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Vol. 45, No. 4, 1999
Issue release date: July–August 1999

Trimethoprim-Induced Hyperkalemia: An Analysis of Reported Cases

Marinella M.A.
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Abstract

Background: Trimethoprim has been recently implicated in the development of hyperkalemia when administered at standard doses to immunocompetent patients. However, many clinicians are unaware of this potentially dangerous adverse effect. Objective: To review reported cases of trimethoprim-induced hyperkalemia in immunocompetent patients and identify predisposing factors, treatment, and outcome. Methods: A MEDLINE literature search was performed using the key words ‘trimethoprim’ and ‘hyperkalemia’. All English-language case reports and bibliographies of immunocompetent patients with trimethoprim-induced hyperkalemia were reviewed. Results: Nine cases were identified. The mean patient age was 77.6 years, and the mean duration of therapy was 10.2 days. Seven patients received standard oral dosages of trimethoprim-sulfamethoxazole for common infections, and 2 patients were concurrently receiving angiotensin-converting enzyme inhibitors. The mean pretreatment levels of creatinine and potassium were 1.01 mg/dl and 4.55 mmol/l, respectively. The mean peak serum potassium level was 7.0 mmol/l. No deaths attributable to hyperkalemia occurred. Conclusions: Hyperkalemia due to trimethoprim typically affects elderly patients administered standard oral dosages, even in the presence of a normal serum creatinine level. Concurrent angiotensin-converting enzyme inhibitor therapy may increase the risk of hyperkalemia. The prognosis is favorable with standard therapy for hyperkalemia and withdrawal of trimethoprim.



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References

  1. Marinella MA: Hyperkalemia in elderly patients associated with trimethoprim-sulfamethoxazoole. J Geriatr Drug Ther 1996;11:93–97.
  2. Acker CG, Johnson JP, Palevsky PM, Greenberg A: Hyperkalemia in hospitalized patients: Causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med 1998;158:917–924.
  3. Tomsik P, Marinella MA: Hyperkalemia. J Am Geriatr Soc 1998;46:252–253.

    External Resources

  4. Marinella MA: Patient care after percutaneous coronary artery interventions. Ann Intern Med 1998;128:598–599.
  5. Reardon LC, Macpherson DS: Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors: How much should we worry? Arch Intern Med 1998;158:26–32.
  6. Marinella MA: Reversible hyperkalemia associated with trimethoprim-sulfamethoxazole. Am J Med Sci 1995;310:115–117.

    External Resources

  7. Greenberg S, Reiser IW, Chou SY, Porush JG: Trimethoprim-sulfamethoxazole induces reversible hyperkalemia. Ann Intern Med 1993;119:291–295.
  8. Velazquez H, Perazella MA, Wright FS, Ellison DH: Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med 1993;119:296–301.
  9. Alappan R, Perazella MA, Buller GK: Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med 1996;124:316–320.

    External Resources

  10. Perazella MA, Mahnensmith RL: Trimethoprim-sulfamethoxazole: Hyperkalemia is an important complication regardless of dose. Clin Nephrol 1996;46:187–192.

    External Resources

  11. Gleckman RA, Czachor JS: Trimethoprim-sulfamethoxazole; in Gorbach SL, Bartlett JG, Blacklow NR (eds): Infectious Diseases. Philadelphia, Saunders, 1992, pp 239–244.
  12. Medina I, Mills J, Leoung G, Hopewell PC, Lee B, Modin G, Bonowith N, Wofsy CB: Oral therapy for Pneumocystis pneumonia in the acquired immunodeficiency syndrome. N Engl J Med 1990;323:776–782.

    External Resources

  13. Choi MJ, Fernandez PC, Patnaik A, Coupaye-Gerard B, D’Andrea D, Szerlip H, Kleyman TR: Brief report: Trimethoprim-induced hyperkalemia in a patient with AIDS. N Engl J Med 1993;328:703–706.
  14. Modest GA, Price B, Mascoli N: Hyperkalemia in elderly patients receiving standard doses of trimethoprim-sulfamethoxazole. Ann Intern Med 1994;120:437.
  15. Pennypacker LC, Mintzer J, Pitner J: Hyperkalemia in elderly patients receiving standard doses of trimethoprim-sulfamethoxazole. Ann Intern Med 1994;120:437.
  16. Canaday DH, Johnson JR: Hyperkalemia in elderly patients receiving standard doses of trimethoprim-sulfamethoxazole. Ann Intern Med 1994;120:437–438.
  17. Perlmutter EP, Sweeney D, Herskovits G, Kleiner M: Severe hyperkalemia in a geriatric patient receiving standard doses of trimethoprim-sulfamethoxazole. Am J Med Sci 1996;311:84–85.

    External Resources

  18. Thomas RJ: Severe hyperkalemia with trimethoprim-quinapril. Ann Pharmacother 1996;30:413–414.
  19. Marinella MA: Severe hyperkalemia associated with trimethoprim-sulfamethoxazole and trimethoprim. Infect Dis Clin Pract 1997;6:256–258.
  20. Elisaf M, Terrovitou C, Tomos P, Siamopoulos KC: Severe hyperkalemia after cotrimoxazole administration in a patient with hyporeninaemic hypoaldosteronism. Nephrol Dial Transplant 1997;12:1254–1255.

    External Resources

  21. Marinella MA: Trimethoprim-sulfamethoxazole associated with hyperkalemia. West J Med 1997;167:356–358.

    External Resources



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