From the Guidelines
Irbesartan is the medication that can cause hyperkalemia (high potassium levels in the blood). Irbesartan belongs to a class of drugs called angiotensin II receptor blockers (ARBs), which work by blocking the action of angiotensin II, a hormone that constricts blood vessels and increases blood pressure. While effective for treating high blood pressure, irbesartan can interfere with the kidney's ability to excrete potassium, leading to its accumulation in the bloodstream. This side effect is particularly important to monitor in patients with kidney disease or those taking other medications that affect potassium levels, such as certain diuretics or potassium supplements. Regular blood tests to check potassium levels are recommended for patients taking irbesartan, as stated in the 2018 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. If you experience symptoms of hyperkalemia such as muscle weakness, irregular heartbeat, or numbness, contact your healthcare provider immediately. None of the other medications listed (atorvastatin for cholesterol, metformin for diabetes, quetiapine for psychiatric conditions, or the FreeStyle Lite testing strips) are typically associated with causing hyperkalemia as a primary concern.
According to the expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors 1, irbesartan is a renin-angiotensin-aldosterone inhibitor (RAASi) that can increase potassium levels, and RAASi-induced hyperkalaemia often limits the use of these drugs, thereby offsetting their survival benefits. The incidence of hyperkalaemia with RAASi monotherapy is < 2% and increases to 5% with dual RAAS inhibition and to 5–10% when dual therapy is administered in patients with heart failure or chronic kidney disease.
Key points to consider:
- Irbesartan can cause hyperkalemia, especially in patients with kidney disease or those taking other medications that affect potassium levels.
- Regular blood tests to check potassium levels are recommended for patients taking irbesartan.
- If you experience symptoms of hyperkalemia, contact your healthcare provider immediately.
- None of the other medications listed are typically associated with causing hyperkalemia as a primary concern. The 2018 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults also states that there is an increased risk of hyperkalemia in CKD or in those on K+ supplements or K+-sparing drugs when taking ARBs such as irbesartan 1.
From the FDA Drug Label
7.1 Agents Increasing Serum Potassium Coadministration of irbesartan with other drugs that raise serum potassium levels may result in hyperkalemia, sometimes severe. 7. 4 Dual Blockade of the Renin-Angiotensin System (RAS) Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy Nephropathy in Type 2 Diabetic Patients Hyperkalemia: In the Irbesartan Diabetic Nephropathy Trial (IDNT) (proteinuria ≥900 mg/day, and serum creatinine ranging from 1.0 to 3.0 mg/dL), the percent of patients with potassium >6.0 mEq/L was 18.6% in the irbesartan group versus 6. 0% in the placebo group. 6. 2 Post-Marketing Experience ... hyperkalemia;
The medications that may cause hyperkalemia are:
- irbesartan
- Other drugs that raise serum potassium levels
- Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren 2 2
From the Research
Medication Regimen
The patient is taking the following medications:
- Atorvastatin 20 mg tablet, once daily by oral route for 90 days, for high cholesterol
- FreeStyle Lite Strips to test blood glucose once a day
- Irbesartan 150 mg tablet, once daily by oral route for 90 days, for high blood pressure
- Metformin ER 500 mg tablet, extended release 24 hr, one tablet with breakfast and one tablet with dinner
- Quetiapine 50 mg tablet, 1.5 tablets every day by oral route for 60 days, with a note to take 2 tablets in the morning and 1 at bed
Hyperkalemia Risk
The medications that may cause hyperkalemia are:
- Irbesartan, an angiotensin II receptor blocker, which can increase potassium levels 3
- Other medications that affect potassium homeostasis, such as angiotensin-converting enzyme inhibitors, spironolactone, amiloride, and triamterene, which can also increase potassium levels 3
Irbesartan Effects
Irbesartan has been shown to be effective in reducing blood pressure and slowing the progression of renal disease in patients with hypertension and type 2 diabetes 4, 5, 6, 7
- It provides 24-hour control of blood pressure with once-daily administration 4, 5
- It has a renoprotective effect in hypertensive patients with type 2 diabetes, which is at least partly independent of its blood pressure-lowering effect 6
- It is well tolerated and has a lower incidence of adverse events compared to other antihypertensive agents 6, 7
Monitoring and Precautions
Patients taking irbesartan should be monitored for renal function and serum electrolytes, particularly potassium levels, to minimize the risk of hyperkalemia 3
- Polypharmacy should be used with caution, and patients should be closely monitored for potential interactions and adverse effects 3