Drug General Information (ID: DDIVMFXI6H)
  Drug Name Ramipril Drug Info Potassium chloride Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antihypertensive Agents Dietary Supplement
  Structure

 Mechanism of Ramipril-Potassium chloride Interaction (Severity Level: Major)
     Increased risk of hyperkalemia Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Ramipril Potassium chloride
      Mechanism Hyperkalemia Hyperkalemia
      Key Mechanism Factor 1
Factor Name Hyperkalemia
Factor Description Hyperkalemia is a condition in which the level of potassium in the blood is higher than normal. While mild cases may not produce symptoms, severe hyperkalemia can lead to fatal arrhythmias if left untreated.
      Mechanism Description
  • Increased risk of hyperkalemia by the combination of Ramipril and Potassium chloride 

Recommended Action
      Management Caution is advised if ACE inhibitors must be used concurrently with potassium salts, particularly in patients with renal impairment, diabetes, old age, severe or worsening heart failure, dehydration, or concomitant therapy with other agents that increase serum potassium such as nonsteroidal anti-inflammatory drugs, beta-blockers, cyclosporine, heparin, tacrolimus, trimethoprim, and licorice. The combination should generally be avoided in these patients unless absolutely necessary and the benefits outweigh the potential risks. Serum potassium and renal function should be checked prior to initiating therapy and regularly thereafter. Patients should be given counseling on the appropriate levels of potassium and fluid intake, and advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as nausea, vomiting, weakness, listlessness, tingling of the extremities, paralysis, confusion, weak pulse, and a slow or irregular heartbeat.

References
1 Burnakis TG, Mioduch HJ "Combined therapy with captopril and potassium supplementation: a potential for hyperkalemia." Arch Intern Med 144 (1984): 2371-2. [PMID: 6391404]
2 Chan TY, Critchley JA "Life-threatening hyperkalaemia in an elderly patient receiving captopril, furosemide (frusemide) and potassium supplements." Drug Saf 7 (1992): 159-61. [PMID: 1605901]
3 Good CB, McDermott L "Diet and serum potassium in patients on ACE inhibitors." JAMA 274 (1995): 538. [PMID: 7629980]
4 Graves JW "Hyperkalemia due to a potassium-based water softener." N Engl J Med 339 (1998): 1790-1. [PMID: 9867563]
5 Jarman PR, Kehely AM, Mather HM "Hyperkalaemia in diabetes: prevalence and associations." Postgrad Med J 71 (1995): 551-2. [PMID: 7479468]
6 Jarman PR, Mather HM "Diabetes may be independent risk factor for hyperkalaemia." BMJ 327 (2003): 812. [PMID: 14525902]
7 Large DM, Carr PH, Laing I, Davies M "Hyperkalaemia in diabetes mellitus--potential hazards of coexisting hyporeninaemic hypoaldosteronism." Postgrad Med J 60 (1984): 370-3. [PMID: 6377287]
8 Lawson DH "Adverse reactions to potassium chloride." Q J Med 43 (1974): 433-40. [PMID: 4424028]
9 Lawson DH, O'Connor PC, Jick H "Drug attributed alterations in potassium handling in congestive cardiac failure." Eur J Clin Pharmacol 23 (1982): 21-5. [PMID: 7128669]
10 Obialo CI, Ofili EO, Mirza T "Hyperkalemia in congestive heart failure patients aged 63 to 85 years with subclinical renal disease." Am J Cardiol 90 (2002): 663-5. [PMID: 12231103]
11 Packer M, Lee WH "Provocation of hyper- and hypokalemic sudden death during treatment with and withdrawal of converting-enzyme inhibition in severe chronic congestive heart failure." Am J Cardiol 57 (1986): 347-8. [PMID: 3004185]
12 Perazella MA "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med 109 (2000): 307-14. [PMID: 10996582]
13 Perazella MA, Mahnensmith RL "Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis." J Gen Intern Med 12 (1997): 646-56. [PMID: 9346463]
14 Ponce SP, Jennings AE, Madias NE, Harrington JT "Drug-induced hyperkalemia." Medicine (Baltimore) 64 (1985): 357-70. [PMID: 2865667]
15 Product Information. K-Dur (potassium chloride). Schering Laboratories, Kenilworth, NJ.
16 Ray K, Dorman S, Watson R "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction." J Hum Hypertens 13 (1999): 717-20. [PMID: 10516744]
17 Reardon LC, Macpherson DS "Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry?" Arch Intern Med 158 (1998): 26-32. [PMID: 9437375]
18 Schuna AA, Schmidt GR, Pitterle ME "Serum potassium concentrations after initiation of captopril therapy." Clin Pharm 5 (1986): 920-3. [PMID: 3536269]
19 Speirs CJ, Dollery CT, Inman WH, et al "Postmarketing surveillance of enalapril II: investigation of the potential role of enalapril in deaths with renal failure." Br Med J 297 (1988): 830-2. [PMID: 2846102]
20 Stoltz ML, Andrews CE Jr "Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use ." JAMA 264 (1990): 2737-8. [PMID: 2172575]
21 Walmsley RN, White GH, Cain M, McCarthy PJ, Booth J "Hyperkalemia in the elderly." Clin Chem 30 (1984): 1409-12. [PMID: 6744599]
22 Warren SE, O'Connor DT "Hyperkalemia resulting from captopril administration." JAMA 244 (1980): 2551-2. [PMID: 7001073]
23 Atlas SA, Case DB, Sealey JE, Laragh JH, McKinstry DN "Interruption of the renin-angiotensin system in hypertensive patients by captopril induces sustained reduction in aldosterone secretion, potassium retention and natriuresis." Hypertension 1 (1979): 279-80. [PMID: 399239]
24 Schoolwerth AC, Sica DA, Ballermann BJ, Wilcox CS, Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart Association "Renal considerations in angiotensin converting enzyme inhibitor therapy: a statement for healthcare professionals from the Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart Association." Circulation 104 (2001): 1985-91. [PMID: 11602506]