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Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Before starting

Heart failure

  • Baseline
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
    • Urea and electrolytes

Care initiating

Consider whether initiation is appropriate where:

Potassium

Potassium is greater than 5.0 mmol/L

Creatinine

Creatinine is greater than 220 micromol/L

After started or dose changed

Heart failure

  • Before and after change
    • Blood pressure
  • After 1 week; then monthly for first 3 months
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
    • Urea and electrolytes

Ongoing once stable

Heart failure

  • Every 3 - 6 months
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
    • Urea and electrolytes

Abnormal results

Reduce dose or reduce frequency

Reduce dose to 25mg on alternate days or halve the dose if any of the following met.

Potassium

Potassium is greater than 5.5 mmol/L

Creatinine

Creatinine is greater than 220 micromol/L

Estimated glomerular filtration rate

eGFR is less than 30mL/min/1.73m2

Stop and seek advice

Stop and seek specialist advice if any of the following met.

Potassium

Potassium is greater than 6 mmol/L

Creatinine

Creatinine is greater than 310 micromol/L

Estimated glomerular filtration rate

eGFR is less than 20mL/min/1.73m2

Notes

Advice to patients

Advise patients to:

  • Avoid NSAIDs unless prescribed
  • Avoid salt substitutes containing potassium
  • Omit spironolactone and contact prescriber if diarrhoea, vomiting, or infection with fever and sweating occurs

Bibliography

Enquiries about this page

Contact us if you have any enquiries about the drug monitoring information on this page.