Medications that may diminish potassium levels include corticosteroids,
amphotericin B, antacids, loop diuretics, thiazide diuretics, and insulin.
Please refer to the depletions monographs related to these medications for
Enzyme (ACE) Inhibitors
ACE inhibitors may produce hyperkalemia, particularly when used in
combination with nonsteroidal anti-inflammatory drugs (NSAIDs),
potassium-sparing diuretics, potassium supplements, potassium-containing salt
substitutes, and in patients with autonomic neuropathy, adrenal insufficiency,
renal impairment, and diabetes mellitus (Howes 1995; Shionoiri 1993). For this
reason, potassium supplements may not be warranted in patients taking these
medications; serum potassium levels should be monitored
Beta-adrenergic blockers may elevate potassium levels by promoting a
redistribution of this electrolyte (Preston et al. 1998). Potassium levels
should be monitored in patients taking these medications, particularly in
patients with compromised renal
Cyclosporine may induce hyperkalemia by decreasing renal excretion of
potassium and interfering with aldosterone production or secretion (Preston et
al. 1998). Potassium levels in patients on cyclosporine therapy, particularly
those with renal insufficiency, should be monitored
Hypokalemia increases the risk of cardiac glycoside toxicity (Whang et al.
1985). Normal levels of potassium should be maintained during digoxin
Heparin may contribute to hyperkalemia by impairing renal excretion of
potassium as a result of interference with aldosterone production or secretion
(Preston et al. 1998). Serum potassium levels should be monitored in patients on
heparin therapy, especially if potassium supplements are added to the medication
Anti-inflammatory Drugs (NSAIDs)
NSAIDs can affect renal function and decrease potassium excretion (Brater
1999). Hyperkalemia can occur in patients with mild renal insufficiency or
normal renal function. Ibuprofen may increase the risk for renal insufficiency
and cause hyperkalemia in patients that are over 76 years old, on certain
diuretic therapy, or who have cirrhosis and renal vascular disease (Blackshear
et al. 1983; Poirier 1984; Whelton, et al. 1990). Individuals taking NSAIDs
should avoid potassium
Standard doses of trimethoprim monotherapy as well as trimethoprim combined
with sulfamethoxazole have been shown to cause hyperkalemia in a significant
number of patients treated for various infections (Alappan et al. 1996;
Perazella 2000). Patients treated with these medications should be closely
monitored for hyperkalemia, especially those with renal insufficiency (Alappan
et al. 1996).
Alappan R, Perazella MA, Buller GK, et al. Hyperkalemia in hospitalized
patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med.
Blackshear JL, Davidman M, Stillman MT. Indentification of risk for renal
insuffciency from nonsteroidal anti-inflammatory drugs. Arch Intern Med.
Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function:
focus on cyclooxygenase-2-selective inhibition. Am J Med.
Howes LG. Which drugs affect potassium? Drug Saf. 1995
Perazella MA. Trimethoprim-induced hyperkalemia: clinical data, mechanism,
prevention and management. Drug Saf. 2000;22(3):227-236.
Poirier TI. Reversible renal failure associated with ibuprofen: case report
and review of the literature. Drug Intell Clin Pharm.
Preston RA, Hirsh MJ MD, Oster, JR MD, et al. University of Miami Division of
Clinical Pharmacology therapeutic rounds: drug-induced hyperkalemia. Am J
Ther. 1998 Mar; 5(2):125-132.
Shionoiri H. Pharmacokinetic drug interactions with ACE inhibitors. Clin
Pharmacokinet. 1993 Jul;25(1):20-58.
Whang R, Oei TO, Watanabe A. Frequency of hypomagnesia in hospitalized
patients receiving digitalis. Arch Intern Med. 1985;145(4):655-656.
Whelton, A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen,
piroxicam, and sulindac in patients with asymptomatic renal failure. A
prospective, randomized, crossover comparison. Ann Intern Med.
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