Hyperkalemia trimethoprim-sulfamethoxazole

BraziUe P, Benveniste O, Herson S, Cherin P. Une cause meconnue d hyperkaliemie le trimethoprime-sulfa-methoxazole. [A cause of unexplained hyperkalemia trimethoprim-sulfamethoxazole.] Rev Med Interne 2001 22(l) 82-3. 

Trimethoprim produces the predictable adverse effects of an antifolate drug, especially megaloblastic anemia, leukopenia, and granulocytopenia. The combination trimethoprim-sulfamethoxazole may cause all of the untoward reactions associated with sulfonamides. Nausea and vomiting, drug fever, vasculitis, renal damage, and central nervous system disturbances occasionally occur also. Patients with AIDS and pneumocystis pneumonia have a particularly high frequency of untoward reactions to trimethoprim-sulfamethoxazole, especially fever, rashes, leukopenia, diarrhea, elevations of hepatic aminotransferases, hyperkalemia, and hyponatremia. 

Trimethoprim- sulfamethoxazole Synergistic combination of folate antagonists blocks purine production and nucleic acid synthesis Bactericidal activity against susceptible bacteria Urinary tract infections Pneumocystis jiroveci pneumonia toxoplasmosis nocardiosis Oral, IV renal clearance (half-life 8 h) dosed every 8-12 h t formulated in a 5 1 ratio of sulfamethoxazole to trimethoprim Toxicity Rash, fever, bone marrow suppression, hyperkalemia... 

Alappan R, Buller GK, Perazella MA. Trimethoprim-sulfamethoxazole therapy in outpatients is hyperkalemia a significant problem Am J Nephrol 1999 19(3) 389-94. 

Greenberg S, Reiser IW, Chou SY, Porush JG. Trimethoprim-sulfamethoxazole induces reversible hyperkalemia. Ann Intern Med 1993 119(4) 291-5. 

Alappan R, Perazella MA, BuUer GK. Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med 1996 124(3) 316-20. 

Koc M, Bihorac A, Ozener Cl, Kantarci G, Akoglu E. Severe hyperkalemia in two renal transplant recipients treated with standard dose of trimethoprim-sulfamethoxazole. Am J Kidney Dis 2000 36(3) E18. 

Margassery S, Bastani B. Life threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment. J Nephrol 2001 14(5) 410-14. 

Mori H, Kuroda Y, Imamura S, Toyoda A, Yoshida I, Kawakami M, et al. Hyponatremia and/or hyperkalemia in patients treated with the standard dose of trimethoprim-sulfamethoxazole. Internal medicine (Tokyo, Japan). 2003 Aug 42(8) 665-9. 

PerazellaMA. Hyperkalemia and trimethoprim-sulfamethoxazole a new problem emerges 25 years later. Connecticut medicine. 1997 Aug 61(8) 451-8. 

Antoniou T, Gomes T, Juurlink DN, Loutfy MR, Glazier RH, Mamdani MM. Trimethoprim-sulfamethoxazole-induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system a population-based study. Arch Intern Med 2010 170(12) 1045-9. 

Anti-Pneumocystis Prophylaxis Sulfamethoxazole-trimethoprim (SMZ-TMP, cotrimoxazole) One SS tablet by mouth once a day3 One DS tablet by mouth once a day3 One DS tablet by mouth every MA/V/F3 Hyperkalemia Myelosuppression Nephrotoxicity Neutropenia Photosensitivity Rash... 

Hyperkalemia due to high doses of co-trimoxazole (14 mg/kg/day trimethoprim and 70 mg/kg/day sulfamethoxazole) occurred in an HIV-positive patient with P. jiroveci pneumonia (70). 

Life-threatening hjrperkalemia secondary to the use of standard oral doses of co-trimoxazole (trimethoprim 320 mg/day and sulfamethoxazole 1600 mg/day) occurred in a 77-year-old man with moderate chronic renal insufficiency from diabetic nephropathy (71). In addition to hyperkalemia, he developed severe metabolic acidosis both resolved on appropriate medical intervention and withdrawal of co-trimoxazole. 

Funai N, Shimamoto Y, Matsuzaki M, Watanabe M, Tokioka T, Sueoka E, Suga K, Ono K, Sano M, Yamaguchi M. Hyperkalemia with renal tubular dysfunction by sulfamethoxazole-trimethoprim for pneumocystis carinii pneumonia in patients with lymphoid malignancy. Haematologia 1993 25 137-141. 

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