title: Dispensed selective and nonselective nonsteroidal anti-inflammatory drugs and the risk of moderate to severe hyperkalemia: a nested case-control study.
abstract: BACKGROUND
  It is not known whether nonselective and cyclooxygenase 2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) differ in terms of hyperkalemia risk. The aim of this study was to compare the differential risk of hyperkalemia associated with various NSAIDs.
  
  
  METHODS
  Nested case-control study.
  
  
  METHODS
  New NSAID users receiving care in the US Department of Veterans Affairs (VA) health care system from October 2000 to September 2006. PREDICTOR OF FACTOR: Different NSAIDs ordered by COX-2 selectivity.
  
  
  METHODS
  Risk of hyperkalemia (defined as first serum potassium value ≥6.0 mEq/L) was estimated with a multivariate conditional logistic model adjusting for age, race, morbidities, medications, and contrast media.
  
  
  RESULTS
  We identified 18,326 cases of hyperkalemia and 355,106 matched controls. Risk of hyperkalemia did not differ in patients using a single NSAID (adjusted OR, 1.03; 95% CI, 0.98-1.08) or 2 or more NSAIDs (OR, 1.16; 95% CI, 0.96-1.41) compared with patients no longer using an NSAID. However, risk varied by specific NSAID and elevated risks were found for use of rofecoxib, celecoxib, diclofenac, and indomethacin, but not meloxicam, etodolac, piroxicam, sulindac, ibuprofen, naproxen, and ketorolac. Interactions were found between NSAID use and exposure to renin-angiotensin blockers and contrast media.
  
  
  CONCLUSIONS
  Some NSAIDs are available over the counter and women are under-represented in the VA population.
  
  
  CONCLUSIONS
  NSAIDs may not by themselves carry a higher risk of moderate to severe hyperkalemia. Certain NSAIDs may increase the risk of hyperkalemia, but it is not related to COX-2 selectivity of the NSAID and may depend on concurrent exposure to other agents.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA. jplaf@bu.edu
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lafrance
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D015897:Comorbidity; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors