Avoid using oral potassium supplements in patients with serum potassium >3.5 mEq/L. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Monitor serum potassium within 1 week of initiation or titration of spironolactone and regularly thereafter. It is on the World Health Organization's List of Essential Medicines. "By demonstrating that for young, healthy women, it's safe to give spironolactone without close potassium monitoring, we hope that more patients will be able to benefit from this medication." The laboratory testing patterns seen here are concordant with older studies documenting suboptimal monitoring after initiation of MRA 13 and other high-risk medications in general populations. 941-944. CrossRef View Record in Scopus Google Scholar. 2 Those at greatest risk of hyperkalaemia are elderly people, people with diabetes, and people who have impaired renal function. Restart monitoring cycle if ACE inhibitor or ARB added or their dose increased. A Study was conducted to evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. Spironolactone can cause hyperkalaemia and requires close monitoring initially Spironolactone carries the risk of hyperkalaemia which is asymptomatic and potentially hazardous. 011-43720751, This site is intended for healthcare professionals only, Potassium being monitored in acne patients on spironolactone, defying guidelines: JAMA, spironolactone for acne, finds a recent study in the journal. spironolactone tablets, USP WARNING Aldactone has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions). to download free article PDFs,
The primary outcome was the proportion of women who received a test for baseline potassium level and the proportion of women whose potassium levels were monitored in the first 180 days of being treated for acne with spironolactone. Spironolactone is available as tablets - 25mg, 50mg, 100mg strengths. 1 • Eplerenone labeling: check There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap. Although recent studies and guideline recommendations indicate that potassium level monitoring is of low usefulness for healthy young women being treated for acne with spironolactone, little is known about whether these recommendations have been implemented in clinical practice. The primary outcome was the proportion of women who received a test for baseline potassium level and the proportion of women whose potassium levels were monitored in the first 180 days of being treated for acne with spironolactone. Not much is known if these recommendations are being implemented in clinical practice. Spironolactone can cause hyperkalaemia and requires close monitoring initially Spironolactone carries the risk of hyperkalaemia which is asymptomatic and potentially hazardous. Ambulatory BP monitoring and morning BP measurements were performed before (baseline) and 12 weeks after introduction of spironolactone therapy. In this cohort study, the overall proportion of 108 547 women with potassium level monitoring decreased from 41% in 2008 to 38% in 2018, with a greater decrease observed among women treated by dermatologists (49% to 41%) than by internists (40% to 38%) but an increase (71% to 75%) among women treated by advanced practice clinicians (ie, nurse practitioners and physician assistants). Moreover, researchers reported no serum potassium monitoring in 40.1% of 618 women or monitoring that took place more than 12 months before or after spironolactone initiation. They may be combined by each other or ACE inhibitors too, taking the necessary precautions and laboratory monitoring. The recommended monitoring for potassium and creatinine is 1 week after initiation or increase in dose of spironolactone, monthly for the first 3 months, then quarterly for a year, and then every 6 months. Participants included 108 547 healthy female patients (aged 12-45 years) who were treated for acne with spironolactone. There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap," they concluded. Spironolactone () Definition (NCI) A synthetic 17-spironolactone corticosteroid with potassium-sparing diuretic, antihypertensive, and antiandrogen activities.Spironolactone competitively inhibits adrenocortical hormone aldosterone activity in the distal renal tubules, myocardium, and vasculature. In a recent study published in JAMA Dermatology, almost 1,000 adult women with acne and 1,200 women on spironolactone were evaluated. Not much is known if these recommendations are being implemented in clinical practice. Results
Spironolactone can cause hyperkalemia. Sixty-seven percent of the original 618 women prescribed spironolactone for acne had no serum potassium monitoring within 12 months of treatment initiation. Laboratory monitoring for patients on spironolactone comprise tests of renal function, complete blood counts, and electrolytes including potassium levels. Adverse Reactions Hyperkalaemia and metabolic acidosis. Despite growing evidence and recommendations supporting the removal of potassium monitoring among healthy young women treated with spironolactone for acne, the results of the current study indicate that potassium monitoring … Privacy Policy| For clinicians who had prescribed at least 5 courses of spironolactone, the percentage of clinicians who ordered baseline potassium testing or monitoring and the percentage of clinicians who always monitored potassium were compared between 2008 and 2015 vs between 2016 and 2018. The majority of subjects (n = 73; 86%) were using spironolactone as an adjunct to estrogen. Aldactone acts both as a diuretic and as an antihypertensive drug by this mechanism. Please see our commenting policy for details. For the purpose, the researchers conducted a, retrospective cohort study using data from the, Optum deidentified Clinformatics Data Mart database. There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap. Monitor more frequently if infant is also given potassium. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. It is available as a generic medication. After 12 weeks, spironolactone significantly improved refractory hypertension. Conclusions and Relevance
To address this knowldge gap, University of Pennsylvania, Philadelphia, and colleagues aimed to. Design, setting, and participants This retrospective cohort study was conducted between January 1, 2008, and June 30, 2019, using data from the Optum deidentified Clinformatics Data Mart database. Avoid using other potassium-sparing diuretics. USA: Potassium monitoring remains common in healthy young women being treated with spironolactone for acne, finds a recent study in the journal JAMA Dermatology. evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. For clinicians who had prescribed at least 5 courses of spironolactone, the percentage of clinicians who ordered baseline potassium testing or monitoring and the percentage of clinicians who always monitored potassium were compared between 2008 and 2015 vs between 2016 and 2018. spironolactone, eplerenone (Inspra )] Potassium and renal function (e.g., serum creatinine) • Guidelines: check potassium and renal function baseline, three and seven days after initiation, monthly for three months, then quarterly. More frequent monitoring may be needed when spironolactone is given with other drugs that cause hyperkalemia or in patients with impaired renal function. "There is a need for future efforts to understand underlying factors for the variation and develop strategies for addressing this practice gap," wrote the authors. Importance
Question
Drug Interactions Spironolactone increases the effects of ACE inhibitors (leading to hyperkalemia), digoxin and sotalol. In a retrospective cohort study of over 100,000 female patients with acne, the percentage of healthcare providers who measured potassium levels within 180 days of […] © 2021 American Medical Association. Between 2008 and 2018, the percentage of women whose potassium levels were monitored within 180 days of starting spironolactone by all clinicians decreased from 41.4% to 38.5%, with a decrease from 48.9% to 41.0% among dermatologists and from 39.7% to 37.7% among internists but with an increase from 71.4% to 75.4% among advanced practice clinicians (ie, nurse practitioners and physician assistants). DOI: https://jamanetwork.com/journals/jamadermatology/article-abstract/2775574, Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. Action required if abnormal results . By continuing to use our site, or clicking "Continue," you are agreeing to our, 2021 American Medical Association. (Spironolactone Tablets, USP) 25 mg and 100 mg Tablets Aldosterone Antagonist Pfizer Canada Inc 17,300 Trans-Canada Highway ... recommended monitoring for potassium and creatinine is one week after initiation or increase in dose of spironolactone, monthly for the first 3 months, then quarterly for a year, and then every 6 months. Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. The conclusion was that the rate of hyperkalemia in healthy young women taking spironolactone for acne is equivalent to the baseline rate of hyperkalemia in this population and that potassium monitoring is unnecessary for healthy women taking spironolactone for acne. M.P. Secondary measures included spironolactone prescriber profiles and potassium monitoring practices. BP Monitoring and Spironolactone Therapy. Patients with chronic heart failure should be monitored in line with 'Chronic heart failure' described above. The recent studies and guidelines have suggested potassium level monitoring to be of low usefulness for healthy young women being treated with spironolactone for acne. No significant difference was found in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%). This retrospective cohort study was conducted between January 1, 2008, and June 30, 2019, using data from the Optum deidentified Clinformatics Data Mart database. Accessibility Statement. Stop ACEI/ARB therapy if serum potassium rises above 6.0mmol/L and other drugs Antiandrogenic effects include reduced hirsutism and gynecomastia. Only prescribe spironolactone for people whose blood potassium level is 4.5 mmol/l or lower. Monitor BP routinely 1. Some prescribers of spironolactone (CaroSpir, Aldactone) for acne are still monitoring patients’ potassium levels despite the move to eliminate this practice, a new study found. Some prescribers of spironolactone (CaroSpir, Aldactone) for pimples are nonetheless monitoring sufferers’ potassium ranges regardless of the transfer to eradicate this observe, a brand new examine discovered. Between 2008 and 2018, the percentage of women whose potassium levels were monitored within 180 days of starting spironolactone by all clinicians decreased from 41.4% to 38.5%, with a decrease from 48.9% to 41.0% among dermatologists and from 39.7% to 37.7% among internists but with an increase from 71.4% to 75.4% among advanced practice clinicians (ie, nurse practitioners and physician assistants). Mean 24-hour ambulatory BP was reduced by 10.9/5.8 mm Hg. It is critical to monitor and manage serum potassium in patients with severe heart failure receiving ALDACTONE. Discontinue or interrupt treatment for serum potassium >5 … Spironolactone is a potassium-sparing diuretic. Rosen et al., 2003 . Doses of spironolactone ranged from 25 to 400 mg/d, with a mean ± SD daily dose of 105 ± 85 mg/d. Because the cost of one potassium measurement exceeds that of a month's supply of spironolactone ($4), there are considerable economic benefits to ending … She can be contacted at editorial@medicaldialogues.in. Our website uses cookies to enhance your experience. Repeat these tests within 1 month of starting treatment. In contrast, the serum potassium measurement was checked in 74.9% of patients with an endocrine disorder who had acne as a secondary feature (P < .01). Monitoring Monitor plasma-potassium concentration (high risk of hyperkalaemia in renal impairment). It’s also used to treat high blood pressure and other conditions. The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. To evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. Contact no. Despite increasing evidence and guidelines supporting the elimination of potassium monitoring among healthy young women treated for acne with spironolactone, the present study findings suggest that potassium monitoring remains common, with substantial variability in clinician practices. "There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap," they concluded. This study finds that potassium level monitoring remains common among young women treated for acne with spironolactone, suggesting a need for future efforts to address this practice gap. The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018.