Primary hyperaldosteronism medical therapy: Difference between revisions

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{{Primary hyperaldosteronism}}
{{Primary hyperaldosteronism}}
{{CMG}}
{{CMG}}; {{AE}}{{HK}}


==Overview==
==Overview==
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The following agents may be used to medical management of primary hyperaldosteronism:
The following agents may be used to medical management of primary hyperaldosteronism:
{| class="wikitable"
{| class="wikitable"
!Drug Class<ref name="pmid3230101">{{cite journal |vauthors=Horsley MG, Bailie GR |title=Effectiveness of theophylline monitoring by the use of serum assays |journal=J Clin Pharm Ther |volume=13 |issue=5 |pages=359–64 |year=1988 |pmid=3230101 |doi= |url= |issn=}}</ref>
!Drug Class
!Agents
!Agents
!Mechanism of action
!Mechanism of action
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* [[Competitive inhibition|Competitive binding]] of receptors at the [[aldosterone]]-dependent sodium-potassium exchange site in the [[Distal convoluted tubule|distal convoluted renal tubule]]<ref name="pmid978470">{{cite journal |vauthors=Greiner JW, Kramer RE, Jarrell J, Colby HD |title=Mechanism of action of spironolactone on adrenocortical function in guinea pigs |journal=J. Pharmacol. Exp. Ther. |volume=198 |issue=3 |pages=709–15 |year=1976 |pmid=978470 |doi= |url= |issn=}}</ref>
* [[Competitive inhibition|Competitive binding]] of receptors at the [[aldosterone]]-dependent sodium-potassium exchange site in the [[Distal convoluted tubule|distal convoluted renal tubule]]<ref name="pmid978470">{{cite journal |vauthors=Greiner JW, Kramer RE, Jarrell J, Colby HD |title=Mechanism of action of spironolactone on adrenocortical function in guinea pigs |journal=J. Pharmacol. Exp. Ther. |volume=198 |issue=3 |pages=709–15 |year=1976 |pmid=978470 |doi= |url= |issn=}}</ref>
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* 12.5 – 25 mg BID
* 12.5 – 25 mg PO q12h
* Max of 400 mg QD
* Max of 400 mg PO daily
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* Digestive: [[Gastrointestinal bleeding|Gastric bleeding]], [[ulceration]], [[gastritis]], [[diarrhea]] and cramping, [[Nausea and vomiting|nausea]], [[vomiting]]  
* Digestive: [[Gastrointestinal bleeding|Gastric bleeding]], [[ulceration]], [[gastritis]], [[diarrhea]] and cramping, [[Nausea and vomiting|nausea]], [[vomiting]]  
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* Hypersensitivity: [[Fever]], [[urticaria]], [[maculopapular]] or [[erythematous]] [[cutaneous]] eruptions, [[Anaphylactic reaction|anaphylactic reactions]], [[vasculitis]]  
* Hypersensitivity: [[Fever]], [[urticaria]], [[maculopapular]] or [[erythematous]] [[cutaneous]] eruptions, [[Anaphylactic reaction|anaphylactic reactions]], [[vasculitis]]  
* [[Hyperkalemia]]  
* [[Hyperkalemia]]  
* [[Nervous system]] /[[Psychiatric disease|psychiatric]]: [[Mental confusion/indecisiveness|Mental confusion]], [[ataxia]], [[headache]], [[drowsiness]], [[lethargy]]  
* [[Nervous system]]/[[Psychiatric disease|psychiatric]]: [[Mental confusion/indecisiveness|Mental confusion]], [[ataxia]], [[headache]], [[drowsiness]], [[lethargy]]  
* [[Liver]] / [[biliary]]: [[Cholestasis|cholestatic]]/[[Hepatocellular Disease|hepatocellular]] toxicity
* [[Liver]] / [[biliary]]: [[Cholestatic]]/[[Hepatocellular Disease|hepatocellular]] toxicity
* [[Renal]]: Renal dysfunction (including [[renal failure]])<ref name="urlwww.accessdata.fda.gov">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* [[Renal]]: Renal dysfunction (including [[renal failure]])<ref name="urlwww.accessdata.fda.gov">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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* [[Parenteral|Parenetral]] administration
* [[Parenteral|Parenetral]] administration


* 200 mg QD
* 200 mg IV daily
* Max of 800 mg QD
* Max of 800 mg daily
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* [[Hoarseness]]
* [[Hoarseness]]
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* Selective [[aldosterone antagonist]]  
* Selective [[aldosterone antagonist]]  
|50 mg QD<ref name="pmid16200104">{{cite journal |vauthors=Craft J |title=Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure |journal=Proc (Bayl Univ Med Cent) |volume=17 |issue=2 |pages=217–20 |year=2004 |pmid=16200104 |pmc=1200656 |doi= |url= |issn=}}</ref>
|50 mg PO daily<ref name="pmid16200104">{{cite journal |vauthors=Craft J |title=Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure |journal=Proc (Bayl Univ Med Cent) |volume=17 |issue=2 |pages=217–20 |year=2004 |pmid=16200104 |pmc=1200656 |doi= |url= |issn=}}</ref>
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* [[Hyperkalaemia]]
* [[Hyperkalaemia]]
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* [[Triamterene]]
* [[Triamterene]]
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* Acts on [[Distal convoluted tubule|distal renal tubule]] where it selectively blocks [[sodium]] transport, leading to inhibition of sodium-potassium exchange<ref name="pmid6927605">{{cite journal |vauthors=Vidt DG |title=Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic |journal=Pharmacotherapy |volume=1 |issue=3 |pages=179–87 |year=1981 |pmid=6927605 |doi= |url= |issn=}}</ref>
* Acts on [[Distal convoluted tubule|distal renal tubule]] where it selectively blocks [[sodium]] transport, leading to inhibition of [[sodium]]-[[potassium]] exchange<ref name="pmid6927605">{{cite journal |vauthors=Vidt DG |title=Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic |journal=Pharmacotherapy |volume=1 |issue=3 |pages=179–87 |year=1981 |pmid=6927605 |doi= |url= |issn=}}</ref>
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* Initial dose: 5 mg QD
* Initial dose: 5 mg PO daily
* [[Maintenance dose]]: 5-10 mg QD<ref name="urlAmiloride Dosage Guide with Precautions - Drugs.com">{{cite web |url=https://www.drugs.com/dosage/amiloride.html |title=Amiloride Dosage Guide with Precautions - Drugs.com |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* [[Maintenance dose]]: 5-10 mg PO daily<ref name="urlAmiloride Dosage Guide with Precautions - Drugs.com">{{cite web |url=https://www.drugs.com/dosage/amiloride.html |title=Amiloride Dosage Guide with Precautions - Drugs.com |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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** [[Nausea]]
** [[Nausea]]
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** [[Headache]]
** [[Headache]]
** [[Dizziness]]
** [[Dizziness]]
** Skin rash
** [[Skin rash]]
** Weakness
** [[Weakness]]
** [[Fatigue]]
** [[Fatigue]]
** [[Constipation]]
** [[Constipation]]
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* Prevent '''[[calcium]]''' from entering cells of the blood [[Blood vessel|vesse]]<nowiki/>l walls, resulting in lower [[blood pressure]]<ref name="pmid3540226">{{cite journal |vauthors=Katz AM |title=Pharmacology and mechanisms of action of calcium-channel blockers |journal=J Clin Hypertens |volume=2 |issue=3 Suppl |pages=28S–37S |year=1986 |pmid=3540226 |doi= |url= |issn=}}</ref>
* Prevent '''[[calcium]]''' from entering cells of the blood [[Blood vessel|vesse]]<nowiki/>l walls, resulting in lower [[blood pressure]]<ref name="pmid3540226">{{cite journal |vauthors=Katz AM |title=Pharmacology and mechanisms of action of calcium-channel blockers |journal=J Clin Hypertens |volume=2 |issue=3 Suppl |pages=28S–37S |year=1986 |pmid=3540226 |doi= |url= |issn=}}</ref>
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* 5 mg QD
* 5 mg PO daily
* Max of 10 mg QD<ref name="urlwww.accessdata.fda.gov2">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019787s042lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* Max of 10 mg PO daily<ref name="urlwww.accessdata.fda.gov2">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019787s042lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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* [[Edema]]
* [[Edema]]
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* Inhibits [[angiotensin-converting enzyme]] ([[ACE]]) thereby decreasing levels of [[angiotensin II]] and blocking the release of [[aldosterone]]<ref name="urlwww.accessdata.fda.gov6">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* Inhibits [[angiotensin-converting enzyme]] ([[ACE]]) thereby decreasing levels of [[angiotensin II]] and blocking the release of [[aldosterone]]<ref name="urlwww.accessdata.fda.gov6">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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* 20mg-40mg QD<ref name="urlwww.accessdata.fda.gov4">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* 20mg-40mg PO daily<ref name="urlwww.accessdata.fda.gov4">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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* [[Cough]]
* [[Cough]]
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* [[Angiotensin II]] inhibition by interacting selectively with the receptor site and blocking it<ref name="pmid10696996">{{cite journal |vauthors=Burnier M, Brunner HR |title=Angiotensin II receptor antagonists |journal=Lancet |volume=355 |issue=9204 |pages=637–45 |year=2000 |pmid=10696996 |doi= |url= |issn=}}</ref> <ref name="pmid162787272">{{cite journal |vauthors=Barreras A, Gurk-Turner C |title=Angiotensin II receptor blockers |journal=Proc (Bayl Univ Med Cent) |volume=16 |issue=1 |pages=123–6 |year=2003 |pmid=16278727 |pmc=1200815 |doi= |url= |issn=}}</ref>
* [[Angiotensin II]] inhibition by interacting selectively with the receptor site and blocking it<ref name="pmid10696996">{{cite journal |vauthors=Burnier M, Brunner HR |title=Angiotensin II receptor antagonists |journal=Lancet |volume=355 |issue=9204 |pages=637–45 |year=2000 |pmid=10696996 |doi= |url= |issn=}}</ref> <ref name="pmid162787272">{{cite journal |vauthors=Barreras A, Gurk-Turner C |title=Angiotensin II receptor blockers |journal=Proc (Bayl Univ Med Cent) |volume=16 |issue=1 |pages=123–6 |year=2003 |pmid=16278727 |pmc=1200815 |doi= |url= |issn=}}</ref>
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* 50 mg QD              ([[Losartan]])<ref name="urlwww.accessdata.fda.gov7">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020386s049lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* [[Losartan]] 50 mg PO daily<ref name="urlwww.accessdata.fda.gov7">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020386s049lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* 16 mg QD              ([[Candesartan]])<ref name="urlwww.accessdata.fda.gov8">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/020838s022lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* [[Candesartan]]16 mg PO daily<ref name="urlwww.accessdata.fda.gov8">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/020838s022lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>


* 80mg-160mg OD    ([[Valsartan]])<ref name="urlwww.accessdata.fda.gov9">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021283s037lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* [[Valsartan]] 80mg-160mg PO daily<ref name="urlwww.accessdata.fda.gov9">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021283s037lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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* [[Dizziness]]
* [[Dizziness]]
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|'''[[Dexamethasone]] therapy(For familial hyperaldosteronism type I)'''
|'''[[Dexamethasone]] therapy(For familial hyperaldosteronism type I)'''
|[[Dexamethasone]]
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* 0.5mg-0.75mg IV daily
* 0.5mg-0.75mg OD
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|}
|}

Revision as of 18:40, 18 October 2017


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

The optimal therapy for primary hyperladosteronism depends on the etiology of hyperaldosteronism. Medical therapy is indicated for bilateral adrenal hyperplasia, and all ambiguous causes of primary hyperaldosteronism.

Medical Therapy

Indications

Medical therapy is indicated for:

The following agents may be used to medical management of primary hyperaldosteronism:

Drug Class Agents Mechanism of action Dosage Side effects
Mineralocorticoid receptor antagonists Spironolactone
  • 12.5 – 25 mg PO q12h
  • Max of 400 mg PO daily
Potassium canrenoate
  • 200 mg IV daily
  • Max of 800 mg daily
Eplerenone 50 mg PO daily[3]
Potassium-sparing diuretics
Calcium channel blockers
  • 5 mg PO daily
  • Max of 10 mg PO daily[7]
ACE inhibitors
  • 20mg-40mg PO daily[11]
Angiotensin receptor blockers
Dexamethasone therapy(For familial hyperaldosteronism type I) Dexamethasone
  • 0.5mg-0.75mg IV daily

References

  1. ↑ Greiner JW, Kramer RE, Jarrell J, Colby HD (1976). "Mechanism of action of spironolactone on adrenocortical function in guinea pigs". J. Pharmacol. Exp. Ther. 198 (3): 709–15. PMID 978470.
  2. ↑ "www.accessdata.fda.gov" (PDF).
  3. ↑ Craft J (2004). "Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure". Proc (Bayl Univ Med Cent). 17 (2): 217–20. PMC 1200656. PMID 16200104.
  4. ↑ Vidt DG (1981). "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic". Pharmacotherapy. 1 (3): 179–87. PMID 6927605.
  5. ↑ "Amiloride Dosage Guide with Precautions - Drugs.com".
  6. ↑ Katz AM (1986). "Pharmacology and mechanisms of action of calcium-channel blockers". J Clin Hypertens. 2 (3 Suppl): 28S–37S. PMID 3540226.
  7. ↑ "www.accessdata.fda.gov" (PDF).
  8. ↑ "www.accessdata.fda.gov" (PDF).
  9. ↑ Brown MJ, Hopper RV (1999). "Calcium-channel blockade can mask the diagnosis of Conn's syndrome". Postgrad Med J. 75 (882): 235–6. PMC 1741191. PMID 10715768.
  10. ↑ "www.accessdata.fda.gov" (PDF).
  11. ↑ "www.accessdata.fda.gov" (PDF).
  12. ↑ "www.accessdata.fda.gov" (PDF).
  13. ↑ Burnier M, Brunner HR (2000). "Angiotensin II receptor antagonists". Lancet. 355 (9204): 637–45. PMID 10696996.
  14. ↑ Barreras A, Gurk-Turner C (2003). "Angiotensin II receptor blockers". Proc (Bayl Univ Med Cent). 16 (1): 123–6. PMC 1200815. PMID 16278727.
  15. ↑ "www.accessdata.fda.gov" (PDF).
  16. ↑ "www.accessdata.fda.gov" (PDF).
  17. ↑ "www.accessdata.fda.gov" (PDF).
  18. ↑ Barreras A, Gurk-Turner C (2003). "Angiotensin II receptor blockers". Proc (Bayl Univ Med Cent). 16 (1): 123–6. PMC 1200815. PMID 16278727.

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