Drugs Q & A

What Drugs Can Cause Low Potassium Levels?

Potassium is an electrolyte that the body needs to stay healthy. As the American Heart Association (AHA) note, foods that contain potassium can help manage blood pressure by reducing the negative impact of sodium. Potassium is necessary for the normal functioning of all cells. It regulates the heartbeat, ensures proper function of the muscles and nerves, and is vital for synthesizing protein and metabolizing carbohydrates.

Potassium may play a role in bone health. Studies have suggested that people who eat a lot of fruits and vegetables that contain potassium may have higher bone mineral density. A diet high in potassium may also help preserve muscle mass in older people and people who have health conditions that lead to muscle wasting.

What is Hypokalemia?

Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Moderate hypokalemia is a serum level of 2.5-3.0 mEq/L, and severe hypokalemia is a level of less than 2.5 mEq/L. Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced (typically caused inadvertently, through an incorrect diagnosis or the prescription of medicine that ends up doing harm).

Medications cause hypokalemia through a variety of mechanisms, including intracellular potassium shifting, increased renal loss, and/or stool loss. In the geriatric population, medication-induced hypokalemia is very common. Severe deficiencies can be life-threatening.

 Signs of a potassium deficiency include:

  • extreme fatigue
  • muscle spasms, weakness, or cramping
  • irregular heartbeat
  • constipation, nausea, or vomiting
What Drugs Can Cause Low Potassium Levels

What Drugs Can Cause Low Potassium Levels?

List Medications Associated With Hypokalemia

Medication ClassExamples of Common DrugsMechanism
AntimicrobialsNafcillin, Ampicillin, Penicillin, Aminoglycosides*,Amphotericin B* Foscarnet*Renal potassium loss
Beta2-receptor agonistsAlbuterol Ephedrine Epinephrine Formoterol Isoproterenol Pseudoephedrine Terbutaline SalmeterolShift of potassium from extracellular fluid to intracellular fluid compartment
DiureticsAcetazolamide Bumetanide Chlorthalidone Ethacrynic acid Furosemide Indapamide Metolazone Thiazides TorsemideRenal potassium loss
InsulinHigh dose (overdose)Shift of potassium from extracellular fluid to intracellular fluid compartment
Mineralocorticoids and glucocorticoidsHydrocortisone Fludrocortisone PrednisoneRenal potassium loss
LaxativesSodium polystyrene sulfonate Phenolphthalein SorbitolStool (gastrointestinal) potassium loss
XanthinesTheophylline CaffeineShift of potassium from extracellular fluid to intracellular fluid compartment
OtherVerapamil (in overdose)Shift of potassium from extracellular fluid to intracellular fluid compartment

Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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