Potassium-sparing diuretics hyperkalaemia with

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. 

AMIODARONE POTASSIUM-SPARING DIURETICS Risk of T levels of eplerenone with amiodarone risk of hyperkalaemia directly related to serum levels Calcium channel blockers inhibit CYP3A4-mediated metabolism of eplerenone Restrict dose of eplerenone to 25mg/day. Monitor serum potassium concentrations closely watch for hyperkalaemia... 

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... 

POTASSIUM-SPARING DIURETICS TRIMETHOPRIM Risk of hyperkalaemia when trimethoprim is co-administered with eplerenone Additive effect Monitor potassium levels 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). 

Interactions. Hyperkalaemia can result from use with potassium-sparing diuretics. Renal clearance of lithium is reduced and toxic concentrations of plasma lithium may follow. Severe hypotension can occur with diuretics (above), and with chlorpro-mazine, and possibly other phenothiazines. 

There is a theoretical risk of hyperkalaemia with preparations containing potassium citrate. Such preparations should be avoided in patients taking potassium-sparing diuretics, spironolactone and angiotensin-converting enzyme inhibitors, and in patients with heart or kidney disease. 

Diuretics. Hypercalcaemia may develop in patients administered thiazide diuretics with either calcium or vitamin D supplements, leading to a need to monitor plasma or serum calcium levels. The concurrent use of potassium-sparing diuretics, and other potassium supplements or potassium-containing salt substitutes, could lead to serious hyperkalaemia. Hyperkalaemia is known to interfere with the absorption of vitamin B12. There is a need to warn patients and monitor serum potassium levels. The risk of hypokalaemia is minimal with low doses of thiazides, for example 5 mg of bendroflumethiazide. Hypokalaemia is a concern in patients receiving treatment with drugs such as digoxin, amiodarone, disopyramide or flecainide (drugs used to treat cardiac disorders). 

Hyperkalaemia with ACE inhibitors and potassium-sparing diuretics, and particularly the aldosterone antagonist spironolactone, is well documented and well established. If it occurs it can be serious and potentially life threatening. Its incidence depends on the presence of other risk factors, and clinically important hyperkalaemia usually only appears to develop if one or more of these are also present, particularly renal impairment. Other risk factors in patients with heart failure include advanced age and diabetes" (hyperkalaemia has been found to be relatively common in both non-insulin-dependent and insulin-dependent diabetics). In addition, doses of spironolactone greater than 25 mg daily increase the risk of hyperkalaemia. 

There is an increased risk of hyperkalaemia if angiotensin II receptor antagonists are given with potassium-sparing diuretics (such as amiloride and the aldosterone antagonists, epierenone and spironolactone), particularly if other risk factors are also present... 

Excessively low sodium levels have been seen in a few patients taking hydrochlorothiazide with amiloride or triamterene when they were given trimethoprim or co-trimoxazole. Trimethoprim may cause hyperkalaemia and this may be additive with potassium-sparing diuretics, including the aldosterone antagonists. 

Not established. Thiazide diuretics combined with potassium-sparing diuretics are said to be particularly liable to cause hyponatraemia. Trimethoprim can also cause hyperkalaemia , by blocking amiloride-sensitive sodium channels in the collecting duct (this produces a similar effect to that of a potassium-sparing diuretic). It seems likely that these adverse effects can be additive with the effects of other drugs. 

Isolated cases of nephrotoxicity have been described when patients taking ciclosporin were given either amiloride with hydrochlorothiazide, metolazone, or mannitol. Furosemide can possibly protect the kidney against ciclosporin damage. The concurrent use of ciclosporin with thiazides, but not loop diuretics, may increase serum magnesium levels. The concurrent use of ciclosporin with potassium-sparing diuretics may cause hyperkalaemia. 

Ciclosporin alone can cause hyperkalaemia, especially if renal function is impaired. Because of this, the US manufacturers suggest that ciclosporin should not be used with potassium-sparing diuretics, whereas the UK manufacturers suggest that caution is required with combined use, with close control of potassium levels. ... 

Pharmacodynamic - concomitant use of two drugs with similar effects [e.g. an angiotensin converting enzyme (ACE) inhibitor plus a potassium sparing diuretic may result in hyperkalaemia and cardiac arrhythmias]. 

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