One Case of Hyperkalemia Induced by Concomitant Use of Cyclosporine and Other Drugs

doi:10.19803/j.1672-8629.2021.12.21

Abstract

Abstract: Objective To explore the mechanism and clinical features of hyperkalemia induced by concomitant use of cyclosporine and other drugs.Methods The diagnosis and treatment of a patient with hyperkalemia caused by concomitant use of cyclosporine, voriconazole and sacurbatrovalsartan were analyzed. Based on literature review, the possible mechanism by which concomitant use of these drugs led to hyperkalemia was studied. Results After five days of combined administration of these drugs, the serum level of potassium began to exceed the upper limit. After withdrawal of cyclosporine and sulbactam, the serum level of potassium did not return to normal within five days until voriconazole was discontinued. There was no abnormal level of serum potassium when voriconazole was administered a second time. All this suggested that the combination of cyclosporine, voriconazole and sacurbatrovalsartan increased the risk of cyclosporine induced hyperkalemia.Conclusion When cyclosporine, voriconazole, and drugs acting on the renin-angiotensin-aldosterone system are administered in combination, hyperkalemia is likely to occur even if the blood concentration of cyclosporine is at a relatively low level.

Key words: cyclosporine, voriconazole, systemic lupus erythematosus, hyperkalemia, drug interaction

CLC Number:

R969.2R994.11

YANG Xiaowen, WANG Xiaoxing. One Case of Hyperkalemia Induced by Concomitant Use of Cyclosporine and Other Drugs[J]. Chinese Journal of Pharmacovigilance, 2021, 18(12): 1192-1195.

References

[1] Awni WM.Pharmacodynamic monitoring of cyclosporin[J]. Clin Pharmacokinet, 1992, 23(6): 428-448.
[2] Moroni G, Doria A, Mosca M, et al.A randomized pilot trial comparing cyclosporine and azathioprine for maintenance therapy in diffuse lupus nephritis over four years[J]. Clin J Am Soc Nephrol, 2006, 1(5): 925-932.
[3] Pavleska-Kuzmanovska S, Popov Z, Ivanovski O, et al.Cyclosporine nephrotoxicity and early posttransplant hyperkalemia in living-donor renal recipients: report of 4 cases[J]. Exp Clin Transplant, 2014, 12(5): 479-483.
[4] Qiu CY, Sui YY, Yu LX, et al.Clinical analysis on hyperpotassemia induced by pharmacologic interaction between tacrolimus and other drugs in 10 renal transplant recipients[J]. Organ Transplantation(器官移植) , 2017, 8(1): 40-43.
[5] Mcmurray JJ, Packer M, Desai AS, et al.Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. New Engl J Med, 2014, 371(11): 993-1004.
[6] Xie C, Ye J, Miao LY.Analysis of Clinical application of angiotensin receptor enkephalinase inhibitor sacubitril valsartan in 61 patients with heart failure[J]. China Pharmacy(中国药房) , 2019, 30(8): 1124-1127.
[7] Zou ZL.Literature analysis of 31 adverse drug reaction/event cases induced by voriconazole[J]. Chinese Journal of Pharmacovigilance(中国药物警戒) , 2013, 10(10): 623-626.
[8] Wang XM, Zhang L.Analysis of 84 cases of adverse reactions induced by voriconazole[J]. Herald of Medicine(医药导报), 2017, 36(12): 1432-1436.
[9] Ding XF.Hyperkalemia developed by the use of ciclosporin combination with voriconazole[J]. The Chinese Journal of Clinical Pharmacology(中国临床药理学杂志), 2012, 28(2): 146-147.
[10] Tian M, Liu XM, Liu P, et al.The diagnosis and treatment of hyperkalemia caused by calcineurin inhibitor associated nephrotoxicity after liver transplantation[J]. Chinese Journal of Transplantation(中华移植杂志), 2016, 10(1): 37-40.
[11] Zhou XL, Wei LN, Lyu WW.Hyperkalemia induced by pharmacologic interaction between tacrolimus and other drugs after liver transplantation[J]. Practical Pharmacy and Clinical Remedies(实用药物与临床杂志), 2018, 21(5): 598-600.
[12] Nazmul MN, Miles CD, Westphal SG.Severe hyperkalemia complicating voriconazole treatment in a kidney transplant recipient with histoplasmosis: a case report[J]. Transplant Proc, 2017, 49(10): 2372-2373.
[13] Deng ZT.Analysis of a case of hyperbaitemia associated with voriconazole due to drug interaction[J]. Chinese Journal of Drug Abuse Prevention and Treatment(中国药物滥用防治杂志), 2019, 25(1): 53-55, 59.
[14] Bantle JP, Nath KA, Sutherland DE, et al.Effects of cyclosporine on the renin-angiotensin-aldosterone system and potassium excretion in renal transplant recipients[J].Arch Intern Med, 1985, 145(3): 505-508.
[15] Kamel KS, Ethier JH, Quaggin S, et al.Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporine[J]. J Am Soc Nephrol, 1992, 2(8): 1279-1284.
[16] Ghnaimat M, Akash N, El-Lozi M.Cyclosporine a induced hyperkalemia in a renal allograft recipient[J]. Saudi J Kidney Dis Transpl, 1996, 7(3): 315-316.
[17] Pei Y, Richardson R, Greenwood C, et al.Extrarenal effect of cyclosporine A on potassium homeostasis in renal transplant recipients[J]. Am J Kidney Dis, 1993, 22(2): 314-319.
[18] Sonino N.The use of ketoconazole as an inhibitor of steroid production[J]. N Engl J Med, 1987, 317(13): 812-818.
[19] Duman AK, Fulco PP.Adrenal insufficiency with voriconazole and inhaled/intranasal corticosteroids: case report and systematic review[J]. J Pharm Pract, 2017, 30(4): 459-463.