI药物相互作用。使用药物相互作用概率量表（DIPS）评估ACEI药物相互作用与不良结局（高钾血症）之间关联的因果关系。
通过实验室检查确定高钾血症作为相互作用的不良临床结局。
纳入分析的489例患者中，48例（9.8%）发生了被认为与ACEI药物相互作用相关的高钾血症。采用二元逻辑回归进行的单因素分析显示，高龄（60岁及以上）和服用超过15种药物是与高钾血症显著相关的独立危险因素。然而，当前和既往吸烟史似乎是一个保护因素。通过多因素逻辑回归确定的作为ACEI药物相互作用继发高钾血症预测因素的危险因素有：高龄（校正OR 2.3，CI 1.07 - 5.01）；肾脏疾病（校正OR 4.7，CI 2.37 - 9.39）；肝脏疾病（校正OR 5.2，CI 1.08 - 25.03）；服用15 - 20种药物（校正OR 4.4，CI 2.08 - 9.19）；以及服用21 - 26种药物（校正OR 9.0，CI 1.64 - 49.74）。
同时接受ACEI与潜在相互作用药物治疗的心脏病患者发生高钾血症的风险很高。高龄（60岁及以上）、肾脏疾病、肝脏疾病以及服用大量药物是可能显著增加其发生这一不良结局易感性的因素；因此，提倡进行频繁监测。
