title: The association between nonsteroidal anti-inflammatory drugs and potassium concentrations: A pharmacoepidemiological study in Saudi Arabia.
abstract: OBJECTIVE
  Several nonsteroidal anti-inflammatory drugs (NSAIDs) have been linked to cardiac death. The mechanism that is responsible for this adverse effect appears to be ischemic insult; however, another possible mechanism involves hyperkalemia. The objective of the present study was to determine the feasibility of conducting pharmacoepidemiological studies in Saudi Arabia using refill prescription data to investigate the association between NSAIDs and increased serum potassium concentrations.
  
  
  METHODS
  This retrospective cohort study included patients from an academic medical center in Riyadh, Saudi Arabia. The patients who were recently prescribed NSAIDs were compared to a control group of paracetamol users, with respect to the drugs' effects on serum potassium concentrations. The covariates that affected the potassium concentration or the use of NSAIDs were controlled for in the analysis. The studied outcome was the first serum potassium concentration of more than 5 mEq/L.
  
  
  RESULTS
  A total of 184 patients were prescribed NSAIDs (n = 101) or paracetamol (n = 83) and met the inclusion criteria. Compared to the control group, the patients who received NSAIDs were more likely to be women, were less likely to use angiotensin-converting enzyme inhibitors, and were more likely to have lower baseline serum creatinine concentrations. The other baseline characteristics were similar between the patients in the NSAID group and the patients who received paracetamol. Compared to the patients who were prescribed paracetamol, those who were prescribed NSAIDs did not have an increased risk of hyperkalemia (odds ratio, 1.1, 95% confidence interval, 0.17-6.7, P = 0.95).
  
  
  CONCLUSIONS
  In the present, small feasibility study, no increase in the risk of hyperkalemia was associated with NSAIDs compared to paracetamol. The present study was exploratory and included only a small number of patients; therefore, this study may not be sufficiently powered to detect small differences between the groups. Future studies with larger sample sizes are needed to investigate the association between NSAIDs and hyperkalemia.
authors: Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
authors: Hisham
authors: H
authors: Aljadhey
keywords: NSAIDs; Pharmacoepidemiology; Potassium
references: Am J Med Sci. 1997 Aug;314(2):80-8
references: 9258209
references: Pharmacoepidemiol Drug Saf. 2010 Nov;19(11):1194-8
references: 20842761
references: Postgrad Med J. 2001 Jan;77(903):50-1
references: 11123398
references: Am J Med. 2009 Mar;122(3):215-21
references: 19272479
references: J Emerg Med. 2002 May;22(4):349-52
references: 12113843
references: Nephrol Dial Transplant. 2004 May;19(5):1149-53
references: 14993496
references: J Pain Symptom Manage. 2002 Apr;23(4 Suppl):S15-20; discussion S21-3
references: 11992745
references: Clin Nephrol. 1995 Oct;44(4):276-7
references: 8575131
references: Lancet. 2005 Feb 5-11;365(9458):475-81
references: 15705456
references: J Am Med Inform Assoc. 1998 May-Jun;5(3):305-14
references: 9609500
references: Ann Intern Med. 2000 Jul 4;133(1):1-9
references: 10877734
references: Br Med J (Clin Res Ed). 1985 Jul 13;291(6488):107-8
references: 3926071
references: Clin Exp Rheumatol. 2002 Mar-Apr;20(2):201-7
references: 12051399
references: Nephrol Dial Transplant. 1999 Feb;14(2):480-2
references: 10069220
references: Epidemiol Rev. 1990;12:87-107
references: 2286228
references: N Engl J Med. 2011 Feb 10;364(6):498-9
references: 21226658
references: Am J Kidney Dis. 1994 Oct;24(4):578-80
references: 7942813
references: Intern Med J. 2005 Sep;35(9):572-3
references: 16105165
references: Int J Med Inform. 1999 Jun;54(3):225-53
references: 10405881
references: J Am Med Inform Assoc. 2003 Jul-Aug;10(4):389-98
references: 12668695
references: Am J Epidemiol. 2003 Nov 1;158(9):915-20
references: 14585769
references: N Engl J Med. 2005 Mar 17;352(11):1092-102
references: 15713943
references: Br J Clin Pharmacol. 1998 May;45(5):419-25
references: 9643612