Hyperkalaemia during treatment with a sartan and an NSAID
Hyperkalaemia during treatment with a sartan and an NSAID
Due to their mechanism of action, sartans and NSAIDs can contribute to hyperkalaemia. As angiotensin II receptor antagonists, sartans inhibit the effect of angiotensin II and, in doing so, the resulting vasoconstriction and the release of aldosterone, which leads to a fall in blood pressure.
At the same time, the reduced release of aldosterone may reduce renal potassium excretion, thereby increasing the risk of hyperkalaemia. NSAIDs inhibit the formation of prostaglandins. This firstly inhibits the synthesis of prostacyclin, which has a kaliuretic effect, and also reduces renal blood flow, which both reduces distal sodium supply and indirectly impairs the effect of aldosterone.
The combination of several medicinal products that can cause hyperkalaemia increases the risk of this adverse reaction. It is particularly important to note this risk if other factors that could promote hyperkalaemia are present.
sartans, valsartan, NSAIDs, hyperkalaemia, electrolyte disorders
Incident data |
Description |
Year: 2024 Age: Elderly Sex: Female Medicinal product: Sartans, NSAIDs Active substances: Valsartan, acemetacin Indication: Arterial hypertension, analgesia ADRs: Hyperkalaemia Outcome: Recovered |
During the inpatient admission of an elderly female patient following a non-syncopal fall, severe hyperkalaemia of 6.8 mmol/L was diagnosed. Measured CK, sodium, creatinine/GFR and pH values were normal. Her prescribed medications taken at home included valsartan 240 mg daily as well as the NSAID acemetacin, which she had probably been taking regularly (up to daily) for several years. One month before her current hospitalisation, mild hyperkalaemia of 5.2 mmol/L had occurred while taking this combination therapy, and valsartan had been temporarily paused. Due to an additional diagnosis of orthostatic dysregulation, valsartan has now finally been discontinued. Rapid normalisation of potassium levels was achieved following administration of furosemide and sodium polystyrene sulfonate (Resonium® A). |
Summary and recommendation
Hyperkalaemia is expressly mentioned in the Information for healthcare professionals for sartans as a possible adverse drug reaction or under “Warnings and precautions”. Depending on the active substance, regular monitoring of serum potassium levels is also recommended.
The “Warnings and precautions” section of the Information for healthcare professionals for acemetacin also refers to increases in serum potassium concentration including hyperkalaemia, in some patients even without existing impaired renal function. These effects are also attributed to hyporeninemic hypoaldosteronism in patients with normal renal function.
The medicinal products taken should be considered as a possible cause in cases of new-onset hyperkalaemia. In addition to potassium-sparing diuretics and potassium-containing products, sartans and NSAIDs, among others, may also be considered; the combination of the high valsartan dose with the NSAID in the case described above may have been the cause of the hyperkalaemia.
Literature:
Swiss Information for healthcare professionals
Statutory duty of healthcare professionals to report adverse drug reactions (ADRs)
In Switzerland, healthcare professionals who are authorised to dispense or administer medicinal products are obligated to report severe and/or previously unknown side effects. Reports to Swissmedic can be entered and sent in the Electronic Vigilance Reporting Portal “ElViS” (ElViS login).
