Potassium-sparing diuretics NSAIDs

The hypotensive effects of most antihypertensive dru are increased when administered with diuretics and other antihypertensives. Many dnigp can interact with the antihypertensive drugs and decrease their effectiveness (eg, antidepressants, monoamine oxidase inhibitors, antihistamines, and sympathomimetic bronchodilators). When the ACE inhibitors are administered with the NSAIDs, their antihypertensive effect may be decreased. Absorption of the ACE inhibitors may be decreased when administered with the antacids. Administration of potassium-sparing diuretics or potassium supplements concurrently with the ACE inhibitors may cause hyperkalemia. When the angiotensin II receptor agonists are administered with... 

Potassium-sparing diuretics may cause hyperkalemia, especially in patients with chronic kidney disease or diabetes, and in patients receiving concurrent treatment with an ACE inhibitor, ARB, NSAID, or potassium supplement. Eplerenone has an increased risk for hyperkalemia and is contraindicated in patients with impaired renal function or type 2 diabetes with proteinuria. Spironolactone may cause gynecomastia in up to 10% of patients, but this effect occurs rarely with eplerenone. 

ACE inhibitors decrease aldosterone and can increase serum potassium concentrations. Hyperkalemia occurs primarily in patients with chronic kidney disease or diabetes and in those also taking ARBs, NSAIDs, potassium supplements, or potassium-sparing diuretics. 

Drugs that may be affected by NSAIDs include the following Aminoglycosides, anticoagulants, ACE inhibitors, beta blockers, cyclosporine, dextromethorphan, digoxin, dipyridamole, hydantoins, lithium, loop diuretics, methotrexate, penicillamine, potassium-sparing diuretics, sympathomimetics, theophylline, thiazide diuretics. 

In combination with potassium-sparing diuretics severe hyperkalaemia may occur. The elimination of lithium is prolonged. Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect of ACE inhibitors. 

POTASSIUM-SPARING DIURETICS ANALGESICS-NSAIDs Risk of hyperkalaemia with NSAIDs Renal insufficiency caused by NSAIDs can exacerbate potassium retention by these diuretics Monitor renal function and potassium closely... 

Diuretics NSAIDs cause sodium retention and reduce diuretic and antihypertensive efficacy risk of hyperkalaemia with potassium-sparing diuretics increased nephrotoxicity risk (with indomethacin, ketorolac). 

Triamterene (Dytac) is a potassium-sparing diuretic which has an action and use similar to that of amiloride. The diuretic effect extends over 10 h. Gastrointestinal upsets occur. Reversible, nonoliguric renal failure may occur when triamterene is used with indomethacin (and presumably other NSAIDs). 

The interaction between potassium-sparing diuretics and NSAIDs is well documented (SED-14, 674). The major complications are deterioration of renal function and hjrper-kalemia. The risk associated with the non-selective COX-2 inhibitors is unknown. However, three patients had hyperkalemia (8.5, 5.4, and 5.1 mmol/1) after developing acute renal insufficiency while taking these drugs (8). 

Potassium-sparing diuretics All NSAIDs Potassium retention and hyperkalemia Avoid combination monitor plasma potassium concentration... 

Many drugs and other chemicals can adversely affect renal function by directly or indirectly affecting the reabsorption of electrolytes and water in the kidney. Chlorpropamide can enhance the secretion of ADH and promote the water conservation actions of the hormone, while lithium use can lead to a nephrogenic diabetes insipidus. NSAIDs block the formation of renal prostaglandins, which can result in hyperkalemia. Hyperkalemia may also result from the use of beta blockers, potassium-sparing diuretics, and cyclosporine. 

Hyperkalemia due to a decrease in aldosterone secretion is rarely found in patients with normal renal function, but it is relatively common in those with CHF and in the elderly. Hyperkalemia is more frequent in patients with renal impairment, diabetes, and in those receiving either K+ or potassium K+-sparing diuretics, heparin or non-steroidal anti-inflammatory drugs (NSAIDs). 

PROGESTOGENS 1. ANALGESICS -NSAIDs 2. ANTI HYPERTENSIVES AND HEART FAILURE DRUGS - ACE inhibitors, angiotensin II receptor antagonists 3. DIURETICS — potassium-sparing t risk of hyperkalaemia Drospirenone (component of the Yasmin brand of combined contraceptive pill) is a progestogen derived from spironolactone that can cause potassium retention Monitor serum potassium weekly until stable and then every 6 months... 

---