Potassium

Potassium/Drug Interactions:

  • AcetazolamideAcetazolamide: Acetazolamide may decrease serum potassium levels, according to secondary sources.
  • Aldosterone antagonistsAldosterone antagonists: In a review, eplerenone and spironolactone have both been reported to increase levels of potassium in the serum (41).
  • Aminoglycoside antibioticsAminoglycoside antibiotics: In animals, potassium has been reported to decrease the nephrotoxic effects of aminoglycosides (121). However, serum potassium may be increased in patients taking aminoglycosides due to nephrotoxic effects (51). Gentamicin has also been reported to increase excretion of potassium in rats (54). Hypokalemia may worsen renal failure resulting from gentamicin (29).
  • Aminosalicylic acidAminosalicylic acid: Aminosalicylic acid may decrease levels of potassium, according to secondary sources.
  • Amphotericin BAmphotericin B: In humans, amphotericin B has been reported to decrease levels of potassium in the serum (52; 53). Administration of potassium has also been reported to decrease the side effects of amphotericin B in the treatment of patients with kala-azar (122).
  • Angiotensin II-converting enzyme (ACE) inhibitors and angiotensin-converting enzyme receptor blockersAngiotensin II-converting enzyme (ACE) inhibitors and angiotensin-converting enzyme receptor blockers: In humans, ACE inhibitors have been reported to increase levels of potassium in the blood (42; 123; 43; 124; 44; 45; 46; 47). However, changes in serum potassium were not reported in renal transplant patients (125).
  • AnticholinergicsAnticholinergics: According to secondary sources, potassium supplements should be avoided with concomitant use of anticholinergics, such as glycopyrrolate.
  • Antidiabetic agentsAntidiabetic agents: In humans, insulin in combination with glucose has been reported to redistribute serum potassium, causing a decrease in the serum potassium levels (31).
  • AntihypertensivesAntihypertensives: In vitro evidence suggests that potassium may affect endothelial cells and increase the release of nitric oxide, which may lead to decreased blood pressure (BP) (126). According to a review, population-based studies link a high-sodium and low-potassium diet to an increase in blood pressure, indicating that potassium supplementation may be useful in the treatment of hypertension (32). Several meta-analyses and systematic reviews have been conducted on the effects of potassium on hypertension (33). One review reported that BP is inversely related to levels of potassium in the urine (127). Three meta-analyses reported a significant decrease in both diastolic and systolic BP with potassium consumption (34; 35; 36).
  • AntimuscarinicsAntimuscarinics: According to secondary sources, potassium supplements should be avoided with concomitant use of antimuscarinics.
  • Beta-agonistsBeta-agonists: In humans, salbutamol and albuterol have been reported to decrease potassium levels by increasing excretion of potassium (31; 55; 56; 57; 58). A review suggested that formoterol may have less of an effect on potassium levels than short-acting beta-2 agonists, but the results are mixed (128; 129).
  • CarbenicillinCarbenicillin: In humans, carbenicillin has been reported to cause hypokalemia (59).
  • Cardiovascular agentsCardiovascular agents: A restriction in sodium intake that is accompanied by increased intake of potassium has been recommended to prevent hypertension and cardiovascular disease (126).
  • CisplatinCisplatin: In humans, cisplatin may cause hypokalemia (60).
  • DiureticsDiuretics: In humans, loop diuretics have been reported to decrease potassium levels by increasing the excretion of potassium (31; 63; 64). In humans, thiazide diuretics have been reported to decrease potassium levels by increasing the excretion of potassium (31; 67).
  • Exchange resinsExchange resins: In humans, ion exchange resins have been reported to redistribute serum potassium, causing a decrease in the serum potassium levels (31).
  • FluconazoleFluconazole: Fluconazole may cause hypokalemia, according to secondary sources.
  • GlucocorticoidsGlucocorticoids: Glucocorticoids may decrease the level of potassium in the serum, according to secondary sources. Supplementation with potassium may help to prevent undesirable side effects (130).
  • Insulin preparationsInsulin preparations: In humans, insulin in combination with glucose has been reported to redistribute serum potassium, causing a decrease in the serum potassium levels (31).
  • LaxativesLaxatives: In humans, laxatives have been shown to increase fecal excretion of potassium (61).
  • LevodopaLevodopa: In humans, levodopa has been reported to increase excretion of potassium (62).
  • MethylxanthinesMethylxanthines: Methylxanthines may decrease the levels of potassium in the serum, according to secondary sources.
  • MineralocorticoidsMineralocorticoids: Mineralocorticoids may decrease serum potassium levels, according to secondary sources.
  • Nonsteroidal antiinflammatory agents (NSAIDs)Nonsteroidal antiinflammatory agents (NSAIDs): In humans, NSAIDs have been reported to reduce excretion of potassium in patients one day out of surgery (37; 38; 39; 40). However, three of the listed meta-analyses appear to cover the same eight trials.
  • Opioid analgesicsOpioid analgesics: According to secondary sources, potassium supplements should be avoided with concomitant use of opioid analgesics, as this may delay potassium passage through the gastrointestinal tract and may increase risk of ulcers. In a randomized controlled trial, potassium supplementation caused analgesic effects in hypokalemic patients with rheumatoid arthritis (109).
  • Penicillin GPenicillin G: Penicillin G may cause hyperkalemia when administered in large doses or with potassium supplements, according to secondary sources.
  • PhenothiazinesPhenothiazines: Phenothiazines may decrease serum potassium levels, according to secondary sources.
  • SalicylatesSalicylates: Salicylates may cause hypokalemia, according to secondary sources.
  • Sodium bicarbonateSodium bicarbonate: In humans, sodium bicarbonate has been reported to redistribute serum potassium, causing a decrease in the serum potassium levels (31).
  • Sodium polystyrene sulfonate (Kayexalate?)Sodium polystyrene sulfonate (Kayexalate?): Sodium polystyrene sulfonate reduces serum potassium levels and is used to treat high blood levels of potassium.
  • SuccinylcholineSuccinylcholine: In humans, hyperkalemia has been reported with the use of succinylcholine (48; 49; 50).
  • TetracyclinesTetracyclines: In humans, outdated tetracyclines have been reported to decrease serum potassium levels (65; 66).

    • Potassium/Herb/Supplement Interactions:

  • AnticholinergicsAnticholinergics: According to secondary sources, potassium supplements should be avoided with concomitant use of anticholinergics.
  • Anti-inflammatory herbsAnti-inflammatory herbs: In humans, anti-inflammatory agents have been reported to reduce excretion of potassium in patients one day out of surgery (37; 38; 39; 40). However, three of the listed meta-analyses appear to cover the same eight trials.
  • AntimuscarinicsAntimuscarinics: According to secondary sources, potassium supplements should be avoided with concomitant use of antimuscarinics.
  • AntineoplastonsAntineoplastons: In humans, antineoplastons have been reported to decrease potassium levels (68).
  • CalciumCalcium: In humans, calcium has been reported to possibly block the arrhythmic effects of hyperkalemia (31).
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: A restriction in sodium intake that is accompanied by increased intake of potassium has been recommended to prevent hypertension and cardiovascular disease (126).
  • DiureticsDiuretics: In humans, thiazide diuretics have been reported to decrease potassium levels by increasing the excretion of potassium (31; 67). In humans, loop diuretics have been reported to decrease potassium levels by increasing the excretion of potassium (31; 63; 64).
  • GlycyrrhizaGlycyrrhiza: In humans, licorice has been reported to decrease levels of potassium in the serum (70).
  • GossypolGossypol: According to a systematic review, gossypol may affect potassium levels (131). However, further information is pending review.
  • HorsetailHorsetail: In humans, horsetail has been reported to decrease serum potassium levels (69).
  • HypoglycemicsHypoglycemics: In humans, insulin in combination with glucose has been reported to redistribute serum potassium, causing a decrease in the serum potassium levels (31).
  • HypotensivesHypotensives: In vitro evidence suggests that potassium may affect endothelial cells and increase the release of nitric oxide, which may lead to decreased blood pressure (BP) (126). According to a review, population-based studies link a high-sodium and low-potassium diet to an increase in blood pressure, indicating that potassium supplementation may be useful in the treatment of hypertension (32). Several meta-analyses and systematic reviews have been conducted on the effects of potassium on hypertension (33). One review reported that BP is inversely related to levels of potassium in the urine (127). Three meta-analyses reported a significant decrease in both diastolic and systolic BP with potassium consumption (34; 35; 36).
  • LaxativesLaxatives: In humans, laxatives have been shown to increase the fecal excretion of potassium (61).
  • Opioid analgesicsOpioid analgesics: According to secondary sources, potassium supplements should be avoided with concomitant use of opioid analgesics, as this may delay potassium passage through the gastrointestinal tract and may increase risk of ulcers. In a randomized controlled trial, potassium supplementation caused analgesic effects in hypokalemic patients with rheumatoid arthritis (109).
  • SalicylatesSalicylates: Salicylates may cause hypokalemia, according to secondary sources.
  • Vitamin B 12Vitamin B 12: Potassium supplements may reduce absorption of vitamin B12 in some people (132).
  • Vitamin DVitamin D: In humans, administration of thiazides and potassium salts has resulted in decreased vitamin D levels in patients with hypercalciuria (133).

    • Potassium/Food Interactions:

  • Salt substitutesSalt substitutes: Salt substitutes may contain high amounts of potassium (2).

    • Potassium/Lab Interactions:

  • GlucoseGlucose: Serum potassium levels affect insulin secretion by pancreatic beta-cells, and hypokalemia associated with diuretic use has been associated with dysglycemia (12).
  • Plasma aldosteronePlasma aldosterone: In humans, potassium administration has been reported to increase plasma aldosterone levels and decrease urinary excretion of aldosterone (134).
  • UrinalysisUrinalysis: Changes in potassium levels may affect urine pH tests. Ingestion of potassium supplements or drugs such as potassium citrate have been shown to increase urine pH.
  • Urinary calciumUrinary calcium: In humans, administration of thiazides and potassium salts has decreased calciuria levels in patients with hypercalciuria (133).
  • Vitamin DVitamin D: In humans, administration of thiazides and potassium salts has resulted in decreased vitamin D levels in patients with hypercalciuria (133).