Spironolactone and risk of upper gastrointestinal events: Spironolactone may not be guilty

doi:10.1136/bmj.333.7566.500-c

BMJ 2006;333:500 (2 September), doi:10.1136/bmj.333.7566.500-c

Letter

Spironolactone and risk of upper gastrointestinal events

Spironolactone may not be guilty

The first 150 words of the full text of this article appear below.

EDITOR—Verhamme et al present their data and case forwarning patients on spironolactone about an increased risk ofupper gastrointestinal bleeding.¹ They use an electronic databaseand conditional logistic regression analysis with adjustments.We do not believe their conclusion, however, and will not alterour clinical practice.

From a population of 300 000, they identified 523 cases withupper gastrointestinal events, of which only 13 were currentlytaking spironolactone. Of these 13, nearly 70% were also onagents known to cause ulcers. Only 30 of the control populationwere currently taking spironolactone, but these controls wereless likely to be taking ulcer causing drugs. Similarly, thecontrol patients overall had significantly less comorbiditythan the case patients.

Despite the efforts of regression analysis, basing a conclusionon such a small number of patients is meaningless. So will wewarn patients about a risk of bleeding—no, not due to. . . [Full text of this article]

Eugene Campbell, research fellow

University of Nottingham, Nottingham NG7 2UH eugene.campbell@nottingham.ac.uk

Anthony Shonde, research fellow, Stephen Foley, research fellow

University of Nottingham, Nottingham NG7 2UH

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