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Drug Safety in Patients With Heart Failure
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In reviewing the safety of various medications for patients with heart failure, Amabile and Spencer1 have provided clinicians with an excellent resource. Although they offer the disclaimer that their review is not exhaustive, they have omitted an exceptionally important cause of drug-related harm in patients with heart failure.
In appropriate patients, spironolactone improves cardiac morbidity and mortality with a relatively low incidence of hyperkalemia.2 However, the reality is that spironolactone is often prescribed to patients with additional risk factors (drug and nondrug) for hyperkalemia, with inadequate clinical and laboratory monitoring, and sometimes to patients with no clear indication for the drug to begin with.3 While several reports describe life-threatening hyperkalemia resulting from the combination of spironolactone and angiotensin-converting enzyme inhibitors, highlighting this drug interaction for clinicians,4-8 they tell us nothing of the sudden prehospital deaths from hyperkalemia that might simply have been ascribed to heart disease.
Drug safety is a . . . [Full Text of this Article]
AUTHOR INFORMATION
David N. Juurlink, MD, PhD;
Philip D. Hansten, PharmD
RELATED ARTICLE
Keeping Your Patient With Heart Failure Safe: A Review of Potentially Dangerous Medications
Celene M. Amabile and Anne P. Spencer
Arch Intern Med. 2004;164(7):709-720.
EXTRACT
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Adverse Effects of Combination Angiotensin II Receptor Blockers Plus Angiotensin-Converting Enzyme Inhibitors for Left Ventricular Dysfunction: A Quantitative Review of Data From Randomized Clinical Trials
Phillips et al.
Arch Intern Med 2007;167:1930-1936.
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