Too much potassium in the blood, a condition called hyperkalemia, can lead to heart attack. In their article on drug-induced abnormalities of potassium metabolism, published in the "Polish Archives of Internal Medicine" in 2008, Polish nephrologists Franciszek Kokot and Lidia Hyla-Klekot say potassium abnormalities such as hyperkalemia can be life-threatening. While medical conditions such as diabetes and kidney failure can result in high potassium levels, there are many drugs that can cause hyperkalemia as well.
ACE Inhibitors
Many people with hypertension take what's called angiotensin-converting enzyme inhibitors, or ACE inhibitors, to lower blood pressure. Because these drugs can cause a rise in potassium levels, patients should be monitored for hyperkalemia. Some examples of ACE inhibitors are ramipril, captopril, benazepril, lisinopril, enalapril and quinapril.
Nephrologist Mark Perazella, M.D. of the Yale University School of Medicine reported in the "American Journal of Medicine" in 2000 that up to 38 percent of patients taking ACE inhibitors are at risk of developing hyperkalemia.
ARBs
Angiotensin II receptor blockers, or ARBs, are used by many people with high blood pressure. Like ACE inhibitors, these drugs also can cause hyperkalemia. Examples of some ARBs are valsartan, losartan, olmesartan and irbesartan. According to Perazella, the risk for developing hyperkalemia from ARBs is about 7 percent.
Immunosuppressants
Individuals who have had an organ transplant must take immunosuppressant drugs to prevent the organ from being rejected by their immune system. Immunosuppressants, however, increase the risk for hyperkalemia. According to Perazella, the risk can be as high as 53 percent in patients taking the immunosuppressant drug tacrolimus and 44 percent in patients using cyclosporine, also an immunosuppressant.
Trimethoprim-Sulfamethoxazole
One antibiotic particularly elevates the risk for hyperkalemia: trimethoprim-sulfamethoxazole, or TMP-SMX. According to a study by Canadian pharmacologist Tony Antoniou and colleagues, published in the "Archives of Internal Medicine," elderly Ontario residents ages 66 years and older, who were taking ACE inhibitors or ARBS and then also took TMP-SMX, had a seven-times greater risk for hospitalization for hyperkalemia. This was compared to patients taking ACE inhibitors or ARBs who were treated with amoxicillin rather than TMP-SMX. The researchers strongly recommend that individuals on ACE inhibitors or ARBs who develop infections should be given an antibiotic other than TMP-SMX. This study was based on hospital admissions for hyperkalemia in the period 1994-2008.
Nonsteroidal Anti-inflammatory Drugs
Some researchers have found an elevated risk for hyperkalemia among patients taking nonsteroidal anti-inflammatory drugs, or NSAIDs. In an analysis of studies of drug-induced hyperkalemia, Perazella reported that NSAIDs increased the risk for hyperkalemia by up to 46 percent.
Potassium-Sparing Diuretics
Kokot and Hyla-Klekot noted in the "Polish Journal of Internal Medicine" that potassium-sparing diuretics may induce hyperkalemia. These drugs, which are often used to treat hypertension, cause the retention of potassium in the body. Perazella said potassium-sparing diuretics may cause hyperkalemia in up to 19 percent of patients.
Examples of potassium-sparing diuretics are amiloride hydrochoride, spironolactone and triamterene.
References
- "Clinical Journal of the American Society of Nephrology"; Beta-Blockers, Trimethoprim-Sulfamethoxazole, and the Risk of Hyperkalemia Requiring Hospitalization in the Elderly"; Matthew A. Weir, et al.; 2010
- "Archives of Internal Medicine"; Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in Patients Receiving Inhibitors of the Renin-Angiotensin System; Tony Antoniou, BscPharm, PharmD; et al; June 28, 2010
- "American Journal of Medicine"' Drug-induced Hyperkalemia: Old Cul[prits and New Offenders; Mark A. Perazella, M.D.; September 2000
- "Polish Archives of Internal Medicine"; Drug-Induced Abnormalities of Potassium Metabolism; Franciszek Kokot and Lidia Hyla-Klekot; 2008
