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Is Routine Potassium Monitoring Necessary with Spironolactone Therapy?

Spironolactone is a generally well-tolerated, effective treatment for hormonally mediated acne. However, its use has been associated with hyperkalemia (elevated blood potassium) among patients with heart failure taking additional drugs that interfere with potassium excretion. Concerns about this serious side effect prompted the US Food and Drug Administration to recommend frequent potassium monitoring in all patients taking spironolactone. Yet, it was unclear whether this guideline made sense for healthy patients taking spironolactone for acne.

A recent retrospective study published in JAMA Dermatology looked at rates of hyperkalemia in healthy young women taking spironolactone for acne, or for an endocrine disorder with associated acne. Fourteen years of data were obtained from a clinical data repository. The objective was to measure the rate of hyperkalemia in a large of healthy young women taking spironolactone and to determine whether potassium monitoring is clinically indicated in this population.

This was the first known study to establish the rate of hyperkalemia in healthy young women receiving spironolactone for acne and provide an estimate of how frequently serum potassium measurement is checked by physicians in clinical practice. The researchers identified a low rate of mild hyperkalemia in patients taking spironolactone for acne that was similar to the baseline rate of hyperkalemia in this population. This suggests spironolactone does not significantly alter the rate of clinical hyperkalemia in young healthy women. In addition, the researchers found that potassium monitoring for patients with acne as the primary diagnosis occurred in 56.4% of patients. The serum potassium measurement was checked in 74.9% of patients with an endocrine disorder who had acne as a secondary feature.

Based on the results of the study, the researchers suggested that potassium monitoring should no longer be conducted in healthy young women taking spironolactone for acne. Abandoning frequent potassium monitoring can decrease unnecessary office visits and reduce health care spending.

Byline: Martha L. Sikes, MS, RPh, PA-C and Wendy Meltzer, MPH


Adapted from the original article.

[image by Phillip Jeffrey]

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