Trimethoprim/Sulfamethoxazole Is Associated with Sudden Death in Patients Who Take Renin-Angiotensin Inhibitors

Renin-angiotensin inhibitors, angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), are associated with hyperkalemia in about 10% of patients. Trimethoprim/sulfamethoxazole (TMP/SMX) also is associated with hyperkalemia, via trimethoprim-induced reduction in potassium excretion in the distal renal tubule. In 2010, investigators demonstrated that hospitalization for hyperkalemia was associated with TMP/SMX use in patients who took ACE inhibitors or ARBs (NEJM JW Infect Dis Jul 14 2010). Now, in a population-based, case-control study, investigators examined whether TMP/SMX plus ACE inhibitors or ARBs is associated with excess risk for sudden death.

From 1994 to 2012, 1.6 million older patients (age, ≥65) in O…