Intended for healthcare professionals


Antibiotics and sudden death in adults taking renin-angiotensin system blockers

BMJ 2014; 349 doi: (Published 30 October 2014) Cite this as: BMJ 2014;349:g6242
  1. Mahyar Etminan, assistant professor12,
  2. James M Brophy, professor3
  1. 1Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  2. 2Therapeutic Evaluation Unit, Child & Family Research Institute of British Columbia, A4-198 WS 2, 709-650 West 28th Avenue, Vancouver, BC, Canada
  3. 3Department of Medicine, Epidemiology and Biostatistics, McGill University, Montreal, Canada
  1. Correspondence to: M Etminan metminan{at}

Is there a cause for concern?

Adverse drug reactions have been associated with up to 10% of hospital admissions in older adults,1 a considerable number of which involve drug-drug interactions. Traditionally, information about drug-drug interactions was of poor quality, usually isolated case reports or small uncontrolled case series, resulting in much uncertainty about any clinical relevance. In recent years, large administrative databases that are linkable to health outcomes data have allowed investigators to better quantify rare drug-drug interactions and examine their effect on both morbidity and mortality.

In the linked paper (doi:10.1136/bmj.g6196), Fralick and colleagues examined the risk of sudden death in users of both co-trimoxazole and renin-angiotensin system blockers (RASBs), two potassium sparing drugs.2 In an earlier study, the same authors reported that their joint administration was associated with a sevenfold increase in the risk of hyperkalemia induced hospital admission compared with RASB users exposed to other antibiotics.3

The new paper considers this same cohort of older RASB users from Ontario’s administrative databases, but now extends follow-up to 18 years and uses a nested case-control approach. The authors report adjusted odds ratios describing the risk of …

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