Can Mavik (trandolapril) cause hyperkalemia?

From the Guidelines

Yes, Mavik (trandolapril) can cause hyperkalemia. Mavik is an angiotensin-converting enzyme (ACE) inhibitor that works by blocking the conversion of angiotensin I to angiotensin II, which ultimately reduces blood pressure. However, this mechanism also decreases aldosterone production, which normally promotes potassium excretion in the kidneys. With reduced aldosterone, the body retains more potassium, potentially leading to hyperkalemia (elevated blood potassium levels) 1.

Key Points to Consider

• Patients taking Mavik should have their potassium levels monitored regularly, especially those with kidney disease, diabetes, or those taking potassium supplements or potassium-sparing diuretics.
• Signs of hyperkalemia include muscle weakness, irregular heartbeat, and numbness or tingling.
• The risk increases with higher doses and in patients with reduced kidney function.
• According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, ACE inhibitors like Mavik can cause hyperkalemia, especially in patients with chronic kidney disease (CKD) or those taking potassium supplements or potassium-sparing diuretics 1.
• The European Heart Journal also notes that renin-angiotensin-aldosterone inhibitors, including ACE inhibitors like Mavik, can cause hyperkalemia, and recommends monitoring potassium levels in patients taking these medications 1. If you're taking Mavik, it's essential to follow your healthcare provider's recommendations for blood tests and to report any unusual symptoms promptly.

From the FDA Drug Label

Trandolapril Component In clinical trials, hyperkalemia (serum potassium > 6.00 mEq/L) occurred in approximately 0. 4 percent of hypertensive patients receiving trandolapril and in 0.8% of patients receiving a dose of trandolapril (0. 5 to 8 mg) in combination with a dose of verapamil hydrochloride SR (120 to 240 mg). Risk factors for the development of hyperkalemia include renal insufficiency, diabetes mellitus, and the concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salt substitutes, which should be used cautiously, if at all, with trandolapril (see PRECAUTIONS - Drug Interactions) Agents Increasing Serum Potassium Trandolapril Component Trandolapril can attenuate potassium loss caused by thiazide diuretics and increase serum potassium when used alone. Use of potassium-sparing diuretics (spironolactone, triamterene, or amiloride), potassium supplements, or potassium-containing salt substitutes concomitantly with ACE inhibitors can increase the risk of hyperkalemia If concomitant use of such agents is indicated, they should be used with caution and with appropriate monitoring of serum potassium (see PRECAUTIONS). Dual Blockade of the Renin-Angiotensin System (RAS) Trandolapril Component 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

Yes, Mavik (trandolapril) can cause hyperkalemia, especially in patients with risk factors such as renal insufficiency, diabetes mellitus, and concomitant use of potassium-sparing diuretics or potassium supplements.

• Risk factors for hyperkalemia include:
  • Renal insufficiency
  • Diabetes mellitus
  • Concomitant use of potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes
• Monitoring of serum potassium levels is recommended when using trandolapril, especially in patients with risk factors for hyperkalemia 2.

From the Research

Mavik and Hyperkalemia

• Mavik, also known as trandolapril, is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure.
• ACE inhibitors, including Mavik, can increase the risk of hyperkalemia (elevated serum potassium levels) by reducing the excretion of potassium in the urine 3, 4, 5.
• The risk of hyperkalemia associated with ACE inhibitors is higher in patients with chronic kidney disease, diabetes, and those taking other medications that can increase potassium levels, such as potassium-sparing diuretics and potassium supplements 3, 6, 7.

Mechanism of Hyperkalemia

• ACE inhibitors, including Mavik, work by blocking the conversion of angiotensin I to angiotensin II, which leads to a decrease in aldosterone levels and a subsequent decrease in potassium excretion in the urine 3, 4.
• This decrease in potassium excretion can lead to an increase in serum potassium levels, particularly in patients with impaired renal function or those taking other medications that can increase potassium levels 6, 7.

Risk Factors for Hyperkalemia

• Patients with chronic kidney disease, particularly those with impaired renal function, are at higher risk of developing hyperkalemia when taking ACE inhibitors, including Mavik 3, 6, 7.
• Other risk factors for hyperkalemia include diabetes, heart failure, and the use of other medications that can increase potassium levels, such as potassium-sparing diuretics and potassium supplements 3, 6, 5.

Monitoring and Prevention

• Regular monitoring of serum potassium levels is recommended when initiating ACE inhibitor therapy, including Mavik, particularly in patients with risk factors for hyperkalemia 3, 6, 5.
• Patients should be educated on the signs and symptoms of hyperkalemia, such as muscle weakness, palpitations, and shortness of breath, and instructed to seek medical attention if they experience any of these symptoms 3, 5.