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Many patients who are treated with spironolactone develop hyperkalemia, especially if spironolactone is co-prescribed with other drugs that also can cause hyperkalemia (e.g., angiotensin-converting–enzyme inhibitors). Trimethoprim, a component of the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX), slows urinary excretion of potassium. In this population-based case-control study, investigators determined risk for hyperkalemia-related hospital admission among older Ontario, Canada, residents (age, >65) who received both spironolactone and TMP-SMX.
Of 166,000 patients treated with spironolactone during the 18-year study period, 6900 were admitted for hyperkalemia: 306 within 14 days of receiving TMP-SMX, nitrofurantoin, norfloxacin (Noroxin…