COMPARATIVE STUDY ON RAMIPRIL AND TELMISARTAN-ASSOCIATED HYPONATREMIA

BHUVANESHWARI S; VIJAYA D

doi:10.22159/ajpcr.2020.v13i12.39848

Authors

BHUVANESHWARI S Department of Pharmacology, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India.
VIJAYA D Department of Biochemistry, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

DOI:

https://doi.org/10.22159/ajpcr.2020.v13i12.39848

Keywords:

Ramipril, Telmisartan, Hyponatremia, Serum sodium level

Abstract

Objectives: This study was planned to study the association of ramipril and telmisartan with hyponatremia and to compare the hyponatremia effect of ramipril and telmisartan.

Methods: The study was conducted in a tertiary care hospital. Serum sodium levels were assayed in patients taking ramipril and telmisartan. Fifty-one patients were recruited. The patient’s age, gender, drug dosage, and frequency of drug administration were collected using a pro forma. Statistical analysis of data was performed using SPSS version 23.0.

Results: About 35.3% (28 out of 51) of the study population administered with ramipril and telmisartan developed hyponatremia. Predisposition to develop hyponatremia was high in males compared to females. Incidence of hyponatremia was 43.8% (7 out of 16) in the age group of 50–60 years. Although, incidence of hyponatremia was 56.5% (13 out of 23) in ramipril group compared to 17.9% (5 out of 28) in telmisartan group, it was not statistically significant.

Conclusion: The current study laid emphasis on the requisite for monitoring of serum sodium level in patients on ramipril and telmisartan administration to avoid morbidity and mortality due to unexpected adverse reactions.

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References

Yawar A, Jabbar A, Haque NU, Zuberi LM, Islam N, Akhtar J. Hyponatraemia: Etiology, management and outcome. J Coll Physicians Surg Pak 2008;18:467-71.

Ma TK, Kam KK, Yan BP, Lam YY. Renin-angiotensin-aldosterone system blockade for cardiovascular diseases: Current status. Br J Pharmacol 2010;160:1273-92.

Izzedine H, Fardet L, Launay-Vacher V, Dorent R, Petitclerc T, Deray G. Angiotensin converting enzyme inhibitor induced syndrome of inappropriate secretion of antidiuretic hormone: Case report and review of the literature. Clin Pharmacol Ther 2002;71:503-7.

Terra SG. Angiotensin receptor blockers. Circulation 2003;107:e215-6.

Moritz ML, Ayus JC. The pathophysiology and treatment of hyponatraemic encephalopathy: An update. Nephrol Dial Transplant 2003;18:2486-91.

Ushio-Yamana H, Minegishi S, Ishigami T, Araki N, Umemura M, Tamura K, et al. Renin angiotensin antagonists normalize aberrant activation of epithelial sodium channels in sodium-sensitive hypertension. Nephron Exp Nephrol 2012;122:95-102.

Cakir M. Significant hyperkalemia and hyponatremia secondary to telmisartan/hydrochlorothiazide treatment. Blood Press 2010;19:380-2.

Wal P, Tiwari R, Wal A, Tiwari G. Versatile RP-HPLC method development for quantitative estimation of telmisartan and ramipril in animal plasma. Int J Appl Pharm 2018;10:51-8.

Bhuvaneshwari S, Saroj PV, Vijaya D, Sowmya MS, Kumar RS. Hyponatremia induced by angiotensin converting enzyme inhibitors and angiotensin receptor blockers-a pilot study. J Clin Diagn Res 2018;12:FC01-3.

Kinoshita H, Kobayashi K, Yaguramaki T, Yasuda M, Fujiki K, Tomiyama J, et al. Losartan potassium/hydrochlorothiazide (Preminent®) and hyponatremia: Caseseries of 40 patients. Hum exp Toxicol 2011;30:1409-14.

Gentric AT. Severe hyponatremia associated with ramipril therapy in an old woman. J Am Geriatr Soc 1995;43:1448-79.