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Original Investigation |

Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne

Molly Plovanich, MD1; Qing Yu Weng, BS1; Arash Mostaghimi, MD, MPA1
[+] Author Affiliations
1Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2015;151(9):941-944. doi:10.1001/jamadermatol.2015.34.
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Importance  Spironolactone has been shown to be an effective treatment option for hormonally mediated acne but can cause hyperkalemia. The prevalence of hyperkalemia among healthy young women taking spironolactone for acne is unclear.

Objective  To measure the rate of hyperkalemia in healthy young women taking spironolactone for acne or for an endocrine disorder with associated acne.

Design, Setting, and Participants  Retrospective study of healthy young women taking spironolactone for acne. Data from December 1, 2000, through March 31, 2014, were obtained from a clinical data repository. Outpatient data were collected from 2 tertiary care centers in the United States. We analyzed rates of hyperkalemia in 974 healthy young women taking spironolactone for acne. We also analyzed 1165 healthy young women taking and not taking spironolactone to obtain a profile for the baseline rate of hyperkalemia in this population. Exclusion criteria were cardiovascular disease, renal failure, and the use of medications that affect the renin-angiotensin-aldosterone system.

Main Outcomes and Measures  The rate of hyperkalemia in healthy young women taking spironolactone for acne was calculated. Secondary measures included spironolactone prescriber profiles and potassium monitoring practices.

Results  There were 13 abnormal serum potassium measurements in 1802 measurements obtained among young women receiving spironolactone therapy, yielding a hyperkalemia rate of 0.72%, equivalent to the 0.76% baseline rate of hyperkalemia in this population. Repeat testing in 6 of 13 patients demonstrated normal values, suggesting that these measurements may have been erroneous. In the remaining 7 patients, no action was taken.

Conclusions and Relevance  The rate of hyperkalemia in healthy young women taking spironolactone for acne is equivalent to the baseline rate of hyperkalemia in this population. Routine potassium monitoring is unnecessary for healthy women taking spironolactone for acne.

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Figure 1.
Flowchart of Cohort Selection

In total, 1559 patients were initially identified through the Research Patient Data Repository query. Of these, 974 who were prescribed spironolactone for acne or for an endocrine disorder with associated acne were included in the analysis.

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Figure 2.
Hyperkalemia Cases

Of 1802 serum potassium measurements for 974 patients taking spironolactone for acne, 13 exceeded 5.0 mEq/L. This corresponds to a 0.72% rate of mild hyperkalemia, which is equivalent to the baseline rate of hyperkalemia in this population. To convert serum potassium level to millimoles per liter, multiply by 1.0.

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