Potassium is the primary intracellular cation. It plays a major role in muscle and nerve cell electrodynamics. Its concentration inside the cell (roughly 150 to 160 mEq/L) is 25 to 35 times greater than extracellular concentrations. Hypokalemia is generally defined as a serum potassium concentration less than 3.5 mEq/liter. However, the National Council on Potassium in Clinical Practice recommends that serum potassium concentrations of at least 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias. In addition, the Council recommends potassium supplementation for patients at risk for developing hypokalemia and associated complications (e.g., patients with potential for diuretic-induced potassium loss, patients sensitive to sodium or with high sodium intake, and patients with reduced GI intake or GI disturbances [e.g., vomiting, diarrhea]). Due to the potential to cause significant harm when used in error, strictly adhere to dilution and administration guidelines for intravenous potassium chloride.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
-In oral dosing for hypokalemia, potassium chloride is the salt of choice due to better GI absorption than other potassium salts.
-All oral dosage forms: Administer with a full glass of water (or other liquid) with or immediately after food.
Oral Solid Formulations
-Effervescent tablets: Do NOT crush or chew. Dissolve in 90 to 120 mL or more of cold water and drink slowly.
-Extended-release tablets (wax matrix):
--Swallow whole; do NOT crush or chew. Do not allow to dissolve in the mouth.
-The tablets contain a wax matrix coating that is not absorbed and may be excreted intact in the stool. Advise patients that if this is observed, it is not an indication of lack of effect.
-Extended-release tablets (micro-dispersible):
--Swallow whole; do NOT crush or chew. Do not allow to dissolve in the mouth.
-For patients with difficulty swallowing, the tablets may be broken in half and each half taken separately with a glass of water: Additionally, these formulations can be made into an aqueous solution by placing the whole dose in a glass or cup containing 120 mL of water. Allow 2 minutes for tablets to dissolve and then stir for approximately 30 seconds. Swirl the suspension and drink immediately. To ensure administration of the entire dose, add 30 mL of water to the glass or cup, swirl, and consume immediately; repeat with a final 30 mL water.
-Extended-release capsules:
--Swallow whole; do NOT crush or chew. Do not allow to dissolve in the mouth.
-For patients with difficulty swallowing, the capsules may be opened and sprinkled over soft food or mixed with juice. The soft food, such as applesauce or pudding, should be swallowed immediately without chewing and followed with a glass of cool water or juice to ensure complete swallowing of the microcapsules. The food used should not be hot and should be soft enough to be swallowed without chewing. Any microcapsule/food mixture should be used immediately and not stored for future use.
Oral Liquid Formulations
-Oral solution: Mix each dose with at least 120 mL of cold water or juice before administration.
-Powder for oral solution: Dissolve in at least 120 mL of cold water or juice before administration.
Extemporaneous Compounding-Oral
-To minimize fluid volume, the injection may be administered orally, after mixing with infant formula.
Injectable Administration
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
Dilution
-DO NOT administer IV push; potassium injection MUST be diluted before administration. Injection of concentrated potassium solution has been instantaneously fatal.
-The preferred diluent for intravenous potassium is saline. Diluents containing dextrose should be avoided, as they may worsen hypokalemia by stimulating insulin release that will cause intracellular shifting of potassium.
-Peripheral line: Potassium infusion via a peripheral vein may cause burning pain and phlebitis at the infusion site. Usual recommended maximum concentration for peripheral line is 100 mEq/L; however, concentrations up to 200 mEq/L have been safely administered via peripheral lines. For pediatric patients, data are limited; the usual recommended maximum concentration for peripheral line ranges from 40 to 100 mEq/L; however, concentrations up to 200 mEq/L have been safely administered via peripheral lines.
-Central line: It is preferable to administer all concentrations of potassium chloride infusions via a central line when possible; highest concentrations of 400 mEq/L must be administered via a central line. Concentrations up to 400 mEq/L have been safely administered via central lines in adults. For pediatric patients, data are limited; the usual recommended maximum concentration for central line ranges from 80 to 200 mEq/L; however, concentrations up to 400 mEq/L may be administered via central line.
-Storage: Pharmacy bulk vial should be discarded within 4 hours of initial entry.
Intravenous infusion
-NEVER administer potassium injection by IV push; maximum concentrations and recommended infusion rates may differ according to institution and patient care setting.
-When administering intravenous potassium solutions, do not use flexible plastic containers in series connections. Such use could result in air embolism due to residual air drawn being drawn from 1 container before administration of the fluid from a secondary container is complete.
-For adults, infuse at a rate of 10 mEq/hour. If an infusion rate exceeding 10 mEq/hour is necessary, infuse via a central line to minimize infusion-related burning and phlebitis and use continuous cardiac monitoring to monitor for signs of hyperkalemia. Infusion rates exceeding 20 mEq/hour are rarely needed. In emergent cases of hypokalemia, infusion rates as high as 40 mEq/hour have been used.
-In pediatric patients, the usual rate of potassium administration is 0.25 to 0.5 mEq/kg/hour ; however, rates as high as 1 mEq/kg/hour (Max: 40 mEq/hour) may be warranted under certain clinical conditions. Higher infusion rates should be infused via a central catheter. Continuous cardiac monitoring (i.e., continuous ECG) is recommended for higher doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour).
Hyperkalemia after administration of potassium chloride may be asymptomatic, but it can develop rapidly into a potentially fatal situation. Warning signs to watch for include: ECG changes (peaking of T-waves, loss of P-waves, ST segment depression, prolonged QT interval, slurring of QTS complex), cardiac arrhythmias/arrhythmia exacerbation (bradycardia, ventricular fibrillation), paresthesias including numbness or tingling in lips, feet or hands, muscular weakness and heaviness of the legs, areflexia/hyporeflexia, unusual fatigue or listlessness, flaccid paralysis of the extremities or muscle paralysis, mental confusion, unexplained anxiety, hypotension, shock, difficulty breathing or shortness of breath (dyspnea) including respiratory paralysis, AV block, asystole, and cardiac arrest. Frequent monitoring of electrolyte concentrations is essential. Continuous cardiac monitoring (i.e., continuous ECG) is recommended for pediatric patients receiving higher IV doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour).
The most commonly reported adverse effects of oral potassium chloride are flatulence, nausea, vomiting, abdominal pain, and diarrhea; these symptoms are best managed by diluting the dose further (if liquid preparation), taking the dose with meals, or reducing the amount of potassium taken at a time since potassium can irritate the GI tract. Additionally, nausea, vomiting, abdominal pain, and diarrhea have also been reported with injectable formulations. Ulceration of the small bowel can result from concentration of potassium in the area of a rapidly dissolving tablet. The incidence of GI lesions is lower with wax matrix tablets compared with formerly available, enteric-coated dosage forms. Microencapsulated preparations of potassium have a low GI complication rate and lack an unpleasant taste. Wax matrix tablets and granules for suspension containing coated crystals should be administered with caution and discontinued immediately if any of the following occur: severe nausea/vomiting, abdominal pain, distension, or GI bleeding. These reactions may indicate GI ulceration, GI obstruction, GI perforation, esophageal bleeding, esophageal ulceration, esophageal stricture, esophagitis, esophageal perforation, or bowel perforation or obstruction. Esophagitis is characterized by sudden onset odynophagia, retrosternal pain, and dysphagia. Potassium chloride-induced esophagitis is characterized by sudden onset odynophagia, retrosternal pain, and dysphagia. Risk factors for potassium chloride-induced esophageal effects include taking the medication without water and taking the medication at night. Symptoms usually resolve within days to weeks after stopping the medication. Patients with the following conditions are at an increased risk for developing potassium chloride-induced GI lesions: elderly; patients unable to move; and patients with scleroderma, diabetes mellitus, mitral valve replacement, cardiomegaly, and esophageal stricture/compression. Liquid preparations of potassium may be used in patients with esophageal compression due to an enlarged left atrium. Although dilute preparations of potassium chloride may reduce GI effects, patient compliance is generally lower with the liquid preparations.
Hypersensitivity and/or anaphylactoid reactions, including anaphylaxis, chills, and angioedema have been reported with intravenous potassium chloride solutions. Chest pain (unspecified) has also been reported with intravenous potassium chloride. Parenteral dosage forms of potassium chloride may cause an injection site reaction in some patients. Injection site reactions reported with intravenous potassium chloride include infusion site thrombosis, phlebitis, erythema, swelling, pain, irritation, and/or burning. The following reactions may also occur because of the solution or technique of administration: febrile response (fever), infection at the injection site, venospasm, and hypervolemia. Rapid infusion of hypertonic solutions may cause local pain and, rarely, vein irritation. The rate of administration should be adjusted according to patient tolerance. Because potassium-containing solutions are irritating to tissues, extravasation is possible, and extreme care should be taken to avoid perivascular infiltration/extravasation. Adverse reactions reported with intravenous potassium chloride solutions in association with extravasation include local tissue necrosis, skin necrosis, skin ulcer, muscle necrosis, nerve injury, tendon injury, and vascular injury. If an adverse reaction does occur, discontinue the infusion and evaluate the patient.
Concentrated potassium chloride injection contains aluminum. Thus, aluminum toxicity may occur with prolonged administration in high-risk patients, including those with renal impairment and premature neonates. Premature neonates are at particular risk for aluminum toxicity because of immature renal function and they require large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with renal impairment, who receive parenteral aluminum at rates greater than 4 to 5 mcg/kg/day, may develop aluminum toxicity (CNS and bone toxicity). Tissue loading may occur at lower administration rates.
The use of potassium chloride may result in metabolic acidosis or hyperchloremia. Monitor plasma chloride concentrations, renal function, and acid-base balance in at-risk patients. Formulations of potassium that contain dextrose may cause hyperglycemia and glycosuria. These adverse effects of hyperglycemia and glycosuria may be a function of the rate of administration or metabolic insufficiency. Slowing the infusion rate and administration of insulin may be appropriate therapy.
Skin rash has been reported rarely in patients receiving potassium chloride.
Acute hyponatremia and hyponatremic encephalopathy, characterized by headache, lethargy, seizures, nausea, and vomiting, have been reported with potassium chloride injection. Monitor serum sodium concentrations closely if use cannot be avoided in patients with or at risk for hyponatremia.
Potassium chloride is contraindicated in patients with known hypersensitivity to any potassium formulation.
Potassium chloride is contraindicated in patients with hyperkalemia since a further increase in serum potassium concentration in such patients can produce cardiac arrest. Due to the risk of developing hyperkalemia, potassium supplementation should be used with caution in patients with adrenal insufficiency (untreated Addison's disease); acute dehydration; systemic metabolic acidosis such as diabetic ketoacidosis; in patients receiving salt substitutes, potassium-sparing diuretics (e.g., amiloride, spironolactone, triamterene), ACE inhibitors, angiotensin II antagonists, cyclosporine, or tacrolimus; or in patients with renal disease, renal failure, or renal impairment. Potassium supplements should also be used cautiously in patients with severe burns because these patients are prone to hyperkalemia secondary to tissue breakdown and renal insufficiency. Serum potassium concentrations and renal function should be monitored closely in patients at risk for hyperkalemia. Because geriatric patients are more likely to have decreased renal function, potassium chloride should be dosed cautiously based on an assessment of renal function and therapeutic goals. Additionally, depending on volume and rate of infusion, administration of potassium chloride injection can cause electrolyte imbalance, overhydration/hypervolemia, and congested states, including pulmonary edema and peripheral edema. Avoid potassium chloride injection in patients at risk for fluid and or solute overloading. Monitor other electrolyte concentrations, fluid balance, and acid-base balance during long term parenteral potassium therapy or whenever the clinical condition of the patient warrants such monitoring. Injectable potassium chloride contains aluminum (content varies with formulation). Thus, aluminum may reach toxic concentrations with prolonged administration in patients with renal impairment. Premature neonates are at particular risk for aluminum toxicity because of immature renal function and they require large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with renal impairment, including neonates, who receive parenteral aluminum at rates greater than 4 to 5 mcg/kg/day may accumulate aluminum at concentrations associated with central nervous system and bone toxicity. Tissue loading may occur at lower administration rates.
Monitor patients with cardiac arrhythmias (e.g., atrial fibrillation, atrial flutter, digitalis toxicity (except due to documented hypokalemia), and ventricular arrhythmias including ventricular fibrillation and ventricular tachycardia), including patients receiving digoxin or other antiarrhythmic therapy, closely during administration of potassium chloride supplements. Patients with other cardiac disorders, such as heart failure or AV block, also require close monitoring when receiving potassium chloride. Clinical practice guidelines recommend that serum potassium concentrations of at least 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias to minimize complications of potassium depletion. Also, potassium supplementation is recommended for patients at risk of developing hypokalemia and associated complications. Potassium supplementation is specifically recommended for patients with potential for diuretic-induced potassium loss (e.g., receiving thiazide or loop diuretics), patients with high sodium intake (unwilling to reduce salt intake), and patients with reduced GI intake (e.g., GI disturbances, laxative abuse). Continuous cardiac monitoring (i.e., continuous ECG) is recommended for pediatric patients receiving higher IV doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour).
All solid oral dosage forms of potassium chloride are contraindicated in patients in whom there is a risk of delayed passage through the GI tract. Patients with gastroparesis, peptic ulcer disease, or GI obstruction, esophageal stricture, or ileus should not receive solid oral dosage forms of potassium chloride due to the potential for gastrointestinal irritation. Esophageal obstruction or compression associated with enlarged left atrium is also a contraindication for potassium chloride solid oral dosage forms due to reports of delayed tablet passage causing esophageal stricture and ulceration; potassium supplementation, when indicated in such patients, should be given as a liquid preparation. In addition, drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium chloride.
When administering concentrated intravenous potassium solutions, use caution to avoid paravenous administration or extravasation. These solutions may be associated with tissue damage, which may be severe and include vascular, nerve, and tendon damage, leading to surgical intervention, including amputation. Secondary complications, such as pulmonary embolism and thrombophlebitis, have been reported as an effect of tissue damage from potassium chloride.
Use potassium chloride with caution in patients with potassium-aggravated skeletal muscle channelopathy, such as hyperkalemic periodic paralysis, paramyotonia congenita, and potassium-aggravated myotonia/paramyotonia.
Avoid potassium chloride injection in patients with or at risk for hyponatremia, as it may cause hyponatremia due to its hypotonicity (osmolarity of 200 to 799 mOsm/L). Acute hyponatremia may lead to hyponatremic encephalopathy characterized by headache, lethargy, seizures, nausea, and vomiting. Patients with brain edema may be at particular risk for severe, irreversible, and life-threatening brain injury. The risk for hyponatremia is increased in children, geriatric patients, postoperative patients, those with psychogenic polydipsia, and in patients treated with medications that increase the risk of hyponatremia (i.e., certain diuretics, antiepileptic and psychotropic medications). Use high volume infusion with potassium chloride injection with caution and close monitoring in patients with pulmonary disease or pulmonary failure, heart failure, and patients with non-osmotic vasopressin release (including SIADH) due to the risk of hospital-acquired hyponatremia. Monitor serum sodium concentrations closely if use cannot be avoided in patients with or at risk for hyponatremia.
In patients with preexisting or at risk for hyperchloremia, potassium chloride use may exacerbate or result in hyperchloremia. Monitor chloride concentrations and renal function in these patients.
There are no adequate, well controlled studies with potassium chloride in pregnancy and animal reproduction studies have not been conducted. However, potassium supplementation that does not lead to hyperkalemia is not expected to cause fetal harm.
Although data are limited, potassium chloride appears to be safe and effective to use during breast-feeding to help meet maternal nutritional requirements. The normal potassium ion content of human milk is about 13 mEq/L. Because exogenous potassium becomes part of the body potassium pool, so long as body potassium is not excessive, potassium supplementation should have little or no effect on the concentration in human milk.
-Potassium supplement dosing must be individualized according to the needs of the patient. Requirement estimation should be based on clinical condition which includes ECG, plasma concentrations, and patient response.
-Hypokalemia is generally defined as a serum potassium concentration less than 3.5 mEq/L; however, serum potassium concentrations do not always correlate with cellular potassium levels. The National Council on Potassium in Clinical Practice recommends that serum potassium concentrations of at least 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias.
-Although extremely variable and based on clinical conditions of the patient, serum potassium decreases an average of 0.3 mmol/L for each 100-mmol reduction in total body stores. To avoid inducing hyperkalemia when correcting potassium loss, it is recommended to utilize the low end of this estimate and administer a moderate dose (orally, if possible) over a period of days to weeks to fully correct the potassium deficit. Among patients in an intensive care unit treated for acute hypokalemia, 20 mEq/hour potassium chloride IV resulted in a mean increase in the serum potassium concentration of 0.25 mmol/L.
-20 mEq (782 mg elemental potassium) of potassium is provided by 1.5 grams of potassium chloride.
For the treatment of hypokalemia, including the treatment of serious hypokalemia or digoxin toxicity:
-for the treatment of serious hypokalemia or digoxin toxicity (arrhythmias or ECG changes) associated with hypokalemia or for hypokalemia in patients unable to take oral potassium supplementation:
Intravenous dosage:
Adults with a serum potassium concentration more than 2.5 mEq/L: Administer at a rate not to exceed 10 mEq/hour IV with a 24-hour dose not to exceed 200 mEq. An initial dose of 20 to 40 mEq IV has been recommended. If an infusion rate exceeding 10 mEq/hour is needed, infuse via a central vein in the presence of continuous cardiac monitoring. Multiple doses may be required to normalize serum potassium. Check serum potassium concentration after administration of 60 to 80 mEq (within 1 to 4 hours after administration) before further potassium is administered.
Adults with a serum potassium concentration less than 2 mEq/L and ECG changes and/or muscle paralysis: In critical situations and under continuous cardiac monitoring, potassium may be cautiously administered via a central vein at a rate up to 40 mEq/hour IV not to exceed 400 mEq IV in 24 hours. Initial doses of up to 40 to 80 mEq have been recommended. Multiple doses may be required to normalize serum potassium. Check serum potassium concentration after administration of 60 to 80 mEq (within 1 to 4 hours after administration) before further potassium is administered. Infusion rates exceeding 20 mEq/hour are rarely needed.
Infants*, Children*, and Adolescents*: 0.25 to 0.5 mEq/kg/dose IV. Doses of 1 mEq/kg/dose (Usual Max: 40 mEq/dose) IV have been used in critical situations with appropriate monitoring. Usual infusion rates are 0.25 to 0.5 mEq/kg/hour. The usual maximum infusion rate is 1 mEq/kg/hour (Max: 40 mEq/hour), which should be infused via a central catheter. Higher infusion rates (up to 2 mEq/kg/hour) have been reported in cases of life-threatening hypokalemia. Continuous cardiac monitoring (i.e., continuous ECG) is recommended for higher doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour). Infusion rate, maximum doses, and maximum concentration may differ according to institutional guidelines and specific patient condition.
Neonates*: 0.25 to 0.5 mEq/kg/dose IV. Doses of 1 mEq/kg/dose IV have been used in critical situations with appropriate monitoring. Usual infusion rates are 0.25 to 0.5 mEq/kg/hour. The usual maximum infusion rate is 1 mEq/kg/hour, which should be infused via a central catheter. Continuous cardiac monitoring (i.e., continuous ECG) is recommended for higher doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour). Infusion rate, maximum doses, and maximum concentration may differ according to institutional guidelines and specific patient condition.
-for the treatment of mild to moderate hypokalemia:
Oral dosage:
Adults: 40 to 100 mEq/day PO in 2 to 5 divided doses, with or after a meal. Adjust dosage according to clinical need and tolerance. Maximum single dose is 40 mEq. Do not exceed 200 mEq/day.
Infants, Children, and Adolescents: 2 to 5 mEq/kg/day PO in 2 to 4 divided doses (Max: 100 mEq/day), with or after a meal; single dose max of 1 mEq/kg/dose (Max: 40 mEq/dose). Higher doses may be necessary; titrate dose based on serum potassium concentrations and patient response. Doses as high as 8 mEq/kg/day were reported in children with Bartter's syndrome, a disease characterized by renal potassium wasting, in a clinical study (n = 13).
Neonates: 2 to 6 mEq/kg/day PO in 2 to 4 divided doses, given with feedings. Higher doses may be necessary; titrate dose based on serum potassium concentrations and patient response.
For hypokalemia prevention, including patients with diabetic ketoacidosis*:
-for maintenance or prevention of hypokalemia, including patients on diuretics:
Oral dosage:
Adults: 20 mEq/day PO in 1 to 2 divided doses, with or after a meal. Maximum single dose is 20 mEq. Adjust dosage according to clinical need and tolerance.
Infants, Children, and Adolescents: 1 to 3 mEq/kg/day PO in 1 to 2 divided doses, with or after a meal. Higher doses may be needed. Higher supplementation (6 mEq/kg/day) has been reported in children with conditions associated with inadequate dietary intake (e.g., Kwashiorkor). The usual maximum daily dose for prevention of hypokalemia in adults is 20 mEq/day; however, doses should be adjusted based on serum potassium concentrations and the requirements of the patient.
Neonates: Initially, 1 to 3 mEq/kg/day PO in 1 to 2 divided doses, given with feedings. Higher doses may be needed; adjust dose base on potassium serum concentrations.
-for the prevention of hypokalemia in patients with diabetic ketoacidosis*:
Intravenous dosage:
Adults: Usual dose is 20 to 40 mEq/L added to replacement IV fluids. This is recommended to be given as half potassium chloride and half potassium acetate or potassium phosphate. Higher doses (up to 80 mEq/L) may be necessary; adjust amount added to fluids based on serum potassium concentrations.
Infants, Children, and Adolescents: Usual dose is 20 to 40 mEq/L added to replacement IV fluids. This is recommended to be given as half potassium chloride and half potassium acetate or potassium phosphate. Higher doses (up to 80 mEq/L) may be necessary; adjust amount added to fluids based on serum potassium concentrations.
For nutritional supplementation*:
-recommended adequate intake (AI) of potassium for nutritional supplementation in healthy individuals:
Oral dosage:
Adults: 4.7 g PO per day.
Adolescents 14 to 17 years: 4.7 g PO per day.
Children and Adolescents 9 to 13 years: 4.5 g PO per day.
Children 4 to 8 years: 3.8 g PO per day.
Children 1 to 3 years: 3 g PO per day.
Infants 7 to 11 months: 0.7 g PO per day.
Neonates and Infants 1 to 6 months: 0.4 g PO per day.
-daily maintenance requirements to prevent hypokalemia in patients receiving total parenteral nutrition (TPN):
Intravenous dosage:
Adults: 1 to 2 mEq/kg/day IV. Titrate dose based on serum potassium concentrations.
Children and Adolescents weighing more than 50 kg: 1 to 2 mEq/kg/day IV. Titrate dose based on serum potassium concentrations.
Infants, Children, and Adolescents weighing 50 kg or less: 2 to 4 mEq/kg/day IV. Titrate dose based on serum potassium concentrations.
Neonates: 1 to 6 mEq/kg/day IV. Potassium requirements may be lower in the first few days after birth, particularly in extremely low birth weight infants. Titrate dose based on serum potassium concentrations.
Maximum Dosage Limits:
-Adults
200 mEq/day PO and up to 400 mEq IV in 24 hours for critical situations.
-Geriatric
200 mEq/day PO and up to 400 mEq IV in 24 hours for critical situations.
-Adolescents
4 mEq/kg/day PO (Max: 100 mEq/day), with single maximum dose of 1 mEq/kg/dose PO (Max: 40 mEq/dose), are FDA-approved maximum dosages; however, higher doses have been used; single maximum doses of 1 mEq/kg/dose IV (Max: 40 mEq/dose) have been recommended.
-Children
4 mEq/kg/day PO (Max: 100 mEq/day), with single maximum dose of 1 mEq/kg/dose PO (Max: 40 mEq/dose), are FDA-approved maximum dosages; however, higher doses have been used; single maximum doses of 1 mEq/kg/dose IV (Max: 40 mEq/dose) have been recommended.
-Infants
4 mEq/kg/day PO, with single maximum dose of 1 mEq/kg/dose PO, are FDA-approved maximum dosages; however, higher doses have been used; single maximum doses of 1 mEq/kg/dose IV have been recommended.
-Neonates
4 mEq/kg/day PO, with single maximum dose of 1 mEq/kg/dose PO, are FDA-approved maximum dosages; however, higher doses have been used; single maximum doses of 1 mEq/kg/dose IV have been recommended.
Patients with Hepatic Impairment Dosing
Dosage should be modified depending on clinical response. Monitor serum potassium levels.
Patients with Renal Impairment Dosing
Dosage should be modified depending on clinical response and degree of renal impairment, but no quantitative recommendations are available. Monitor serum potassium concentrations and renal function carefully to avoid development of hyperkalemia. Cardiac monitoring is recommended in patients with renal impairment receiving IV potassium.
*non-FDA-approved indication
Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Aspirin: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Aliskiren: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and aliskiren are used together. Concomitant use may increase the risk of hyperkalemia.
Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and aliskiren are used together. Concomitant use may increase the risk of hyperkalemia.
Aluminum Hydroxide: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Carbonate: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Hydroxide: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Trisilicate: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Amiloride: (Major) The use of potassium supplements in patients treated with amiloride is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Amiloride; Hydrochlorothiazide, HCTZ: (Major) The use of potassium supplements in patients treated with amiloride is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Aminosalicylate sodium, Aminosalicylic acid: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Amlodipine; Benazepril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Celecoxib: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Olmesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Angiotensin II receptor antagonists: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Angiotensin-converting enzyme inhibitors: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Aspirin, ASA: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Butalbital; Caffeine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Caffeine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Dipyridamole: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Omeprazole: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Oxycodone: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Atropine: (Moderate) Use anticholinergics, such as atropine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Atropine; Difenoxin: (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy. (Moderate) Use anticholinergics, such as atropine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Azilsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Azilsartan; Chlorthalidone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Belladonna; Opium: (Moderate) Use anticholinergics, such as belladonna, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Benazepril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance. (Moderate) Use anticholinergics, such as hyoscyamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Benzphetamine: (Major) Urinary alkalinizers, such as potassium citrate diminish the urinary excretion of benzphetamine. These medications increase the proportion of non-ionized amphetamines, resulting in increased renal tubular reabsorption of these compounds. The half-life and therapeutic actions of benzphetamine will be prolonged in the presence of potassium citrate. This combination should be avoided.
Benztropine: (Moderate) Use anticholinergics, such as benztropine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Bismuth Subsalicylate: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Budesonide; Glycopyrrolate; Formoterol: (Major) Glycopyrrolate oral solution is contraindicated with concomitant solid oral dosage forms of potassium chloride due to risk for gastrointestinal mucosal injury. Glycopyrrolate orally disintegrating tablets are not recommended for use with solid oral dosage forms of potassium chloride. Use other glycopyrrolate dosage forms with solid oral dosage forms of potassium chloride with caution. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Bupivacaine; Meloxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Candesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Captopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Celecoxib: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Celecoxib; Tramadol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Chlordiazepoxide; Clidinium: (Moderate) Use anticholinergics, such as clidinium bromide, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Choline Salicylate; Magnesium Salicylate: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Cyclosporine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and cyclosporine are used together. Concomitant use may increase the risk of hyperkalemia.
Dextromethorphan; Quinidine: (Major) Alkalinizing agents such as potassium citrate can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible.
Diclofenac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diclofenac; Misoprostol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Dicyclomine: (Moderate) Use anticholinergics, such as dicyclomine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Diflunisal: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Digoxin: (Minor) Potassium levels should be monitored closely in patients receiving digoxin and potassium supplementation. Both hypokalemia and hyperkalemia increase the risk of digoxin toxicity. Some patients at increased risk are patients with renal impairment, patients on diuretics, and patients who are on potassium-sparing medications concurrently. Monitor renal function, potassium concentrations, and digoxin concentrations and clinical response during concurrent treatment.
Diphenhydramine; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diphenhydramine; Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diphenoxylate; Atropine: (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy. (Moderate) Use anticholinergics, such as atropine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Donepezil; Memantine: (Moderate) Increases in urinary pH may decrease elimination of memantine, resulting in drug accumulation and potential toxicity.
Drospirenone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Estetrol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Estradiol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Ethinyl Estradiol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Enalapril, Enalaprilat: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Ephedrine: (Moderate) The renal elimination of ephedrine susceptible to changes in urinary pH. Potassium citrate is a urinary alkalinizing agent. Concomitant administration of ephedrine with urinary alkalinizers may increase the likelihood of adverse reactions.
Ephedrine; Guaifenesin: (Moderate) The renal elimination of ephedrine susceptible to changes in urinary pH. Potassium citrate is a urinary alkalinizing agent. Concomitant administration of ephedrine with urinary alkalinizers may increase the likelihood of adverse reactions.
Eplerenone: (Contraindicated) The use of potassium supplements in patients receiving eplerenone for the treatment of hypertension is contraindicated. Concomitant use may increase the risk of hyperkalemia. Minimize the risk of hyperkalemia with proper patient selection and monitoring.
Eprosartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Etodolac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Fenoprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Finerenone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Flavoxate: (Moderate) Use anticholinergics, such as flavoxate, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Flecainide: (Moderate) Urinary alkalinization can decrease the renal clearance of flecainide, resulting in an increased elimination half-life and AUC for flecainide.
Flurbiprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Fosinopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Glycopyrrolate: (Major) Glycopyrrolate oral solution is contraindicated with concomitant solid oral dosage forms of potassium chloride due to risk for gastrointestinal mucosal injury. Glycopyrrolate orally disintegrating tablets are not recommended for use with solid oral dosage forms of potassium chloride. Use other glycopyrrolate dosage forms with solid oral dosage forms of potassium chloride with caution. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Glycopyrrolate; Formoterol: (Major) Glycopyrrolate oral solution is contraindicated with concomitant solid oral dosage forms of potassium chloride due to risk for gastrointestinal mucosal injury. Glycopyrrolate orally disintegrating tablets are not recommended for use with solid oral dosage forms of potassium chloride. Use other glycopyrrolate dosage forms with solid oral dosage forms of potassium chloride with caution. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Homatropine; Hydrocodone: (Moderate) Use anticholinergics, such as homatropine hydrobromide, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Hydrocodone; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Hyoscyamine: (Moderate) Use anticholinergics, such as hyoscyamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance. (Moderate) Use anticholinergics, such as hyoscyamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibuprofen; Famotidine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibuprofen; Oxycodone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibuprofen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Indacaterol; Glycopyrrolate: (Major) Glycopyrrolate oral solution is contraindicated with concomitant solid oral dosage forms of potassium chloride due to risk for gastrointestinal mucosal injury. Glycopyrrolate orally disintegrating tablets are not recommended for use with solid oral dosage forms of potassium chloride. Use other glycopyrrolate dosage forms with solid oral dosage forms of potassium chloride with caution. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Indomethacin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Irbesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Ketoprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ketorolac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Lisdexamfetamine: (Major) Urinary alkalinizers, such as potassium citrate, diminish the urinary excretion of amphetamines. These drug combinations should be avoided, especially in amphetamine overdose situations.
Lisinopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Lithium: (Moderate) Moderate to significant dietary sodium changes, or changes in sodium and fluid intake, may affect lithium excretion. Systemic sodium chloride administration may result in increased lithium excretion and therefore, decreased serum lithium concentrations. In addition, high fluid intake may increase lithium excretion. For patients receiving sodium-containing intravenous fluids, symptom control and lithium concentrations should be carefully monitored. It is recommended that patients taking lithium maintain consistent dietary sodium consumption and adequate fluid intake during the initial stabilization period and throughout lithium treatment. Supplemental oral sodium and fluid should be only be administered under careful medical supervision.
Losartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Magnesium Salicylate: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Meclofenamate Sodium: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Mefenamic Acid: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Meloxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Memantine: (Moderate) Increases in urinary pH may decrease elimination of memantine, resulting in drug accumulation and potential toxicity.
Methamphetamine: (Major) As potassium citrate is a urinary alkalinizer, use will diminish the urinary excretion of and increase the half-life of amphetamines. The interaction of amphetamines with urinary alkalinizers is well documented. Avoid concurrent use, especially in amphetamine overdose situations.
Methenamine: (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended.
Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Use anticholinergics, such as hyoscyamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Methenamine; Sodium Salicylate: (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Methscopolamine: (Moderate) Use anticholinergics, such as methscopolamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Moexipril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Nabumetone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Naproxen; Esomeprazole: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Naproxen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Nebivolol; Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Neostigmine; Glycopyrrolate: (Major) Glycopyrrolate oral solution is contraindicated with concomitant solid oral dosage forms of potassium chloride due to risk for gastrointestinal mucosal injury. Glycopyrrolate orally disintegrating tablets are not recommended for use with solid oral dosage forms of potassium chloride. Use other glycopyrrolate dosage forms with solid oral dosage forms of potassium chloride with caution. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Nonsteroidal antiinflammatory drugs: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Oxaprozin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Oxybutynin: (Moderate) Use anticholinergics, such as oxybutynin, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Penicillin G: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and high doses of penicillin G potassium are used together. Concomitant use may increase the risk for hyperkalemia. Penicillin G potassium contains 1.7 mEq of potassium per million units of penicillin G activity.
Perindopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Perindopril; Amlodipine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Use anticholinergics, such as atropine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa. (Moderate) Use anticholinergics, such as hyoscyamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa. (Moderate) Use anticholinergics, such as scopolamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Piroxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinapril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinidine: (Major) Alkalinizing agents such as potassium citrate can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible.
Quinine: (Moderate) Use caution if using potassium citrate and quinine concomitantly. Urinary alkalinizing agents may increase plasma quinine concentrations because quinine is reabsorbed when the urine is alkaline.
Ramipril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Sacubitril; Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Salicylates: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Salsalate: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Scopolamine: (Moderate) Use anticholinergics, such as scopolamine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Sodium Polystyrene Sulfonate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Sparsentan: (Moderate) Monitor potassium during concomitant use of sparsentan and potassium. Concomitant use increases the risk for hyperkalemia.
Spironolactone: (Major) The use of potassium supplements in patients receiving spironolactone may increase the risk for hyperkalemia. Potassium supplements should generally be avoided in heart failure patients receiving spironolactone. Monitor serum potassium concentrations closely if concomitant use is necessary.
Spironolactone; Hydrochlorothiazide, HCTZ: (Major) The use of potassium supplements in patients receiving spironolactone may increase the risk for hyperkalemia. Potassium supplements should generally be avoided in heart failure patients receiving spironolactone. Monitor serum potassium concentrations closely if concomitant use is necessary.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia.
Sulindac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Sumatriptan; Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Tacrolimus: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and tacrolimus are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan; Amlodipine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Tolmetin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Tolvaptan: (Moderate) Coadministration of tolvaptan and hypertonic saline (e.g., 3% NaCl injection solution) is not recommended. The use of hypertonic sodium chloride in combination with tolvaptan may result in a too rapid correction of hyponatremia and increase the risk of osmotic demyelination (i.e., central pontine myelinolysis).
Trandolapril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Trandolapril; Verapamil: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Triamterene: (Major) The use of potassium supplements in patients treated with triamterene is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Triamterene; Hydrochlorothiazide, HCTZ: (Major) The use of potassium supplements in patients treated with triamterene is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Trientine: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and trientine each inhibit oral absorption of the other, 2 hours should elapse between administration of trientine and iron doses.
Trihexyphenidyl: (Moderate) Use anticholinergics, such as trihexyphenidyl, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa.
Trimethoprim: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia.
Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium is actively transported into cells through a process facilitated by dextrose, insulin, and oxygen. Transport maintains a high potassium gradient across cell membranes, thus playing a vital role in electrical excitability of nerves and muscle. Relatively high intracellular potassium concentrations lead to passive diffusion out of the cell. The membrane gradient is responsible for the resting transmembrane electric potential, primarily determined by the diffusion of potassium out of the cell. Membrane depolarization will occur only when a current is applied to the nerve that exceeds the outward potassium current. This is usually accomplished by sodium rushing into the cell by fast inward channels, causing the action or 'spike' potential. Repolarization is partially but quickly attained by potassium flowing out of the cell through its own channel.
Hydrogen ions are also in higher concentration inside cells. When the extracellular hydrogen ion concentration is increased, as occurs in acidosis, potassium shifts to the extracellular environment; when it is decreased, potassium ions move into the cells. Hypo- or hyperkalemia can initiate changes in concentration of other ions. In the former state, when potassium becomes depleted, as the ion leaves the cell it is exchanged with extracellular sodium and hydrogen ions to maintain electroneutrality. The redistribution of hydrogen ions causes intracellular acidosis and extracellular alkalosis. The opposite happens in hyperkalemia.
Within or near the normal range of potassium balance, the ion plays a part in regulating renal synthesis of ammonia and in the pH of urine. A decrease in dietary intake of potassium stimulates renal synthesis of ammonia and increases urinary pH slightly by diminishing net acid secretion. If potassium loss is low, metabolic acidosis results. Greater potassium loss can cause systemic metabolic alkalosis and intracellular acidosis. Tubular secretion of potassium is inhibited by acidemia and stimulated by alkalemia.
Potassium chloride is administered orally and intravenously. Potassium first enters the extracellular fluid and is then actively transported into cells. Skeletal muscle accounts for the bulk of the intracellular store of potassium. Renal excretion of potassium normally is equal to the amount being absorbed in the diet. Potassium is freely filtered at the glomerulus and almost completely reabsorbed in the proximal tubule. Tubular secretion occurs in the late distal convoluted tubule and collecting duct, and accounts for the potassium excreted in the urine, which is about 10% of the amount filtered. Fecal elimination of potassium is minimal and plays no significant role in potassium homeostasis. Although extremely variable and based on clinical conditions of the patient, serum potassium decreases an average of 0.3 mEq/L for each 100-mEq reduction in total body stores.
Affected cytochrome P450 isoenzymes: none
-Route-Specific Pharmacokinetics
Oral Route
The bioavailability of potassium chloride is similar for the oral solution and extended-release products.
Micro-dispersible tablets and capsules
The extended-release tablets and capsules contain individual microencapsulated potassium chloride crystals which disperse upon tablet/capsule disintegration. These formulations are designed to slow the release of potassium so that the likelihood of a high localized concentration of potassium chloride within the GI tract is minimized. Potassium chloride ions are released over an 8 to 10-hour period.
Film-coated tablets
The film-coated extended-release tablets have a wax matrix coating designed to slow the release of potassium so that the likelihood of a high localized concentration of potassium chloride within the GI tract is minimized. The wax matrix coating is not absorbed and may be excreted intact in the stool. Urinary potassium excretion is first observed 1 hour after administration, reaches a peak at 4 hours, and extends up to 8 hours.
Intravenous Route
Among adult patients in an intensive care unit treated for acute hypokalemia, 20 mEq/hour of potassium chloride IV resulted in a mean increase in the serum potassium concentration of 0.25 mEq/L.