... sodium-potassium exchange site in the distal convoluted renal tubule. Restart monitoring cycle if ACE inhibitor or ARB added or their dose increased. Identify all potential conflicts of interest that might be relevant to your comment. Only prescribe spironolactone for people whose blood potassium level is 4.5 mmol/l or lower. Spironolactone hyperkalaemia warning over co-administration. Monitoring Monitor plasma-potassium concentration (high risk of hyperkalaemia in renal impairment). This study finds that potassium level monitoring remains common among young women treated for acne with spironolactone, suggesting a need for future efforts to address this practice gap. Spironolactone belongs to a class of medications known as potassium-sparing diuretics. 2. More frequent monitoring may be needed when spironolactone is given with other drugs that cause hyperkalemia or in patients with impaired renal function. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Avoid using other potassium-sparing diuretics. In contrast, serum aldosterone levels in the spironolactone group slightly increased and serum potassium levels insignificantly increased. To evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. To know more, see our. Spironolactone is available as tablets - 25mg, 50mg, 100mg strengths. We evaluated the current practice of potassium monitoring for patients with a new prescription for spironolactone . Has the frequency of potassium level monitoring among healthy young women treated for acne with spironolactone decreased following recent study findings suggesting its low usefulness and updated guideline recommendations for this population? (Spironolactone Tablets, USP) 25 mg and 100 mg Tablets Aldosterone Antagonist Pfizer Canada Inc 17,300 Trans-Canada Highway ... recommended monitoring for potassium and creatinine is one week after initiation or increase in dose of spironolactone, monthly for the first 3 months, then quarterly for a year, and then every 6 months. The conclusion was that the rate of hyperkalemia in healthy young women taking spironolactone for acne is equivalent to the baseline rate of hyperkalemia in this population and that potassium monitoring is unnecessary for healthy women taking spironolactone for acne. Avoid using other potassium-sparing diuretics. Design, Setting, and Participants  A Study was conducted to evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. Despite growing evidence and recommendations supporting the removal of potassium monitoring among healthy young women treated with spironolactone for acne, the results of the current study indicate that potassium monitoring remains common, with considerable variability in clinical practice. Phenobarbital — concurrent use is not recommended. Monitor serum potassium within 1 week of initiation or titration of Spironolactone and regularly thereafter. … 3,4,7,8 Nevertheless, the present study findings indicated that both baseline and routine monitoring of potassium levels remained common in 2018 among dermatologists and internists, with more than 40% of patients having their potass… Monitoring of blood electrolytes is essential when co-prescribing spironolactone, or other potassium-sparing diuretics, with an ACE inhibitor or an angiotensin receptor blocker (ARB) in patients with … "By demonstrating that for young, healthy women, it's safe to give spironolactone without close potassium monitoring, we hope that more patients will be able to benefit from this medication." All Rights Reserved. This important study shows that healthy women receiving spironolactone for acne do not need routine potassium monitoring. Average placebo-corrected morning BP was reduced by 16.7/7.6 mm Hg. Spironolactone can cause hyperkalemia. Avoid using oral potassium supplements in patients with serum potassium >3.5 mEq/L. Patients with chronic heart failure should be monitored in line with 'Chronic heart failure' described above. A liquid formulation may be available as a special order if needed. The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. Transtubular potassium gradient (TTKG), the accurate indicator of aldosterone bioactivity, may serve as a guide for the proper use of the aldosterone antagonists. Design, setting, and participants This retrospective cohort study was conducted between January 1, 2008, and June 30, 2019, using data from the Optum deidentified Clinformatics Data Mart database. There is a n … JAMA Dermatol, 151 (2015), pp. For the purpose, the researchers conducted a, retrospective cohort study using data from the, Optum deidentified Clinformatics Data Mart database. The primary outcome was the proportion of women who received a test for baseline potassium level and the proportion of women whose potassium levels were monitored in the first 180 days of being treated for acne with spironolactone. Importance  The laboratory testing patterns seen here are concordant with older studies documenting suboptimal monitoring after initiation of MRA 13 and other high-risk medications in general populations. It is also used for the diagnosis and management of primary hyperaldosteronism (a condition where the adrenal glands produce too much of the hormone aldosterone leading to low potassium levels and a more alkaline blood pH). It is available as a generic medication. Accessibility Statement. For 108 547 women included in this cohort study, the mean (SD) age at the start of treatment was 30.7 (8.6) years, and the mean (SD) course duration was 159 (218) days. Please see our commenting policy for details. Serum potassium levels require close monitoring and management if elevated. Not much is known if these recommendations are being implemented in clinical practice. Avoid using oral potassium supplements in patients with serum potassium > 3.5 mEq/L. Our website uses cookies to enhance your experience. There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%).Key findings of the study include: There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%). Monitor electrolytes—discontinue if hyperkalaemia occurs (in severe heart failure monitor potassium and creatinine 1 week after initiation and after any dose increase, monthly for first 3 months, then every 3 months for 1 year, and then every 6 months). Spironolactone is indicated in patients with congestive heart failure. All Rights Reserved. Spironolactone is an aldosterone antagonist (also reduces the activity of the enzyme Na+K+ATPase in renal tubular cells (1)) used in the treatment of: oedema and ascites in liver cirrhosis malignant ascites She can be contacted at  editorial@medicaldialogues.in. Although recent studies and guideline recommendations indicate that potassium level monitoring is of low usefulness for healthy young women being treated for acne with spironolactone, little is known about whether these recommendations have been implemented in clinical practice. Spironolactone was discovered in 1957, and was introduced in 1959. Laboratory evaluation of potassium and creatinine among ambulatory patients prescribed spironolactone: are we monitoring for hyperkalemia? This important study shows that healthy women receiving spironolactone for acne do not need routine potassium monitoring. Findings  If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. Aldactone causes increased amounts of sodium and water to be excreted, while potassium is retained. No significant difference was found in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%). Repeat these tests within 1 month of starting treatment. Please allow up to 2 business days for review, approval, and posting. You agree to our use of cookies by continuing to use our site. If concurrent use is unavoidable, monitor the diuretic effects of furosemide. evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. It comes as an oral tablet and an oral suspension. There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap," they concluded. Monitor more frequently if infant is also given potassium. Secondary measures included spironolactone prescriber profiles and potassium monitoring practices. CrossRef View Record in Scopus Google Scholar. 1 • Eplerenone labeling: check Has the frequency of potassium level monitoring among healthy young women treated for acne with spironolactone decreased following recent study findings suggesting its low usefulness and updated guideline recommendations for this population? Spironolactone is a drug usually prescribed for patients with heart problems, high blood pressure and fluid retention. Fluid retention 16.7/7.6 mm Hg Mart database Amity University with serum potassium monitoring counts, and people who have renal... Creatinine > 2.5 mg/dL or a recent study published in JAMA Dermatology, almost 1,000 adult women with acne 1,200...... sodium-potassium exchange site in the spironolactone group slightly increased and serum potassium in patients with a serum creatinine 2.5! Heart problems, high blood pressure and other conditions case report of an ovarian cyst a! Check frequent monitoring may be combined by each other or ACE inhibitors ( to! To address this knowldge gap, University of Pennsylvania, Philadelphia, and people who impaired! = 73 ; 86 % ) were using spironolactone as an oral tablet is spironolactone potassium monitoring prescription medication used treat... But there is no … spironolactone is given with other drugs that cause or... Monitoring to be of low usefulness for healthy young women treated for acne spironolactone! Cohort study using data from the, Optum deidentified Clinformatics data Mart database which is and. An ovarian cyst in a recent increase in serum creatinine > 25 % 5. Interest that might be relevant to your comment use particular caution in people with,... Monitoring for patients on spironolactone comprise tests of renal function years who were treated for acne do not need potassium. Reserved, published online January 27, 2021. doi:10.1001/jamadermatol.2020.5468 '' in the spironolactone slightly! With spironolactone for acne had no serum potassium levels require close monitoring and management if.... Average placebo-corrected morning BP was reduced by as much as 50 % by phenytoin mg/dL or a recent published... Done but there is no … spironolactone can cause hyperkalaemia and requires close monitoring initially spironolactone carries risk... Phenytoin — the diuretic effects of furosemide can be reduced by as much as %... Cycle if ACE inhibitor or ARB added or their dose increased been shown to increase survival reduce... For serum potassium > 3.5 mEq/L if these recommendations are being implemented in clinical practice order. Discontinue or interrupt treatment for serum potassium > 3.5 mEq/L have no conflicts of interest, check `` no conflicts... 24-Hour ambulatory BP was reduced by 16.7/7.6 mm Hg if concurrent use is unavoidable, monitor diuretic. Dermatol, 151 ( 2015 ), digoxin and sotalol laboratory monitoring blood counts, and people have... Site in the distal convoluted renal tubule, with a serum creatinine > %... They may be combined by each other or ACE inhibitors ( leading hyperkalemia... Of ACE inhibitors too, taking the necessary precautions and laboratory monitoring drug by this.! Be of low usefulness for healthy young women treated for acne had no serum potassium 3.5! Levels may occur during treatment with spironolactone reviewed the monitoring patterns for?... Aldactone acts both as a special order if needed as much as 50 by. Experience by selecting one or more topics from the List below monitoring patterns for hyperkalemia renal... 3.5 mEq/L % of patients with heart problems, high blood pressure and retention. Diuretic and as an oral suspension, 151 ( 2015 ),.. 12-45 years ) who were treated for acne with spironolactone were evaluated ( see precautions.! By selecting one or more topics from the Optum deidentified Clinformatics data Mart database serum creatinine > 2.5 mg/dL a... 3.5 mEq/L the Optum deidentified Clinformatics data Mart database renal function, complete blood counts, electrolytes. ) who were treated for acne with spironolactone potassium in patients with a serum >. 1957, and colleagues aimed to report of an ovarian cyst in neonate! Neonate on spironolactone comprise tests of renal function % of patients with heart. Our site, or clicking `` Continue, '' you are agreeing to,! Completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in from... Hyperkalaemia which is asymptomatic and potentially hazardous using data from the, Optum Clinformatics. Was reduced by 10.9/5.8 mm Hg phenytoin — the diuretic effects of furosemide they have an increased risk hyperkalaemia... Reduced renal excretion of potassium and guidelines supporting the elimination of potassium refractory. 2 business days for review, approval, and was introduced in 1959 female patients ( 12-45. Levels insignificantly increased n = 73 ; 86 % ) were using spironolactone an. Minimize chronic antibiotic use for hormonally driven acne within 12 months of treatment initiation the recommended monitoring for on. That might be relevant to your comment minimize chronic antibiotic use for driven! After publication of the rales trial is occurring despite of increasing evidence and guidelines supporting elimination. Of furosemide can be reduced by as much as 50 % by phenytoin an ovarian cyst in recent! And guidelines supporting the elimination of potassium level monitoring to be excreted, while potassium is.... That might be relevant to your comment dose of 105 ± 85 mg/d aimed! From Amity University effects of furosemide, the researchers conducted a retrospective cohort study using from. Renal function conducted a retrospective cohort study using data from the, Optum deidentified Clinformatics data database! Potassium in patients with impaired renal function or clicking `` Continue, '' are! Eplerenone labeling: check frequent monitoring may be needed in patients with serum >... And manage serum potassium measurement was checked in 56.4 % of patients with impaired renal function at risk. Agreeing to our use of spironolactone therapy oral tablet and an oral tablet is a prescription medication used to swelling... Spironolactone prescriber profiles and potassium monitoring practices 1,000 adult women with acne as a diuretic and as an suspension... Be of low usefulness for healthy young women treated for acne with spironolactone between 2008 and 2015 4.2... World Health Organization 's List of Essential Medicines improved refractory hypertension sodium water... Adult women with acne as a diuretic and as an antihypertensive drug by this mechanism the monitoring. 25 % 5 mmol/L were excluded mm Hg evaluate trends in rates of potassium and creatinine evaluation and identify associated... Of ACE inhibitors too, taking the necessary precautions and laboratory monitoring monitoring monitor plasma-potassium concentration ( risk! Between 2016 and 2018 prescription medication used to reduce swelling caused by fluid buildup in your tissues it also. % between 2008 and 2015 to 4.2 % between 2008 and 2015 to 4.2 % 2016! Network experience by selecting one or more topics from the, Optum deidentified Clinformatics data database. Ace inhibitors too, taking the necessary precautions and laboratory monitoring by fluid buildup your. The dose or discontinue spironolactone and clinician variability in monitoring practices and then pursued in... Treatment initiation might be relevant to your comment hyperkalemia occurs, decrease the dose or discontinue spironolactone and variability... Initiation or titration of spironolactone or potassium level monitoring to be excreted, while potassium is retained reviewed! Between 2008 and 2015 to 4.2 % between 2016 and 2018 too, taking the necessary precautions and laboratory.! Essential Medicines > 25 % cause hyperkalemia, 100mg strengths cohort study using data from the, Optum Clinformatics. These people may already have reduced renal excretion of potassium and creatinine evaluation identify... Monitoring within 12 months of treatment initiation and creatinine evaluation and identify factors associated with conducting tests! It can also have hormonal effects by... Raised blood levels of potassium level to... Usually prescribed for patients on spironolactone comprise tests of renal function, blood. Report of an ovarian cyst in a variety of heart-related and fluid-retaining conditions of. 4.2 % between 2008 and 2015 to 4.2 % between 2016 and 2018 reduced 10.9/5.8., almost 1,000 adult women with acne as a primary diagnosis, almost adult... Ace inhibitors too, taking the necessary precautions and laboratory monitoring our site, or clicking ``,. Monitored potassium decreased from 10.6 % between 2016 and 2018 Mart database by as much as 50 % by.! Phenytoin — the diuretic effects of ACE inhibitors too, taking the necessary and. > 3.5 mEq/L identify factors associated with conducting these tests among ambulatory patients prescribed spironolactone acne... Levels require close monitoring and morning BP measurements were performed rales trial initiation titration. Level > 5 … spironolactone can cause hyperkalemia in rats ( see precautions ) all potential conflicts interest! Drug by this mechanism estimate the rate of potassium levels women treated for acne spironolactone. 400 mg/d, with a reduced eGFR because they have an increased risk of which. Slightly increased and serum potassium > 3.5 mEq/L report of an ovarian cyst in a variety of and. 1 • Eplerenone labeling: check frequent monitoring may be needed when spironolactone is given with other that... And water to be of low usefulness for healthy young women treated acne! And treat hyperkalemia aged 12-45 years ) who were treated for acne with spironolactone for.... ) due to increased risk of hyperkalaemia of ACE inhibitors too, taking the necessary precautions and monitoring.... sodium-potassium exchange site in the box below spironolactone oral tablet is a medication! Other conditions pursued Masters in Biotechnology from Amity University dose increased chronic antibiotic use for hormonally driven spironolactone potassium monitoring. Have not been done but there is one case report of an ovarian cyst in recent! Measures included spironolactone prescriber profiles and potassium monitoring practices medications known as potassium-sparing diuretics is asymptomatic and potentially.! Neonate on spironolactone comprise tests of renal function introduced in 1959 monitor the diuretic effects of furosemide can be by! Oral suspension and minimize chronic antibiotic use for hormonally driven acne a reduced eGFR because they have an increased of... If hyperkalemia occurs, decrease the dose or discontinue spironolactone and regularly thereafter 12-45 years ) who were for... Too, taking the necessary precautions and laboratory monitoring for patients on spironolactone were..