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CaroSpir (spironolactone) Disease Interactions

There are 7 disease interactions with CaroSpir (spironolactone):

Major

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Acidosis

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus, Acidosis, Pulmonary Impairment

Acidosis alters the ratio of extracellular to intracellular potassium and may commonly lead to rapid increases in serum potassium levels. Conversely, high serum potassium concentrations may potentiate acidosis. Because of their hyperkalemic effects, therapy with potassium-sparing diuretics should be avoided in patients with metabolic or respiratory acidosis. These agents should be used cautiously in patients in whom acidosis may occur, such as patients with cardiopulmonary disease, severe respiratory disease, or poorly controlled diabetes. Acid-base balance and serum potassium levels should be monitored at regular intervals.

References

  1. "Product Information. Midamor (amiloride)." Merck & Co, Inc, West Point, PA.
  2. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic." Pharmacotherapy 1 (1981): 179-86
  3. Gabow PA, Moore S, Schrier RW "Spironolactone-induced hyperchloremic acidosis in cirrhosis." Ann Intern Med 90 (1979): 338-40
  4. "Product Information. Aldactone (spironolactone)." Searle, Skokie, IL.
  5. Feinfeld DA, Carvounis CP "Fatal hyperkalemia and hyperchloremic acidosis. Association with spironolactone in the absence of renal impairment." JAMA 240 (1978): 1516
  6. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.
  7. Jariwalla AG, Jones CR, Lever A, Hall R "Spironolactone and diabetic ketoacidosis." Postgrad Med J 57 (1981): 573-4
  8. Ochs HR, Greenblatt DJ, Bodem G, Smith TW "Spironolactone." Am Heart J 96 (1978): 389-400
View all 8 references
Major

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Diabetes

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus

Potassium-sparing diuretics can cause hyperkalemia, which may result in life-threatening cardiac arrhythmias. Patients with diabetes mellitus, with or without nephropathy, may be particularly susceptible to the hyperkalemic effect of these drugs due to a defect in the renin-angiotensin-aldosterone axis. Therapy with potassium-sparing diuretics should be avoided, if possible, in patients with diabetes, especially uncontrolled or insulin-dependent diabetes mellitus. If these drugs are used, serum potassium levels and renal function should be monitored at regular intervals. Determination of serum electrolytes is especially important during initiation of therapy, after a dosage adjustment, and during illness that could alter renal function.

References

  1. "Product Information. Aldactone (spironolactone)." Searle, Skokie, IL.
  2. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic." Pharmacotherapy 1 (1981): 179-86
  3. Walker BR, Capuzzi DM, Alexander F, Familiar RG, Hoppe RC "Hyperkalemia after triamterene in diabetic patients." Clin Pharmacol Ther 13 (1972): 643-51
  4. Amery A, Berthaux P, Bulpitt C, Deruyttere M, de Schaepdryver A, Dollery C, Fagard R, Forette F, Hellemans J, Lund-Johansen PMutsers A, Tuomilehto J "Glucose intolerance during diuretic therapy. Results of trial by the European Working Party on Hypertension in the Elderly." Lancet 1 (1978): 681-3
  5. Hollenberg NK, Mickiewicz CW "Postmarketing surveillance in 70,898 patients treated with a triamterene/hydrochlorothiazide combination (Maxzide) [published erratum appears in Am J Cardiol 1990 Aug 1;66(3):388]." Am J Cardiol 63 (1989): b37-41
  6. Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients." Clin Pharmacol Ther 34 (1983): 448-53
  7. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.
  8. "Product Information. Midamor (amiloride)." Merck & Co, Inc, West Point, PA.
  9. Jariwalla AG, Jones CR, Lever A, Hall R "Spironolactone and diabetic ketoacidosis." Postgrad Med J 57 (1981): 573-4
  10. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  11. Yap V, Patel A, Thomsen J "Hyperkalemia with cardiac arrhythmia. Induction by salt substitutes, spironolactone, and azotemia." JAMA 236 (1976): 2775-6
  12. Hollenberg NK, Mickiewicz C "Hyperkalemia in diabetes mellitus. Effect of a triamterene- hydrochlorothiazide combination." Arch Intern Med 149 (1989): 1327-30
  13. McNay JL, Oran E "Possible predisposition of diabetic patients to hyperkalemia following administration of potassium-retaining diuretic, amiloride (MK 870)." Metabolism 19 (1970): 58-70
View all 13 references
Major

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Electrolytes/Fluid

Severe Potential Hazard, High plausibility

Applies to: Electrolyte Abnormalities, Hyponatremia

All diuretics may cause or aggravate fluid and electrolyte disturbances. Potassium-sparing diuretics may cause hyperkalemia and, infrequently, hyponatremia. The latter generally occurs when these agents are combined with other diuretics such as thiazides or used in markedly edematous patients with restricted sodium intake. Therapy with potassium-sparing diuretics should be administered cautiously in patients with or predisposed to electrolyte abnormalities. Electrolyte imbalances should be corrected prior to initiating therapy, and serum electrolyte concentrations should be monitored periodically and maintained at normal ranges during therapy. Determination of serum electrolytes is especially important during initiation of therapy, after a dosage adjustment, and during illness that could alter renal function.

References

  1. Maddox RW, Arnold WS, Dewell WM "Extreme hyperkalemia associated with amiloride ." South Med J 78 (1985): 365
  2. "Product Information. Aldactone (spironolactone)." Searle, Skokie, IL.
  3. Davidson C, Burkinshaw L, Morgan DB "The effects of potassium supplements, spironolactone or amiloride on the potassium status of patients with heart failure." Postgrad Med J 54 (1978): 405-9
  4. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic." Pharmacotherapy 1 (1981): 179-86
  5. Walker BR, Capuzzi DM, Alexander F, Familiar RG, Hoppe RC "Hyperkalemia after triamterene in diabetic patients." Clin Pharmacol Ther 13 (1972): 643-51
  6. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.
  7. Hollenberg NK, Mickiewicz CW "Postmarketing surveillance in 70,898 patients treated with a triamterene/hydrochlorothiazide combination (Maxzide) [published erratum appears in Am J Cardiol 1990 Aug 1;66(3):388]." Am J Cardiol 63 (1989): b37-41
  8. Roberts CJ, Channer KS, Bungay D "Hyponatraemia induced by a combination of hydrochlorothiazide and triamterene." Br Med J (Clin Res Ed) 288 (1984): 1962
  9. Hollenberg NK, Mickiewicz C "Hyperkalemia in diabetes mellitus. Effect of a triamterene- hydrochlorothiazide combination." Arch Intern Med 149 (1989): 1327-30
  10. Jeunemaitre X, Dreft-Jais C, Chatellier G, Julien J, Degoulet P, Plouin P, Menard J, Corvol P "Long-term experience of spironolactone in essential hypertension." Kidney Int 34 Suppl (1988): s14-7
  11. Udezue EO, Harrold BP "Hyperkalaemic paralysis due to spironolactone." Postgrad Med J 56 (1980): 254-5
  12. Feinfeld DA, Carvounis CP "Fatal hyperkalemia and hyperchloremic acidosis. Association with spironolactone in the absence of renal impairment." JAMA 240 (1978): 1516
  13. Millar JA, Fraser R, Mason P, Leckie B, Cumming AM, Robertson JI "Metabolic effects of high dose amiloride and spironolactone: a comparative study in normal subjects." Br J Clin Pharmacol 18 (1984): 369-75
  14. Tarssanen L, Huikko M, Rossi M "Amiloride-induced hyponatremia." Acta Med Scand 208 (1980): 491-4
  15. Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients." Clin Pharmacol Ther 34 (1983): 448-53
  16. Brest AN "Spironolactone in the treatment of hypertension: a review." Clin Ther 8 (1986): 568-85
  17. "Product Information. Midamor (amiloride)." Merck & Co, Inc, West Point, PA.
  18. McNay JL, Oran E "Possible predisposition of diabetic patients to hyperkalemia following administration of potassium-retaining diuretic, amiloride (MK 870)." Metabolism 19 (1970): 58-70
  19. Hansen KB, Bender AD "Changes in serum potassium levels occurring in patients treated with triamterene and a triamterene-hydrochlorothiazide combination." Clin Pharmacol Ther 8 (1967): 392-9
  20. Hirschl MM, Seidler D, Laggner AN "Spironolactone-associated hyponatremic coma." Nephron 67 (1994): 503
  21. Cohen AB "Hyperkalemic effects of triamterene." Ann Intern Med 65 (1966): 521-7
  22. Yap V, Patel A, Thomsen J "Hyperkalemia with cardiac arrhythmia. Induction by salt substitutes, spironolactone, and azotemia." JAMA 236 (1976): 2775-6
  23. Ochs HR, Greenblatt DJ, Bodem G, Smith TW "Spironolactone." Am Heart J 96 (1978): 389-400
  24. Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension." Int J Clin Pharmacol Ther Toxicol 23 (1985): 585-8
View all 24 references
Major

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Hyperkalemia

Severe Potential Hazard, High plausibility

Applies to: Hyperkalemia

The use of potassium-sparing diuretics is contraindicated in the presence of elevated serum potassium concentrations (> 5.5 mEq/L). Potassium-sparing diuretics can cause hyperkalemia, which may result in life-threatening cardiac arrhythmias. Careful monitoring of serum potassium levels is necessary in all patients treated with potassium-sparing diuretics, especially during initiation of therapy, after dosage adjustment, and during illness that could alter renal function. The diuretic should be withdrawn immediately if hyperkalemia develops, and measures should be initiated to lower serum potassium if it exceeds 6.5 mEq/L. The combined use of a potassium-sparing diuretic with a kaliuretic diuretic (e.g., thiazides) may decrease the risk of hyperkalemia.

References

  1. Brest AN "Spironolactone in the treatment of hypertension: a review." Clin Ther 8 (1986): 568-85
  2. Ochs HR, Greenblatt DJ, Bodem G, Smith TW "Spironolactone." Am Heart J 96 (1978): 389-400
  3. Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension." Int J Clin Pharmacol Ther Toxicol 23 (1985): 585-8
  4. Cohen AB "Hyperkalemic effects of triamterene." Ann Intern Med 65 (1966): 521-7
  5. "Product Information. Midamor (amiloride)." Merck & Co, Inc, West Point, PA.
  6. Yap V, Patel A, Thomsen J "Hyperkalemia with cardiac arrhythmia. Induction by salt substitutes, spironolactone, and azotemia." JAMA 236 (1976): 2775-6
  7. McNay JL, Oran E "Possible predisposition of diabetic patients to hyperkalemia following administration of potassium-retaining diuretic, amiloride (MK 870)." Metabolism 19 (1970): 58-70
  8. Hollenberg NK, Mickiewicz C "Hyperkalemia in diabetes mellitus. Effect of a triamterene- hydrochlorothiazide combination." Arch Intern Med 149 (1989): 1327-30
  9. Jeunemaitre X, Dreft-Jais C, Chatellier G, Julien J, Degoulet P, Plouin P, Menard J, Corvol P "Long-term experience of spironolactone in essential hypertension." Kidney Int 34 Suppl (1988): s14-7
  10. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic." Pharmacotherapy 1 (1981): 179-86
  11. Walker BR, Capuzzi DM, Alexander F, Familiar RG, Hoppe RC "Hyperkalemia after triamterene in diabetic patients." Clin Pharmacol Ther 13 (1972): 643-51
  12. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.
  13. Hansen KB, Bender AD "Changes in serum potassium levels occurring in patients treated with triamterene and a triamterene-hydrochlorothiazide combination." Clin Pharmacol Ther 8 (1967): 392-9
  14. Udezue EO, Harrold BP "Hyperkalaemic paralysis due to spironolactone." Postgrad Med J 56 (1980): 254-5
  15. Maddox RW, Arnold WS, Dewell WM "Extreme hyperkalemia associated with amiloride ." South Med J 78 (1985): 365
  16. Feinfeld DA, Carvounis CP "Fatal hyperkalemia and hyperchloremic acidosis. Association with spironolactone in the absence of renal impairment." JAMA 240 (1978): 1516
  17. Millar JA, Fraser R, Mason P, Leckie B, Cumming AM, Robertson JI "Metabolic effects of high dose amiloride and spironolactone: a comparative study in normal subjects." Br J Clin Pharmacol 18 (1984): 369-75
  18. "Product Information. Aldactone (spironolactone)." Searle, Skokie, IL.
  19. Davidson C, Burkinshaw L, Morgan DB "The effects of potassium supplements, spironolactone or amiloride on the potassium status of patients with heart failure." Postgrad Med J 54 (1978): 405-9
  20. Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients." Clin Pharmacol Ther 34 (1983): 448-53
  21. Hollenberg NK, Mickiewicz CW "Postmarketing surveillance in 70,898 patients treated with a triamterene/hydrochlorothiazide combination (Maxzide) [published erratum appears in Am J Cardiol 1990 Aug 1;66(3):388]." Am J Cardiol 63 (1989): b37-41
View all 21 references
Major

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Rapid alterations in fluid and electrolyte balance may precipitate hepatic coma in patients with liver disease. Hepatic encephalopathy has been associated with the use of diuretics, most frequently thiazides but also some potassium-sparing diuretics. Therapy with all diuretics should be administered cautiously in patients with severely impaired hepatic function. These patients should be monitored carefully for signs and symptoms of hepatic encephalopathy such as tremors, confusion, increased jaundice, and coma. Since spironolactone and triamterene are primarily metabolized by the liver, reduced dosages of these drugs may also be necessary in severe hepatic impairment.

References

  1. Karim A, Zagarella J, Hribar J, Dooley M "Spironolactone I: disposition and metabolism." Clin Pharmacol Ther 19 (1976): 158-69
  2. Sungaila I, Bartle WR, Walker SE, DeAngelis C, Uetrecht J, Pappas C, Vidins E "Spironolactone pharmacokinetics and pharmacodynamics in patis with cirrhotic ascites." Gastroenterology 102 (1992): 1680-5
  3. "Product Information. Midamor (amiloride)." Merck & Co, Inc, West Point, PA.
  4. Renkes P, Gaucher P, Trechot P "Spironolactone and hepatic toxicity." JAMA 273 (1995): 376-7
  5. Sadee W, Schroder R, Leitner E, Dagcioglu M "Multiple dose kinetics of spironolactone and canrenoate-potassium in cardiac and hepatic failure." Eur J Clin Pharmacol 7 (1974): 195-200
  6. Abshagen U, Rennekamp H, Luszpinski G "Disposition kinetics of spironolactone in hepatic failure after single doses and prolonged treatment." Eur J Clin Pharmacol 11 (1977): 169-76
  7. Villeneuve JP, Rocheleau F, Raymond G "Triamterene kinetics and dynamics in cirrhosis." Clin Pharmacol Ther 35 (1984): 831-7
  8. Overdiek HW, Merkus FW "The metabolism and biopharmaceutics of spironolactone in man." Rev Drug Metab Drug Interact 5 (1987): 273-302
  9. Dao MT, Villeneuve JP "Kinetics and dynamics of triamterene at steady-state in patients with cirrhosis." Clin Invest Med 11 (1988): 6-9
  10. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.
  11. Mutschler E, Gilfrich HJ, Knauf H, Mohrke W, Volger KD "Pharmacokinetics of triamterene." Clin Exp Hypertens A 5 (1983): 249-69
  12. "Product Information. Aldactone (spironolactone)." Searle, Skokie, IL.
View all 12 references
Major

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

The use of potassium-sparing diuretics is contraindicated in patients with anuria, acute or progressive renal insufficiency, or diabetic nephropathy. Potassium-sparing diuretics can cause hyperkalemia, which may result in life-threatening cardiac arrhythmias. Patients with impaired renal function may be particularly susceptible to the hyperkalemic effect of these drugs. Therapy with potassium-sparing diuretics should be administered cautiously in patients with evidence of renal function impairment (BUN > 30 mg/dL or serum creatinine > 1.5 mg/dL). If these drugs are used, serum potassium levels and renal function should be monitored at regular intervals. Determination of serum electrolytes is especially important during initiation of therapy, after a dosage adjustment, and during illness that could alter renal function.

References

  1. Roy LF, Villeneuve JP, Dumont A, Dufresne LR, Duran MA, Morin C, Jobin J "Irreversible renal failure associated with triamterene." Am J Nephrol 11 (1991): 486-8
  2. Knauf H, Reuter K, Mutschler E "Limitation on the use of amiloride in early renal failure." Eur J Clin Pharmacol 28 (1985): 61-6
  3. George CF "Amiloride handling in renal failure." Br J Clin Pharmacol 9 (1980): 94-5
  4. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic." Pharmacotherapy 1 (1981): 179-86
  5. Neale TJ, Lynn KL, Bailey RR "Spironolactone-associated aggravation of renal functional impairment." N Z Med J 83 (1976): 147-9
  6. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.
  7. Hollenberg NK, Mickiewicz CW "Postmarketing surveillance in 70,898 patients treated with a triamterene/hydrochlorothiazide combination (Maxzide) [published erratum appears in Am J Cardiol 1990 Aug 1;66(3):388]." Am J Cardiol 63 (1989): b37-41
  8. "Product Information. Aldactone (spironolactone)." Searle, Skokie, IL.
  9. Lynn KL, Bailey RR, Swainson CP, Sainsbury R, Low WI "Renal failure with potassium-sparing diuretics." N Z Med J 98 (1985): 629-33
  10. Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients." Clin Pharmacol Ther 34 (1983): 448-53
  11. "Product Information. Midamor (amiloride)." Merck & Co, Inc, West Point, PA.
  12. "Triamterene and the kidney." Lancet 1 (1986): 424
  13. Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension." Int J Clin Pharmacol Ther Toxicol 23 (1985): 585-8
  14. Yap V, Patel A, Thomsen J "Hyperkalemia with cardiac arrhythmia. Induction by salt substitutes, spironolactone, and azotemia." JAMA 236 (1976): 2775-6
  15. Somogyi A, Hewson D, Muirhead M, Bochner F "Amiloride disposition in geriatric patients: importance of renal function." Br J Clin Pharmacol 29 (1990): 1-8
View all 15 references
Moderate

Potassium-Sparing Diuretics (Includes CaroSpir) ↔ Hyperuricemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Gout

Potassium-sparing diuretics have been reported to elevate serum uric acid levels. Therapy with these agents should be administered cautiously in patients with a history of gout.

References

  1. "Product Information. Dyrenium (triamterene)." SmithKline Beecham, Philadelphia, PA.

CaroSpir (spironolactone) drug Interactions

There are 582 drug interactions with CaroSpir (spironolactone)

CaroSpir (spironolactone) alcohol/food Interactions

There is 1 alcohol/food interaction with CaroSpir (spironolactone)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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