OBJECT DRUGS

Potassium-sparing diuretics:

• Amiloride (Midamor)
• Eplerenone (Inspra)
• Spironolactone (Aldactone)
• Triamterene (Dyrenium)

PRECIPITANT DRUGS

Angiotensin Receptor Blockers:

• Azilsartan (Edarbi)
• Candesartan (Atacand)
• Eprosartan (Teveten)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Olmesartan (Benicar)
• Telmisartan (Micardis)
• Valsartan (Diovan)

Comment:

Concurrent use of potassium-sparing diuretics and angiotensin receptor blockers (ARBs) may lead to additive hyperkalemic effects and excessive serum potassium levels, especially in the presence of one or more predisposing factors such as significant renal impairment, severe diabetes, potassium supplements, high potassium diet, and advanced age. Fatal hyperkalemia has occurred, but is rare. ARBs are frequently used with potassium-sparing diuretics with good results, but close monitoring is necessary in patients with risk factors. Other drugs that may exhibit hyperkalemic activity include ACE inhibitors, drospirenone (Yasmin), heparins, nonselective beta-blockers, NSAIDs, COX-2 inhibitors, cyclosporine, tacrolimus, succinylcholine, pentamidine, trimethoprim, and potassium-containing salt substitutes.

Class 3: Assess Risk & Take Action if Necessary

• Monitor: Monitor serum potassium concentrations, especially in patients with predisposing factors such as renal disease, diabetes, and advanced age.