I want to spend a brief time this week telling my readers about a story of a drug that just may have saved my patient’s life. She is a 72-year old woman who has CHF with a weak heart (a cardiomyopathy). I have been working to get her on a couple medications that will help the heart function, help prevent CHF from worsening and will prolong her life. These medications—carvedilol and sacubitril/valsartan (Entresto™)—both have a tendency to make the potassium level in the bloodstream rise. Usually it is only a lit bit, but in the case of my patient, it was progressive and eventually reached levels where it could destabilize the heart electrically and cause a life-threatening heart rhythm. I was faced with the prospect of having to stop one or both of these medications—with the potential consequence that my patient’s heart function would decline and she could develop worsened CHF and even die.
But I recalled a medication that had been released a few years ago, which can decrease the absorption of potassium in the GI tract and thus lower blood levels. It is called Veltassa™ and I had only used it once before, so unusual is this situation in cardiology. Her potassium level, which had risen to 6.0 (normal is between 3.8-5.2) went down within a few days to 5.0. I had temporarily stopped her Entresto, but now plan to resume it and continue to monitor her potassium levels while she takes her CHF meds with the Veltassa.
Why am I telling this story today? For one, I was very happy to find that there was a simple drug that could help my patient stay on her life-saving medications and I want others to be reminded it is available, in case they face a similar situation. Secondly, it is fortuitous that a drug exists that has a such a specific effect and is used only rarely. I suspect that my nephrology (the specialty of kidney diseases) colleagues use this drug more often, as patients with kidney failure have a strong tendency to accumulate potassium.
Some drugs don’t have many uses, but when they’re needed, we are glad they’re available. So, to the developers of innovation in our medical industry, keep up the good work!
Greg Koshkarian, MD, FACC