ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015
Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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22 citing papers in PubMed, 1 synthesis or guideline pooled it, 66 citations in OpenAlex.
- Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients.The Journal of antimicrobial chemotherapy · 2019Pooled it
- 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
- 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
- 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
- Drug-induced Sudden Death: A Scoping Review.Current drug safety · 2023Article
- Low-dose trimethoprim-sulfamethoxazole for the treatment ofBMJ open · 2022Article
- The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits.Integrated pharmacy research & practice · 2022Article
- Severe hyponatremia due to trimethoprim-sulfamethoxazole-induced SIADH.SAGE open medical case reports · 2022Article
- The Risk of Ventricular Dysrhythmia or Sudden Death in Patients Receiving Serotonin Reuptake Inhibitors With Methadone: A Population-Based Study.Frontiers in pharmacology · 2022Article
- Cotrimoxazole-induced hyperkalaemia in a patient with known hypoaldosteronism.BMJ case reports · 2021Article
- Applying the Infectious Diseases Literature to People who Inject Drugs.Infectious disease clinics of North America · 2020Review
- Retrospective analysis of adverse events with spironolactone in females reported to the United States Food and Drug Administration.International journal of women's dermatology · 2020Article
- Hyponatremia Associated with Prophylactic Low-Dose Trimethoprim during Systemic Corticosteroid Therapy for AQP4-Positive Optic Neuritis in a Diabetic Patient.Antibiotics (Basel, Switzerland) · 2020Article
- 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
- A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study.CMAJ open · 2017Article
- Potassium: friend or foe?Pediatric nephrology (Berlin, Germany) · 2017Review
- Signal Enhancement in the HPLC-ESI-MS/MS analysis of spironolactone and its metabolites using HFIP and NHAnalytical and bioanalytical chemistry · 2017Article
- Association between statin use and ischemic stroke or major hemorrhage in patients taking dabigatran for atrial fibrillation.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017Article
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7 authors at 3 institutions in 2 countries.
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Abstract
backgroundTrimethoprim-sulfamethoxazole increases the risk of hyperkalemia when used with spironolactone. We examined whether this drug combination is associated with an increased risk of sudden death, a consequence of severe hyperkalemia.
methodsWe conducted a population-based nested case-control study involving Ontario residents aged 66 years or older who received spironolactone between Apr. 1, 1994, and Dec. 31, 2011. Within this group, we identified cases as patients who died of sudden death within 14 days after receiving a prescription for trimethoprim-sulfamethoxazole or one of the other study antibiotics (amoxicillin, ciprofloxacin, norfloxacin or nitrofurantoin). For each case, we identified up to 4 controls matched by age and sex. We determined the odds ratio (OR) for the association between sudden death and exposure to each antibiotic relative to amoxicillin, adjusted for predictors of sudden death using a disease risk index.
resultsOf the 11,968 patients who died of sudden death while receiving spironolactone, we identified 328 whose death occurred within 14 days after antibiotic exposure. Compared with amoxicillin, trimethoprim-sulfamethoxazole was associated with a more than twofold increase in the risk of sudden death (adjusted OR 2.46, 95% confidence interval [CI] 1.55-3.90). Ciprofloxacin (adjusted OR 1.55, 95% CI 1.02-2.38) and nitrofurantoin (adjusted OR 1.70, 95% CI 1.03-2.79) were also associated with an increased risk of sudden death, although the risk with nitrofurantoin was not apparent in a sensitivity analysis.
interpretationThe antibiotic trimethoprim-sulfamethoxazole was associated with an increased risk of sudden death among older patients taking spironolactone. When clinically appropriate, alternative antibiotics should be considered in these patients.
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