Interaction of spironolactone with ACE inhibitors or angiotensin receptor blockers: analysis of 44 cases

摘要

There seem to be conditions that may lead to the development of severe hyperkalaemia in patients with heart failure who are taking spironolactone and ACE inhibitors or AT_1 receptor blockers: advanced age, dose of spironolactone > 25 mg daily, reduced renal function, and diabetes mellitus type 2. Plasma potassium concentration should be monitored frequently in these patients, in whom we recommend that the dose of spironolactone should be limited to 25 mg a day or even every other day. A test of renal function (at least by applying the Cockroft and Gault formula) before treatment is started is useful as a plasma creatinine concentration <221 μmol/l does not reliably exclude patients with renal failure. Undetected hyperkalaemia may be suspected as a possible cause of sudden death in some patients treated for heart failure with spironolactone and ACE inhibitors or AT_1 receptor blockers.