Drug Interactions between losartan and magnesium sulfate / potassium chloride / sodium sulfate

MONITOR CLOSELY: Concomitant use of angiotensin II receptor blockers (ARBs) and potassium salts may increase the risk of hyperkalemia. Inhibition of angiotensin II results in decreased aldosterone secretion, which in turn causes potassium retention. Life-threatening and fatal hyperkalemia can occur, especially when the combination is used in patients with risk factors such as renal impairment, diabetes, advanced age, severe or worsening heart failure, dehydration, and concomitant use of other agents that block the renin-angiotensin-aldosterone system or otherwise increase serum potassium levels.

MANAGEMENT: Caution and close monitoring are advised if angiotensin II receptor blockers (ARBs) must be used concurrently with potassium salts due to the risk of potentially life-threatening hyperkalemia. Some authorities advise against combining certain ARBs with potassium salts unless the anticipated benefits substantially outweigh the potential risks. The risk of hyperkalemia is increased in older patients, those with certain disease states (e.g., renal impairment, diabetes, severe or worsening heart failure, dehydration) or when ARBs are also combined with other agents that increase serum potassium (e.g., nonsteroidal anti-inflammatory drugs, beta-blockers, cyclosporine, heparin, tacrolimus, trimethoprim). Should the benefits outweigh the risks for a particular patient, serum potassium and renal function should be checked prior to initiating therapy and regularly thereafter. Patients and their caregivers should be given counseling on the appropriate levels of potassium and fluid intake, and advised to seek medical attention if they experience signs and symptoms of hyperkalemia (e.g., nausea, vomiting, weakness, listlessness, tingling of the extremities, paralysis, confusion, weak pulse, and a slow or irregular heartbeat). Individual product labeling should be consulted for further guidance.

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MONITOR: Coadministration with agents that affect renal function or perfusion such as diuretics, ACE inhibitors, angiotensin receptor blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk and/or severity of fluid and electrolyte disturbances associated with the use of bowel cleansing preparations. Fluid and electrolyte disturbances can lead to serious adverse events including cardiac arrhythmias, seizures, and renal impairment.

MANAGEMENT: Caution is advised when bowel cleansing preparations are used in patients treated with agents that affect renal function or perfusion, particularly if they are frail or elderly or have preexisting renal impairment. Baseline and postprocedure labs including serum electrolytes, BUN, and creatinine should be considered. Patients should be advised to drink sufficient quantities of clear fluids before, during, and after bowel cleansing. Hospitalization and intravenous fluid hydration may be appropriate for frail or elderly patients who may be unable to drink an adequate volume of fluid.

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