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]). Potassium acetate is indicated for the treatment and prevention of hypokalemia when oral treatment is not feasible and when the correction of acidemia is also needed. Due to the potential to cause significant harm when used in error, strictly adhere to dilution and administration guidelines for intravenous potassium acetate.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
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 acetate 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.
-Dilution in a large volume of intravenous fluids (i.e., 0.9% NaCl Injection, Total Parenteral Nutrition) is recommended.
-Peripheral line: Potassium infusion via a peripheral vein may cause burning pain and phlebitis at the infusion site. For continuous infusion of potassium, the concentration should not exceed 80 mEq/L for peripheral line infusion in adults. The usual maximum recommended concentration in pediatric patients with a peripheral line is 40 mEq/L. In severe hypokalemia, up to 80 mEq/L has been used.
-Central line: For continuous infusion of potassium, the concentration should not exceed 120 mEq/L in adults. The maximum recommended concentration in pediatric patients with a central line is 20 mEq/100 mL (200 mEq/L).
-Storage: Pharmacy bulk vial should be discarded within 4 hours of initial entry.
Intravenous infusion
-NEVER administer potassium acetate by IV push; maximum concentrations and recommended infusion rates may differ according to institution and patient care setting.
-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 acetate may be asymptomatic, but it can develop rapidly into a potentially fatal situation. Warning signs to watch for with potassium administration 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.
Hypersensitivity and/or anaphylactoid reactions, including anaphylaxis, chills, and angioedema, have been reported with intravenous potassium solutions. Chest pain (unspecified) has also been reported with intravenous potassium products. Parenteral dosage forms of potassium may cause an injection site reaction in some patients. Injection site reactions reported with intravenous potassium solutions 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 the patient's 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 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 occurs, discontinue the infusion and evaluate the patient.
Concentrated potassium acetate 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.
Excessive administration of potassium acetate may lead to metabolic alkalosis.
Potassium acetate is contraindicated in patients with known hypersensitivity to any potassium formulation.
Potassium acetate 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 should be dosed cautiously based on an assessment of renal function and therapeutic goals. Additionally, 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 acetate 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 acetate. Patients with other cardiac disorders, such as heart failure or AV block, also require close monitoring when receiving IV potassium supplementation. 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. In addition, potassium supplementation is recommended for patients at risk for 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 children receiving higher IV potassium doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour).
Use potassium acetate with caution in patients with metabolic alkalosis or respiratory alkalosis. Patients with severe hepatic disease or hepatic impairment may have decreased excretion or utilization of acetate.
There are no adequate, well controlled studies with potassium acetate in pregnant women and animal reproduction studies have not been conducted. Therefore, it is unknown whether potassium acetate can cause fetal harm when administered during pregnancy. Use potassium acetate during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Although data are limited, potassium acetate 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.
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 other injectable potassium salts (i.e., chloride).
Use potassium acetate with caution in patients with potassium-aggravated skeletal muscle channelopathy, such as hyperkalemic periodic paralysis, paramyotonia congenita, and potassium-aggravated myotonia/paramyotonia.
-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.
-20 mEq (782 mg elemental potassium) of potassium is provided by approximately 1.97 grams of potassium acetate.
For the treatment of hypokalemia and hypokalemia prevention, including patients with diabetic ketoacidosis*, when oral replacement therapy is not feasible:
-for the treatment of hypokalemia:
NOTE: Potassium chloride is typically used for the acute treatment of hypokalemia; however, potassium acetate may be used if correction of acidemia is needed.
Intravenous dosage:
Adults with a serum potassium concentration more than 2.5 mEq/L: 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: 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. 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.
-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.
-daily maintenance requirements to prevent hypokalemia in patients receiving total parenteral nutrition (TPN):
Intravenous dosage:
Adults: 1 to 2 mEq/kg/day IV (Usual Max: 80 mEq/day). 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
Single maximum doses of 80 mEq in cases of severe hypokalemia; 80 mEq/day IV is usual maximum for normal daily potassium requirements; however, dosage must be individualized according to serum concentrations and patient requirements.
-Geriatric
Single maximum doses of 80 mEq in cases of severe hypokalemia; 80 mEq/day IV is usual maximum for normal daily potassium requirements; however, dosage must be individualized according to serum concentrations and patient requirements.
-Adolescents
Safety and efficacy have not been established in pediatric patients; single maximum doses of 1 mEq/kg/dose (Max: 40 mEq/dose) have been recommended; 2 mEq/kg/day IV is usual maximum for normal daily potassium requirements; however, dosage must be individualized according to serum concentrations and patient requirements.
-Children
Safety and efficacy have not been established in pediatric patients; single maximum doses of 1 mEq/kg/dose (Max: 40 mEq/dose) have been recommended; 4 mEq/kg/day IV is usual maximum for normal daily potassium requirements; however, dosage must be individualized according to serum concentrations and patient requirements.
-Infants
Safety and efficacy have not been established in pediatric patients; single maximum doses of 1 mEq/kg/dose have been recommended; 4 mEq/kg/day IV is usual maximum for normal daily potassium requirements; however, dosage must be individualized according to serum concentrations and patient requirements.
-Neonates
Safety and efficacy have not been established in pediatric patients; single maximum doses of 1 mEq/kg/dose have been recommended; 6 mEq/kg/day IV is usual maximum for normal daily potassium requirements; however, dosage must be individualized according to serum concentrations and patient requirements.
Patients with Hepatic Impairment Dosing
Dosage should be modified based on clinical response and serum potassium concentrations. Potassium acetate excretion and utilization may be impaired in patients with severe hepatic impairment.
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; 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.
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.
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.
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.
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.
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.
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.
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.
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.
Cyclosporine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and cyclosporine are used together. Concomitant use may increase the risk of hyperkalemia.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Acetate, a source of hydrogen ion acceptors, is an alternative source of bicarbonate by metabolic conversion in the liver. This has been shown to proceed readily, even in the presence of severe liver disease.
Potassium acetate is administered 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