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

This report displays the potential drug interactions for the following 2 drugs:

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Major

potassium chloride spironolactone

Applies to: magnesium sulfate / potassium chloride / sodium sulfate and spironolactone

GENERALLY AVOID: The concomitant use of potassium-sparing diuretics and potassium preparations may result in hyperkalemia. Death has been reported.

MANAGEMENT: The use of potassium preparations in patients treated with potassium-sparing diuretics is generally not recommended. Caution is advised if coadministration is required, particularly in patients with renal impairment, diabetes, old age, worsening heart failure, and/or a risk for dehydration. Serum potassium and renal function should be checked regularly, and oral potassium supplementation should be avoided in patients with severe congestive heart failure who have serum potassium levels above 3.5 mEq/L. Patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as weakness, listlessness, confusion, tingling of the extremities, and irregular heartbeat.

References

  1. Walmsley RN, White GH, Cain M, McCarthy PJ, Booth J (1984) "Hyperkalemia in the elderly." Clin Chem, 30, p. 1409-12
  2. McNay JL, Oran E (1970) "Possible predisposition of diabetic patients to hyperkalemia following administration of potassium-retaining diuretic, amiloride (MK 870)." Metabolism, 19, p. 58-70
  3. Ponce SP, Jennings AE, Madias NE, Harrington JT (1985) "Drug-induced hyperkalemia." Medicine (Baltimore), 64, p. 357-70
  4. O'Reilly MV, Murnaghan DP, Williams MB (1974) "Transvenous pacemaker failure induced by hyperkalemia." JAMA, 228, p. 336-7
  5. Shapiro S, Slone D, Lewis GP, Jick H (1971) "Fatal drug reactions among medical inpatients." JAMA, 216, p. 467-72
  6. Greenblatt DJ, Koch-Weser J (1973) "Adverse reactions to spironolactone: a report from the Boston Collaborative Drug Surveillance Program." JAMA, 225, p. 40-3
  7. Lawson DH, O'Connor PC, Jick H (1982) "Drug attributed alterations in potassium handling in congestive cardiac failure." Eur J Clin Pharmacol, 23, p. 21-5
  8. Mashford ML, Robertson MB (1972) "Spironolactone and ammonium and potassium chloride." Br Med J, 4, p. 298-9
  9. (2001) "Product Information. Aldactone (spironolactone)." Searle
  10. Lawson DH (1974) "Adverse reactions to potassium chloride." Q J Med, 43, p. 433-40
  11. (2001) "Product Information. K-Dur (potassium chloride)." Schering Corporation
  12. Walker BR, Hoppe RC, Alexander F (1972) "Effect of triamterene on the renal clearance of calcium, magnesium, phosphate, and uric acid in man." Clin Pharmacol Ther, 13, p. 245-50
  13. Bozkurt B, Agoston I, Knowlton AA (2003) "Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines." J Am Coll Cardiol, 41, p. 211-4
  14. Martin J, Mourton S, Nicholls G (2003) "Severe hyperkalaemia with prescription of potassium-retaining agents in an elderly patient." N Z Med J, 116, U542
  15. Jarman PR, Mather HM (2003) "Diabetes may be independent risk factor for hyperkalaemia." BMJ, 327, p. 812
  16. Svensson M, Gustafsson F, Galatius S, Hildebrandt PR, Atar D (2003) "Hyperkalaemia and impaired renal function in patients taking spironolactone for congestive heart failure: retrospective study." BMJ, 327, p. 1141-2
  17. Masoudi FA, Gross CP, Wang Y, et al. (2005) "Adoption of spironolactone therapy for older patients with heart failure and left ventricular systolic dysfunction in the United States, 1998-2001." Circulation, 112, p. 39-47
  18. Marcy TR, Ripley TL (2006) "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm, 63, p. 49-58
  19. Perazella MA (2000) "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med, 109, p. 307-14
  20. Berry C, McMurray JJ (2001) "Serious adverse events experienced by patients with chronic heart failure taking spironolactone." Heart, 85, E8
  21. Jarman PR, Kehely AM, Mather HM (1995) "Hyperkalaemia in diabetes: prevalence and associations." Postgrad Med J, 71, p. 551-2
  22. Perazella MA, Mahnensmith RL (1997) "Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis." J Gen Intern Med, 12, p. 646-56
View all 22 references

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Moderate

spironolactone sodium sulfate

Applies to: spironolactone and magnesium sulfate / potassium chloride / sodium sulfate

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.

References

  1. (2010) "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories
  2. (2013) "Product Information. Suclear (polyethylene glycol 3350 with electrolytes)." Braintree Laboratories

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Drug and food interactions

Moderate

sodium sulfate food

Applies to: magnesium sulfate / potassium chloride / sodium sulfate

ADJUST DOSING INTERVAL: Bowel cleansing products can increase the gastrointestinal transit rate. Oral medications administered within one hour of the start of administration of the bowel cleansing solution may be flushed from the gastrointestinal tract and not properly absorbed.

MANAGEMENT: Patients should be advised that absorption of oral medications may be impaired during bowel cleansing treatment. Oral medications (e.g., anticonvulsants, oral contraceptives, antidiabetic agents, antibiotics) should not be administered during and within one hour of starting bowel cleansing treatment whenever possible. However, if concomitant use cannot be avoided, monitoring for reduced therapeutic effects may be advisable.

References

  1. "Product Information. Golytely (polyethylene glycol 3350 with electrolytes)." Braintree
  2. (2022) "Product Information. Prepopik (citric acid/Mg oxide/Na picosulfate)." Ferring Pharmaceuticals Inc

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Moderate

spironolactone food

Applies to: spironolactone

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

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