title: Carvedilol accelerate elevation of serum potassium in chronic heart failure patients administered spironolactone plus furosemide and either enalapril maleate or candesartan cilexetil.
abstract: OBJECTIVE
  To retrospectively investigate the effect of carvedilol and spironolactone plus furosemide, administered concomitantly with an angiotensin II converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) to patients with chronic heart failure (CHF).
  
  
  METHODS
  Patients with CHF, who visited Departments of Cardiovascular Internal Medicine at the National Hospital Organization Osaka Medical Center, were enrolled for this study. Serum potassium, blood urea nitrogen (BUN), serum creatinine (Scr) and serum sodium were measured in every patient at the time of start of treatment and after 3 and 12 months of treatment. Data from patients in groups A (20 mg/day carvedilol + 25 mg/day spironolactone + 40 mg/day furosemide + an ACE-I) and B (20 mg/day carvedilol + 25 mg/day spironolactone + 40 mg/day furosemide + ARB) were compared.
  
  
  RESULTS
  When 20 mg/day carvedilol plus 25 mg/day spironolactone plus 5 mg/day enalapril maleate (enalapril, group A) or 8 mg/day candesartan cilexetil (candesartan, group B) plus 40 mg/day furosemide were used concomitantly, the mean serum potassium increased significantly in both groups of patients. Seven of 59 (11.9%) patients had hyperkalemia (>5.5 mEq/L) during 12 months of treatment whereas 8.5% of patients (five of 59) had hypokalemia (< or =3.5 mEq/L).
  
  
  CONCLUSIONS
  When carvedilol is used concomitantly with spironolactone, furosemide and enalapril or candesartan, it is necessary to monitor serum potassium concentration, even if spironolactone is administered at a low dose of 25 mg/day.
authors.affiliation: Department of Pharmacy, National Hospital Organization Osaka Medical Center, Osaka, Japan. m-saito@omh.go.jp
authors.forename: M
authors.initials: M
authors.lastname: Saito
authors.forename: D
authors.initials: D
authors.lastname: Nakayama
authors.forename: M
authors.initials: M
authors.lastname: Takada
authors.forename: K
authors.initials: K
authors.lastname: Hirooka
authors.forename: Y
authors.initials: Y
authors.lastname: Yasumura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001562:Benzimidazoles / Q000008:administration & dosage*; D001713:Biphenyl Compounds / Q000008:administration & dosage*; D002227:Carbazoles / Q000494:pharmacology*; D000077261:Carvedilol; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood*; D011412:Propanolamines / Q000494:pharmacology*; D012189:Retrospective Studies; D013148:Spironolactone / Q000008:administration & dosage*; D013777:Tetrazoles / Q000008:administration & dosage*
chemical_list: D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002227:Carbazoles; D011412:Propanolamines; D013777:Tetrazoles; D000077261:Carvedilol; D013148:Spironolactone; D004656:Enalapril; D005665:Furosemide; C077793:candesartan cilexetil; D011188:Potassium