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Trimethoprim is a potassium-sparing diuretic like amiloride and causes hyperkalemia in high-risk patients
1Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8029, USA.
Abstract:
Trimethoprim-sulfamethoxazole is a commonly prescribed antimicrobial agent. Twenty-five years after its introduction into clinical practice, an unrecognized and potentially lethal adverse reaction associated with trimethoprim-sulfamethoxazole therapy, hyperkalemia, was described. Both "high-dose" and "standard-dose" trimethoprim-sulfamethoxazole have been associated with this electrolyte disorder. Recognition of this potassium disturbance led to the subsequent description of the mechanism by which trimethoprim-sulfamethoxazole induced hyperkalemia. Trimethoprim was found to act like the potassium-sparing diuretic amiloride and reduce renal potassium excretion. Hence, trimethoprim is in fact a potassium-sparing diuretic like amiloride and causes hyperkalemia in high-risk patients.
Insights
Trimethoprim-sulfamethoxazole can cause hyperkalemia, a dangerous electrolyte imbalance. This occurs because trimethoprim acts as a potassium-sparing diuretic, similar to amiloride, reducing kidney potassium excretion in susceptible patients.
Area of Science:
- Pharmacology
- Nephrology
- Internal Medicine
Background:
- Trimethoprim-sulfamethoxazole is a widely used antibiotic.
- Hyperkalemia was identified as a serious adverse effect of this drug.
- Both standard and high doses have been linked to this condition.
Purpose of the Study:
- To describe the adverse reaction of hyperkalemia associated with trimethoprim-sulfamethoxazole.
- To elucidate the mechanism of trimethoprim-induced hyperkalemia.
Main Methods:
- Clinical observation and case reports.
- Pharmacological analysis of trimethoprim's action on renal potassium excretion.
Main Results:
- Trimethoprim-sulfamethoxazole therapy is associated with hyperkalemia.
- Trimethoprim inhibits renal potassium excretion.
- This effect is similar to that of amiloride, a known potassium-sparing diuretic.
Conclusions:
- Trimethoprim acts as a potassium-sparing diuretic.
- Trimethoprim can induce hyperkalemia, particularly in high-risk individuals.
- Understanding this mechanism is crucial for patient safety.