Severe hyperkalaemia due to a potential drug–drug interaction between eplerenone and antiretrovirals in a HIV-positive patient after a myocardial infarction

Córdova, Ezequiel; Garibaldi, F.; Bono, Leandro; Rodríguez, Claudia

doi:10.1177/0956462420987422

Cited by 4 publications

(2 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, clinical evidence of these drugÀdrug interactions has not been elucidated. Ezequiel et al [21] showed that a life-threatening hyperkalemic event resulted from a drug-drug interaction between eplerenone and ritonavir, a strong CYP3A4 inhibitor, in a patient infected with the human immunodeficiency virus. Clarithromycin also has a potent inhibition profile for CYP3A4 [12] and may interact with eplerenone and esaxerenone.…”

Section: Discussionmentioning

confidence: 99%

Hyperkalemia by eplerenone or esaxerenone in the presence or absence of clarithromycin in hypertensive patients: a retrospective observational cohort study

Hirai¹,

Ueda²,

Ogura

et al. 2023

Journal of Hypertension

View full text Add to dashboard Cite

Objective: Mineralocorticoid receptor antagonists (MRAs), eplerenone and esaxerenone, cause hyperkalemia dosedependently. We investigated the cytochrome P450 3A4mediated drugÀdrug interaction between the MRAs and clarithromycin.Methods: This retrospective observational study included adult hypertensive patients with MRA plus clarithromycin or MRA alone with a propensity score matching (1:1). The difference in serum potassium level (DK, maximum levelbaseline level) between groups was compared using the Mann-Whitney U-test. Linear regression analysis was used to detect variables that correlated with DK in patients with MRA plus clarithromycin.Results: After propensity score matching (each nine patients), serum potassium level was elevated after treatment with MRA plus clarithromycin [4.3 (3.5 to 5.1) meq/l to 4.9 (4.0 to 5.5) meq/l, P ¼ 0.0234] and MRA alone [4.3 (4.0 to 4.7) meq/l to 4.6 (4.4 to 5.2) meq/l, P ¼ 0.0469]. Although there was no significant difference in DK between groups [MRA plus clarithromycin: 0.5 (0.1 to 1.1) meq/l vs. MRA alone: 0.3 (0.1 to 1.2) meq/l, P ¼ 0.7231], DK was significantly higher in esaxerenone plus clarithromycin than in esaxerenone alone [0.6 (0.5 to 1.1) meq/l vs. 0.1 (0.1 to 0.2) meq/l, P ¼ 0.0495]. Conversely, clarithromycin did not show a significant effect on DK in patients with eplerenone [0.4 (À0.2 to 1.2) meq/l vs. 0.8 (0.1 to 1.3) meq/l, P ¼ 0.5745]. A positive correlation was found between DK and age in patients with MRA plus clarithromycin (y ¼ 0.03 Â x À 1.38, r ¼ 0.71, P ¼ 0.0336). Conclusion:The drug-drug interaction between MRAs and clarithromycin was evident, particularly in esaxerenone. Serum potassium levels should be closely monitored in older patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Hyperkalemia by eplerenone or esaxerenone in the presence or absence of clarithromycin in hypertensive patients: a retrospective observational cohort study

Hirai¹,

Ueda²,

Ogura

et al. 2023

Journal of Hypertension

View full text Add to dashboard Cite

show abstract

“…Concurrently administration of eplerenone with protease inhibitors may cause a fourfold hike in the area under the curve (AUC) of eplerenone, which translates into the delayed clearance of the drug from the body (Talasaz et al 2020). Delayed clearance of eplerenone due to the said interaction leads to an increased risk of side effects, primarily hyperkalemia (Cordova et al 2021). Alternatively, the use of spironolactone is recommended in COVID-19 patients on protease inhibitors.…”

Section: Heart Failurementioning

confidence: 99%

The impact of SARS-CoV-2 treatment on the cardiovascular system: an updated review

et al. 2022

View full text Add to dashboard Cite

The coronavirus disease-2019 (COVID-19) pandemic has become a major global health problem. COVID-19 is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and exhibits pulmonary and extrapulmonary effects, including cardiovascular involvement. There are several attempts to identify drugs that could treat COVID-19. Moreover, many patients infected with COVID-19 have underlying diseases, particularly cardiovascular diseases. These patients are more likely to develop severe illnesses and would require optimized treatment strategies. The current study gathered information from various databases, including relevant studies, reviews, trials, or meta-analyses until April 2022 to identify the impact of SARS-CoV-2 treatment on the cardiovascular system. Studies have shown that the prognosis of patients with underlying cardiovascular disease is worsened by COVID-19, with some COVID-19 medications interfering with the cardiovascular system. The COVID-19 treatment strategy should consider many factors and parameters to avoid medication-induced cardiac injury, mainly in elderly patients. Therefore, this article provides a synthesis of evidence on the impact of different COVID-19 medications on the cardiovascular system and related disease conditions.

show abstract

Eplerenone/fosamprenavir/ritonavir interaction

2021

Reactions Weekly

View full text Add to dashboard Cite

Severe hyperkalaemia due to a potential drug–drug interaction between eplerenone and antiretrovirals in a HIV-positive patient after a myocardial infarction

Cited by 4 publications

References 9 publications

Hyperkalemia by eplerenone or esaxerenone in the presence or absence of clarithromycin in hypertensive patients: a retrospective observational cohort study

Hyperkalemia by eplerenone or esaxerenone in the presence or absence of clarithromycin in hypertensive patients: a retrospective observational cohort study

The impact of SARS-CoV-2 treatment on the cardiovascular system: an updated review

Eplerenone/fosamprenavir/ritonavir interaction

Contact Info

Product

Resources

About