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Trimethoprim–sulfamethoxazole was linked to sudden death in older patients using spironolactone

Ann Intern Med. 2015;162(12):JC13. doi:10.7326/ACPJC-2015-162-12-013
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Do not prescribe more than one drug at a time causing hyperkalemia
Posted on July 31, 2015
Gauranga Dhar
Bangladesh Institute of Family Medicine and Research
Conflict of Interest: None Declared
Poly-pharmacy is a big problem in the management of chronic diseases in the elderly and synergistic effects of different drugs leading to hyperkalemia are common. TMP-SMX as well as ciprofloxacine is commonly used as anti-bacterial agents for different indications who are under spironolactone, eplerenone, ARBs, ACEIs and so on. This article is a good alert for the physicians because still there is no effective management strategy for hyperkalemia. Although there is a new treatment of hyperkalemia; sodium zirconium cyclosilicate (ZS-9), physicians should be cautious about prescribing more than one drug simultaneously causing hyperkalemia and if necessary screen for high serum potassium level once any symptom is evident.
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