If you have hyperkalemia, you’ve got very high potassium levels in your bloodstream. Kidney disease is one possible cause. But certain medicines can make your potassium levels skyrocket, too.
Medicines that boost potassium may do so in different ways. Some directly add more potassium to your body. Others slow your kidneys’ removal of the potassium you’ve gotten from other sources. There are also drugs that change the way potassium moves through your body, which can affect the levels in your bloodstream.
Even a small increase in potassium can have big effects on your health – especially if you already have kidney disease. That's why it's important to check your medicine cabinet for these medicines and talk to your doctor about them.
Blood Pressure Medicines
These drugs lower blood pressure and protect your kidneys. In the process, they make your kidneys hold on to extra potassium. You're more likely to get hyperkalemia from blood pressure medications if your kidneys are already damaged from kidney disease.
These are the blood pressure meds that can cause this problem:
- Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), enalapril (Vasotec), and ramipril (Altace)
- Angiotensin-II receptor blockers, such as candesartan (Atacand), losartan (Cozaar), and telmisartan (Micardis)
- Beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL), and propranolol (Inderal)
- Calcium channel blockers, such as amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Procardia)
- Direct renin inhibitors, such as aliskiren (Tekturna)
Potassium-Sparing Diuretics
Also called "water pills," diuretics treat high blood pressure. They help your body remove extra salt and water to lower your blood pressure. Most diuretics reduce potassium levels in your blood, too. But potassium-sparing diuretics are different – they make your body hold on to more potassium.
These are potassium-sparing diuretics:
- Amiloride (Midamor)
- Eplerenone (Inspra)
- Spironolactone (Aldactone, Carospir)
- Triamterene (Dyrenium)
Nonsteroidal Anti-Inflammatory drugs (NSAIDs)
Medicines like ibuprofen, aspirin, and naproxen relieve occasional aches and pains. But you’re not supposed to take them long-term. If you do, they can damage your kidneys and cause your potassium levels to rise. NSAIDs are more likely to cause hyperkalemia in people who have already lost kidney function from kidney disease.
Immune-Suppressing Medicines
Some immune-suppressing drugs, namely cyclosporine and tacrolimus, lower your immune system activity to stop your body from rejecting a new kidney or other organ after a transplant. Others, called calcineurin inhibitors, calm your immune system down to treat autoimmune diseases like lupus and atopic dermatitis.
Both types of immune-suppressing drugs can damage your kidneys and cause hyperkalemia. Your health care team will monitor you for high potassium and other side effects while you take these medicines.
Antibiotics
Not all antibiotics drive up your potassium levels. But two of them – trimethoprim-sulfamethoxazole (Bactrim, Septra) and pentamidine – may increase potassium levels in certain people. Both antibiotics treat a very serious type of pneumonia caused by AIDS. Trimethoprim is also a treatment for urinary tract infections.
Blood Thinners
Heparin prevents blood clots during surgery. It also treats conditions like deep vein thrombosis (DVT) and atrial fibrillation (AF). Heparin can cause hyperkalemia by making your body remove more salt and keep extra potassium.
You're more likely to have high blood potassium while taking blood thinners if you have kidney failure, diabetes, or you take ACE inhibitors, trimethoprim, or NSAIDs.
Herbal Remedies
Some people use herbal remedies to treat a variety of health conditions. Though these supplements are natural, they can still cause side effects.
Some of the herbal supplements that can raise potassium levels are:
- Alfalfa
- Dandelion
- Horsetail
- Lily of the valley
- Milkweed
- Nettle
If you have kidney disease, it may not be safe for you to take herbal supplements. Check with your doctor before you try any of these products.
Supplements
Some muscle-building supplements and salt substitutes contain very large amounts of potassium. If your kidneys are healthy, they should be able to process the extra potassium. But if you have kidney damage or you take an ACE inhibitor, potassium-sparing diuretic, or other medicine that increases potassium, your potassium levels could rise to dangerous levels with these supplements.
A few people have gotten severe hyperkalemia and gone into cardiac arrest after taking these supplements. That's why it's important to not take any supplements without talking to your doctor first. Most people with kidney disease should avoid muscle-building supplements or salt substitutes.
Are Your Medicines a Problem?
These medicines shouldn't raise your potassium levels if you're healthy, but they could be a problem if you have kidney damage. That’s because your kidneys handle more than 90% percent of the potassium removal for your body.
You're also more likely to get hyperkalemia from medications if you have any of these conditions:
- Heart failure
- Diabetes
- High blood pressure
- Too little of the hormone aldosterone (hypoaldosteronism)
- Underactive adrenal glands (Addison's disease)
- High potassium because you're on dialysis, you eat a lot of potassium-rich foods, or you have a medical problem like bleeding in your gut or muscle damage (rhabdomyolysis)
If a medicine you take has increased your potassium to a high level, you might have symptoms like:
- Weakness
- Nausea or vomiting
- Numbness or tingling
- Heart palpitations or chest pain
- Shortness of breath
Sometimes hyperkalemia doesn't cause any symptoms. That's why, if you have kidney problems, it's important to tell your doctor and pharmacist about every medicine you take and ask whether you could be at risk for hyperkalemia.
The benefits of taking a medicine if you really need it may outweigh the risk of high potassium. But your doctor might be able to switch you to another medicine that won’t raise potassium.
Show Sources
SOURCES:
American Journal of Emergency Medicine: "Life-threatening hyperkalemia from nutritional supplements: uncommon or undiagnosed?"
Arquivos Brasileiros De Cirurgia Digestiva: "Prevalence and risk factors of hyperkalemia after liver transplantation."
Cleveland Clinic Journal of Medicine: "ACE inhibitors and ARBs: Managing potassium and renal function."
Cureus: "Hyperkalemia from dietary supplements."
Drug Safety: "Drug-induced hyperkalemia."
Mayo Clinic: "Diuretics.," "Pentamidine (Inhalation Route)."
MedlinePlus: "Heparin Injection.," "Trimethoprim."
Medsafe New Zealand: "Medicines and Hyperkalemia."
National Kidney Foundation: "Hyperkalemia (high potassium)," "Your Kidneys and High Potassium (Hyperkalemia): Are You At Risk?"
StatPearls: "ACE Inhibitors.," "Calcineurin Inhibitors."
The BMJ: "Do not forget heparin induced hyperkalemia."
The New England Journal of Medicine: "Trimethoprim-Induced Hyperkalemia in a Patient with AIDS."
