New prescriptions of spironolactone associated with angiotensin-converting- enzyme inhibitors and/or angiotensin receptor blockers and their laboratory monitoring from 2001 to 2008: A population study on older people living in the community in Italy

Claudio Bilotta, Carlotta Franchi, Alessandro Nobili, Paola Nicolini, Codjo Djignefa Djade, Mauro Tettamanti, Ida Fortino, Angela Bortolotti, Luca Merlino, Carlo Vergani

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring. Methods: The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs). Results: Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P <0.001). In the 6 months before starting the co-prescriptions 96 to 100% of patients measured serum creatinine (mean 99.3%), sodium (97.3%) and potassium (98.6%). Within 3 months of starting the co-prescriptions 96 to 99% of patients measured serum sodium (mean 97.3%) and potassium (98.6%), but on average only 48% of them (range 43 to 53%) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95% CI 1.02-1.05, P <0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P <0.001). Conclusions: Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.

Original languageEnglish
Pages (from-to)909-917
Number of pages9
JournalEuropean Journal of Clinical Pharmacology
Volume69
Issue number4
DOIs
Publication statusPublished - Apr 2013

Fingerprint

Spironolactone
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Italy
Prescriptions
Creatinine
Independent Living
Polypharmacy
Hematologic Tests
Serum
Population
Potassium
Multivariate Analysis
Sodium
Health
Pharmaceutical Preparations
Odds Ratio
Databases
Kidney
Therapeutics

Keywords

  • Angiotensin receptor blockers
  • Angiotensin-converting-enzyme inhibitors
  • Co-prescription
  • Creatinine
  • Hyperkalaemia
  • Older people
  • Spironolactone

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

New prescriptions of spironolactone associated with angiotensin-converting- enzyme inhibitors and/or angiotensin receptor blockers and their laboratory monitoring from 2001 to 2008 : A population study on older people living in the community in Italy. / Bilotta, Claudio; Franchi, Carlotta; Nobili, Alessandro; Nicolini, Paola; Djade, Codjo Djignefa; Tettamanti, Mauro; Fortino, Ida; Bortolotti, Angela; Merlino, Luca; Vergani, Carlo.

In: European Journal of Clinical Pharmacology, Vol. 69, No. 4, 04.2013, p. 909-917.

Research output: Contribution to journalArticle

@article{16671d47f6ea4cd59773e4658fd528fe,
title = "New prescriptions of spironolactone associated with angiotensin-converting- enzyme inhibitors and/or angiotensin receptor blockers and their laboratory monitoring from 2001 to 2008: A population study on older people living in the community in Italy",
abstract = "Purpose: To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring. Methods: The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs). Results: Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P <0.001). In the 6 months before starting the co-prescriptions 96 to 100{\%} of patients measured serum creatinine (mean 99.3{\%}), sodium (97.3{\%}) and potassium (98.6{\%}). Within 3 months of starting the co-prescriptions 96 to 99{\%} of patients measured serum sodium (mean 97.3{\%}) and potassium (98.6{\%}), but on average only 48{\%} of them (range 43 to 53{\%}) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95{\%} CI 1.02-1.05, P <0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P <0.001). Conclusions: Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.",
keywords = "Angiotensin receptor blockers, Angiotensin-converting-enzyme inhibitors, Co-prescription, Creatinine, Hyperkalaemia, Older people, Spironolactone",
author = "Claudio Bilotta and Carlotta Franchi and Alessandro Nobili and Paola Nicolini and Djade, {Codjo Djignefa} and Mauro Tettamanti and Ida Fortino and Angela Bortolotti and Luca Merlino and Carlo Vergani",
year = "2013",
month = "4",
doi = "10.1007/s00228-012-1401-8",
language = "English",
volume = "69",
pages = "909--917",
journal = "European Journal of Clinical Pharmacology",
issn = "0031-6970",
publisher = "Springer Verlag",
number = "4",

}

TY - JOUR

T1 - New prescriptions of spironolactone associated with angiotensin-converting- enzyme inhibitors and/or angiotensin receptor blockers and their laboratory monitoring from 2001 to 2008

T2 - A population study on older people living in the community in Italy

AU - Bilotta, Claudio

AU - Franchi, Carlotta

AU - Nobili, Alessandro

AU - Nicolini, Paola

AU - Djade, Codjo Djignefa

AU - Tettamanti, Mauro

AU - Fortino, Ida

AU - Bortolotti, Angela

AU - Merlino, Luca

AU - Vergani, Carlo

PY - 2013/4

Y1 - 2013/4

N2 - Purpose: To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring. Methods: The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs). Results: Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P <0.001). In the 6 months before starting the co-prescriptions 96 to 100% of patients measured serum creatinine (mean 99.3%), sodium (97.3%) and potassium (98.6%). Within 3 months of starting the co-prescriptions 96 to 99% of patients measured serum sodium (mean 97.3%) and potassium (98.6%), but on average only 48% of them (range 43 to 53%) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95% CI 1.02-1.05, P <0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P <0.001). Conclusions: Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.

AB - Purpose: To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring. Methods: The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs). Results: Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P <0.001). In the 6 months before starting the co-prescriptions 96 to 100% of patients measured serum creatinine (mean 99.3%), sodium (97.3%) and potassium (98.6%). Within 3 months of starting the co-prescriptions 96 to 99% of patients measured serum sodium (mean 97.3%) and potassium (98.6%), but on average only 48% of them (range 43 to 53%) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95% CI 1.02-1.05, P <0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P <0.001). Conclusions: Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.

KW - Angiotensin receptor blockers

KW - Angiotensin-converting-enzyme inhibitors

KW - Co-prescription

KW - Creatinine

KW - Hyperkalaemia

KW - Older people

KW - Spironolactone

UR - http://www.scopus.com/inward/record.url?scp=84876733545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876733545&partnerID=8YFLogxK

U2 - 10.1007/s00228-012-1401-8

DO - 10.1007/s00228-012-1401-8

M3 - Article

C2 - 22996075

AN - SCOPUS:84876733545

VL - 69

SP - 909

EP - 917

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

SN - 0031-6970

IS - 4

ER -