ArticleBMJ (Clinical research ed.)2011
Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study.
Article in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 77 citations in OpenAlex.
- The effect of co-trimoxazole on serum potassium concentration: safety evaluation of a randomized controlled trial.British journal of clinical pharmacology · 2017Trial
- Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease: Clinical Evidence, Pharmacology, and Drug-Drug Interactions for Personalized Management of Hyperkalemia.International journal of molecular sciences · 2026Review
- Reassessing the efficacy and safety of trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia: a retrospective study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- The safety profile of trimethoprim-sulfamethoxazole regarding concomitant other drugs: a comparative analysis of adverse effects in a tertiary level adult intensive care unit.BMC infectious diseases · 2025Observational
- Severe hyponatremia due to trimethoprim-sulfamethoxazole: a case report.AME case reports · 2025Article
- Hyperkalemic effect of drug-drug interaction between esaxerenone and trimethoprim in patients with hypertension: a pilot study.Journal of pharmaceutical health care and sciences · 2024Article
- Pharmacotherapeutic Considerations in the Treatment of Nontuberculous Mycobacterial Infections: A Primer for Clinicians.Open forum infectious diseases · 2024Review
- Prescription of oxycodone versus codeine after childbirth and risk of persistent opioid use: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Trimethoprim-sulfamethoxazole and the risk of a hospital encounter with hyperkalemia: a matched population-based cohort study.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Article
- Maternal opioid treatment after delivery and risk of adverse infant outcomes: population based cohort study.BMJ (Clinical research ed.) · 2023Article
- Prevalence and risk factors of trimethoprim/sulfamethoxazole-related acute kidney injury in pediatric patients: an observational study from a public database.Translational pediatrics · 2022Article
- Low-dose trimethoprim-sulfamethoxazole for the treatment ofBMJ open · 2022Article
- Longitudinal Data Discontinuity in Electronic Health Records and Consequences for Medication Effectiveness Studies.Clinical pharmacology and therapeutics · 2022Article
- Severe hyponatremia due to trimethoprim-sulfamethoxazole-induced SIADH.SAGE open medical case reports · 2022Article
- Southern African HIV Clinicians' Society gender-affirming healthcare guideline for South Africa.Southern African journal of HIV medicine · 2021Article
- Single-Center Retrospective Analysis of Prophylaxis and Treatment of Pneumocystis carinii Pneumonia in Patients with Renal Dysfunction After Renal Transplantation.Annals of transplantation · 2020Article
- Evaluation of community pharmacists' knowledge about drug-drug interaction in Central Saudi Arabia.Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society · 2019Article
- Risk of adverse outcomes following urinary tract infection in older people with renal impairment: Retrospective cohort study using linked health record data.PLoS medicine · 2018Article
- Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study.BMJ (Clinical research ed.) · 2018Article
- Potassium: friend or foe?Pediatric nephrology (Berlin, Germany) · 2017Review
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
Abstract
objectivesTo characterise the risk of admission to hospital for hyperkalaemia in elderly patients treated with trimethoprim-sulfamethoxazole in combination with spironolactone.
designPopulation based nested case-control study.
settingOntario, Canada, from 1 April 1992 to 1 March 2010.
participantsCases were residents of Ontario aged 66 years or above receiving chronic treatment with spironolactone and admitted to hospital with hyperkalaemia within 14 days of receiving a prescription for either trimethoprim-sulfamethoxazole, amoxicillin, norfloxacin, or nitrofurantoin. Up to four controls for each case were identified from the same cohort, matched on age, sex, and presence or absence of chronic kidney disease and diabetes, and required to have received one of the study antibiotics within 14 days before the case's index date.
main outcome measuresOdds ratio for association between admission to hospital with hyperkalaemia and receipt of a study antibiotic in the preceding 14 days, adjusted for conditions and drugs that may influence risk of hyperkalaemia.
resultsDuring the 18 year study period, 6903 admissions for hyperkalaemia were identified, 306 of which occurred within 14 days of antibiotic use. Of these, 248 (81%) cases were matched to 783 controls. 10.8% (17,859/165,754) of spironolactone users received at least one prescription for trimethoprim-sulfamethoxazole. Compared with amoxicillin, prescription of trimethoprim-sulfamethoxazole was associated with a marked increase in the risk of admission to hospital for hyperkalaemia (adjusted odds ratio 12.4, 95% confidence interval 7.1 to 21.6). The population attributable fraction was 59.7%, suggesting that approximately 60% of all cases of hyperkalaemia in older patients taking spironolactone and treated with an antibiotic for a urinary tract infection could be avoided if trimethoprim-sulfamethoxazole was not prescribed. Treatment with nitrofurantoin was also associated with an increase in the risk of hyperkalaemia (adjusted odds ratio 2.4, 1.3 to 4.6), but no such risk was found with norfloxacin (adjusted odds ratio 1.6, 0.8 to 3.4)
conclusionsAmong older patients receiving spironolactone, treatment with trimethoprim-sulfamethoxazole was associated with a major increase in the risk of admission to hospital for hyperkalaemia. This drug combination should be avoided when possible.
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