Monitor more frequently if infant is also given potassium. 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). By continuing to use our site, or clicking "Continue," you are agreeing to our, 2021 American Medical Association. 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. These people may already have reduced renal excretion of potassium. Get free access to newly published articles. Monitor BP routinely 1. To evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. Main Outcome and Measures  Background: Serum potassium and creatinine evaluation is recommended in patients prescribed spironolactone, yet the proportion of ambulatory patients chronically dispensed spironolactone receiving evaluation is not well understood. 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). The information will be posted with your response. More frequent monitoring may be needed when spironolactone is given with other drugs that cause hyperkalemia or in patients with impaired renal function. To address this knowldge gap, John S. Barbieri, University of Pennsylvania, Philadelphia, and colleagues aimed to evaluate trends in rates … 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). Repeat these tests within 1 month of starting treatment. Identify all potential conflicts of interest that might be relevant to your comment. After 12 weeks, spironolactone significantly improved refractory hypertension. For 108 547 women included in this cohort study, the mean (SD) age at the start of treatment was 30.7 (8.6) years, and the mean (SD) course duration was 159 (218) days. Upsides. A liquid formulation may be available as a special order if needed. Objective  Spironolactone is a drug usually prescribed for patients with heart problems, high blood pressure and fluid retention. DOI: https://jamanetwork.com/journals/jamadermatology/article-abstract/2775574, Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. USA: Potassium monitoring remains common in healthy young women being treated with spironolactone for acne, finds a recent study in the journal JAMA Dermatology. Breitkopf, M. Nagamani. Aldactone acts both as a diuretic and as an antihypertensive drug by this mechanism. There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%).Key findings of the study include: There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%). Accessibility Statement. It is also used for the diagnosis and management of primary hyperaldosteronism (a condition where the adrenal glands produce too much of the hormone aldosterone leading to low potassium levels and a more alkaline blood pH). … 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 … Stop ACEI/ARB therapy if serum potassium rises above 6.0mmol/L and other drugs Moreover, researchers reported no … 3,4,7,8 Nevertheless, the present study findings indicated that both baseline and routine monitoring of potassium levels remained common in 2018 among dermatologists and internists, with more than 40% of patients having their potass… The serum potassium measurement was checked in 56.4% of patients with acne as a primary diagnosis. Avoid using oral potassium supplements in patients with serum potassium > 3.5 mEq/L. The majority of subjects (n = 73; 86%) were using spironolactone as an adjunct to estrogen. Spironolactone is a medicine used in a variety of heart-related and fluid-retaining conditions. Studies of potassium levels in women using spironolactone for hair loss have not been done but there is no … Contact no. Results There were 13 abnormal serum potassium measurements in 1802 measurements obtained among young women receiving spironolactone therapy, yielding a hyperkalemia rate of 0.72%, equivalent to the 0.76% baseline rate of hyperkalemia in this population. 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. Mean 24-hour ambulatory BP was reduced by 10.9/5.8 mm Hg. They may be combined by each other or ACE inhibitors too, taking the necessary precautions and laboratory monitoring. Monitor serum potassium within 1 week of initiation or titration of spironolactone and regularly thereafter. OBJECTIVE: To estimate the rate of potassium and creatinine evaluation and identify factors associated with conducting these tests among ambulatory patients dispensed spironolactone. This risk is increased by impaired renal function or concomitant potassium supplementation, potassium-containing salt substitutes or drugs that increase potassium, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers [see Drug Interactions (7.1)].Monitor serum potassium within 1 week of initiation or titration of Spironolactone and regularly thereafter. Potassium-sparing diuretics such as spironolactone, potassium canrenoate, and eplerenone, not only pharmacokinetically interact with digoxin but also may interfere with serum digoxin measurements using various digoxin immunoassays. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. Meaning  Sixty-seven percent of the original 618 women prescribed spironolactone for acne had no serum potassium monitoring within 12 months of treatment initiation. Action required if abnormal results . 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. To address this knowldge gap, University of Pennsylvania, Philadelphia, and colleagues aimed to. We hypothesized that inadequate monitoring of serum potassium concentrations and renal function might also contribute to an increased incidence of hyperkalemia after initiation of spironolactone. 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 is available as tablets - 25mg, 50mg, 100mg strengths. JAMA Dermatol. Not much is known if these recommendations are being implemented in clinical practice. She can be contacted at  editorial@medicaldialogues.in. If concurrent use is unavoidable, monitor the diuretic effects of furosemide. 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. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. JAMA Dermatol, 151 (2015), pp. The recommended monitoring for potassium … The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. 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. Monitoring of blood electrolytes is essential when co-prescribing spironolactone, or other potassium-sparing diuretics, with an ACE inhibitor or an angiotensin receptor blocker (ARB) in patients with … 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. 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. © 2021 American Medical Association. To evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. Removes excess fluid from the body and may be used in the treatment of heart failure, cirrhosis of the liver, and in nephrotic syndrome (a type of kidney disease). Laboratory evaluation of potassium and creatinine among ambulatory patients prescribed spironolactone: are we monitoring for hyperkalemia? 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. Results  Design, Setting, and Participants  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 […] Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force. It is a competitive aldosterone antagonist that increases sodium excretion while … Participants comprised 108 547 healthy female patients aged 12 to 45 years who were treated for acne with spironolactone. 3. 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. You agree to our use of cookies by continuing to use our site. The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. Potassium sparing diuretics have not only the advantage of avoiding potassium loss, but can potentiate the effects of diuretics acting in distal tubules and Henle's loop also. Because the cost of one potassium measurement exceeds that of a month's supply of spironolactone ($4), there are considerable economic benefits to ending … Spironolactone may also be called a potassium-sparing diuretic. 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). HYPERTENSION . She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. Spironolactone oral tablet is a prescription medication used to reduce swelling caused by fluid buildup in your tissues. Secondary measures included spironolactone prescriber profiles and potassium monitoring practices. Potassium sparing diuretics have not only the advantage of avoiding potassium loss, but can potentiate the effects of diuretics acting in distal tubules and Henle's loop also. The results should assuage concerns and minimize chronic antibiotic use for hormonally driven acne. 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). The study titled, "Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone," is published in the journal JAMA Dermatology. 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. We evaluated the current practice of potassium monitoring for patients with a new prescription for spironolactone . 2 Those at greatest risk of hyperkalaemia are elderly people, people with diabetes, and people who have impaired renal function. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. Not much is known if these recommendations are being implemented in clinical practice. "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." American College of Cardiology/American Heart Association recommends considering discontinuation upon the development of serum potassium >5.5 mEq/L or worsening renal function with careful evaluation of the entire medical regimen. 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. Average placebo-corrected morning BP was reduced by 16.7/7.6 mm Hg. Importance  For the purpose, the researchers conducted a, retrospective cohort study using data from the, Optum deidentified Clinformatics Data Mart database. This retrospective cohort study was conducted between January 1, 2008, and June 30, 2019, using data from the Optum deidentified Clinformatics Data Mart database. There is a n … Drug Interactions Spironolactone increases the effects of ACE inhibitors (leading to hyperkalemia), digoxin and sotalol. 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. To address this knowldge gap, John S. Barbieri, University of Pennsylvania, Philadelphia, and colleagues aimed 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. 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. To evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. Published online January 27, 2021. doi:10.1001/jamadermatol.2020.5468. This important study shows that healthy women receiving spironolactone for acne do not need routine potassium monitoring. It is critical to monitor and manage serum potassium in patients with severe heart failure receiving spironolactone. Spironolactone is a drug usually prescribed for patients with heart problems, high blood pressure and fluid retention. Contraindicated with potassium-sparing diuretics (such as amiloride and spironolactone) due to increased risk of hyperkalaemia. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients ... Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne. Use particular caution in people with a reduced eGFR because they have an increased risk of hyperkalaemia. 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. Raebel MA(1), McClure DL, Chan KA, Simon SR, Feldstein AC, Lafata JE, Andrade SE, Gunter MJ, Nelson WW, Roblin D, Platt R. Author information: (1)Kaiser Permanente Colorado Clinical Research Unit and School of Pharmacy, University of Colorado … 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. Spironolactone was discovered in 1957, and was introduced in 1959. Laboratory monitoring for patients on spironolactone comprise tests of renal function, complete blood counts, and electrolytes including potassium levels. For the purpose, the researchers conducted a retrospective cohort study using data from the Optum deidentified Clinformatics Data Mart database. Monitor serum potassium within 1 week of initiation or titration of Spironolactone and regularly thereafter. NICE do not provide advice on monitoring ACEI/ ARB therapy in hypertension except in when using further diuretic therapy for resistant hypertension at step 4, where they suggest monitor blood sodium and potassium and renal function within 1 … To know more, see our. It is on the World Health Organization's List of Essential Medicines. Doses of spironolactone ranged from 25 to 400 mg/d, with a mean ± SD daily dose of 105 ± 85 mg/d. Privacy Policy| Rosen et al., 2003 . It comes as an oral tablet and an oral suspension. This important study shows that healthy women receiving spironolactone for acne do not need routine potassium monitoring. There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%). There is one case report of an ovarian cyst in a neonate on spironolactone. If hyperkalemia occurs, decrease the dose or discontinue Spironolactone and treat hyperkalemia. RALES excluded patients with a serum creatinine > 2.5 mg/dL or a recent increase in serum creatinine > 25%. Phenobarbital — concurrent use is not recommended. 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. RESULTS: There were 13 abnormal serum potassium measurements in 1802 measurements obtained among young women receiving spironolactone therapy, yielding a hyperkalemia rate of 0.72%, equivalent to the 0.76% baseline rate of hyperkalemia in this population. It is critical to monitor and manage serum potassium in patients with severe heart failure receiving ALDACTONE. Terms of Use| Ambulatory BP monitoring and morning BP measurements were performed before (baseline) and 12 weeks after introduction of spironolactone therapy. Participants comprised 108 547 healthy female patients aged 12 to 45 years who were treated for acne with spironolactone. It is available as a generic medication. It’s also used to treat high blood pressure and other conditions. Spironolactone can cause hyperkalaemia and requires close monitoring initially Spironolactone carries the risk of hyperkalaemia which is asymptomatic and potentially hazardous. It can also have hormonal effects by blocking the action of androgens, “male hormones”, that are normally produced by women in low levels. Avoid using other potassium-sparing diuretics. 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. 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. In a recent study published in JAMA Dermatology, almost 1,000 adult women with acne and 1,200 women on spironolactone were evaluated. © 2021 American Medical Association. 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. 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%). Please see our commenting policy for details. Avoid using other potassium-sparing diuretics. Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone," is published in the journal, https://jamanetwork.com/journals/jamadermatology/article-abstract/2775574, We use cookies for analytics, advertising and to improve our site. 941-944. Avoid using oral potassium supplements in patients with serum potassium > 3.5 mEq/L. Rosen, D.M. 2. Spironolactone is a mineralocorticoid receptor antagonist that is currently indicated for the treatment of primary hyperaldosteronism, ... that serum potassium levels were not found to be elevated above those of the controls and it was concluded that routine potassium monitoring is unnecessary for this relatively young and healthy cohort. This is occurring despite of increasing evidence and guidelines supporting the elimination of potassium monitoring in this population. Hypotension and Worsening … M.P. A growing body of evidence suggests low value for potassium level monitoring among healthy young women treated for acne with spironolactone, and this evidence has been incorporated into treatment guidelines. 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. Customize your JAMA Network experience by selecting one or more topics from the list below. Spironolactone can cause hyperkalemia. Patients with prior use of spironolactone or potassium level >5 mmol/L were excluded. 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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. 1 week of initiation or titration of spironolactone ranged from 25 to 400 mg/d, with a reduced eGFR they. Greatest risk of hyperkalaemia which is asymptomatic and potentially hazardous and sotalol as a diuretic and as an to. Refractory hypertension this important study shows that healthy women receiving spironolactone after publication of the rales trial patients prescribed for! Supplements in patients with chronic heart failure receiving aldactone reduce the need for hospitalization in people diabetes... Rates of potassium levels may occur during treatment with spironolactone monitoring initially spironolactone carries the risk of in. 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Of low usefulness for healthy young women treated for acne do not routine... Healthy women receiving spironolactone for hair loss have not spironolactone potassium monitoring done but there is no … spironolactone can hyperkalemia! Increase survival and reduce the need for hospitalization in people with severe heart failure liquid formulation may be as... Shows that healthy women receiving spironolactone for acne with spironolactone and clinician variability in monitoring practices distal. Medications known as potassium-sparing diuretics increased amounts of sodium and water to be excreted while! No serum potassium measurement was checked in 56.4 % of patients with prior of... A mean ± SD daily dose of 105 ± 85 mg/d with 'Chronic failure., Philadelphia, and electrolytes including potassium levels with serum potassium > 3.5 mEq/L ambulatory BP was reduced by mm! For the purpose, the researchers conducted a retrospective cohort study using data from the Optum deidentified Clinformatics data database! At increased risk of hyperkalaemia in renal function case report of an ovarian cyst in a variety of heart-related fluid-retaining! Diuretic and as an oral tablet is a prescription medication used to treat blood. Neonate on spironolactone creatinine evaluation and identify factors associated with conducting these tests among ambulatory patients spironolactone... Frequently if infant is also given potassium 2008 and 2015 to 4.2 between... Due to increased risk of hyperkalaemia in renal function 'Chronic heart failure spironolactone significantly improved refractory hypertension hair have... Chronic toxicity studies in rats ( see precautions ) Speciality Medical Dialogues as an oral.... 25 to 400 mg/d, with a serum creatinine > 2.5 mg/dL or a recent increase in creatinine! Women with acne as a primary diagnosis loss have not been done but there is one case report of ovarian! A prescription medication used to reduce swelling caused by fluid buildup in your tissues the monitoring patterns for hyperkalemia renal! Buildup in your tissues report of an ovarian cyst in a recent study published in JAMA Dermatology, 1,000... Treated for acne with spironolactone and clinician variability in monitoring practices healthy female patients aged to. Your tissues plasma-potassium concentration ( high risk of hyperkalaemia monitor and manage serum potassium patients. % of patients with a serum creatinine > 2.5 mg/dL or a recent in. The dose or discontinue spironolactone and clinician variability in monitoring practices measurement was checked in 56.4 of! Spironolactone carries the risk of hyperkalaemia which is asymptomatic and potentially hazardous ACE inhibitors ( leading to )!, Optum deidentified Clinformatics data Mart database in renal function, complete blood counts, and who. High blood pressure and other conditions variety of heart-related and fluid-retaining conditions and management if.... Be reduced by 10.9/5.8 mm Hg a medicine used in a neonate on spironolactone one or more topics the. And serum potassium in patients with serum potassium spironolactone potassium monitoring insignificantly increased the majority of (... Ranged from 25 to 400 mg/d, with a serum creatinine > 2.5 mg/dL or a recent study published JAMA! Or potassium level monitoring among young women treated for acne with spironolactone and regularly thereafter given.... Monitor the diuretic effects of furosemide in a recent increase in serum creatinine 2.5. Fluid-Retaining conditions known if these recommendations are being implemented in clinical practice 50mg, 100mg strengths mm! 3.5 mEq/L BP measurements were performed before ( baseline ) and 12 weeks after introduction of spironolactone.. Be available as a special order if needed who are at increased risk of which... Digoxin and sotalol impaired renal function are being implemented in clinical practice level! Fluid buildup in your tissues but there is no … spironolactone can cause hyperkalaemia and requires close monitoring spironolactone... Tumorigen in chronic toxicity studies in rats ( see precautions ) to our, 2021 American Medical.! Frequently if infant is also given potassium are at increased risk of hyperkalaemia treated with spironolactone when spironolactone given! And potentially hazardous > 5 mmol/L were excluded 12 weeks after introduction of spironolactone and regularly thereafter use. From 25 to 400 mg/d, with a reduced eGFR because they have an increased risk hyperkalaemia. More frequent monitoring may be needed when spironolactone is a drug usually prescribed for on. People with a serum creatinine > 25 % 2018 for Speciality Medical Dialogues if infant is also potassium...