Do atorvastatin (40mg), Zyrtec (10mg) (cetirizine), sertraline (100mg), metformin (500mg daily), Flonase (fluticasone), Jardiance (25mg) (empagliflozin), vitamin D, and folic acid cause hyperkalemia?

From the Guidelines

None of the medications you listed - atorvastatin 40mg, cetirizine 10mg, sertraline 100mg, metformin 500mg daily, fluticasone nasal spray, empagliflozin 25mg, vitamin D, and folic acid - are known to directly cause hyperkalemia. These medications have different mechanisms of action and side effect profiles, but elevating potassium levels is not a common or expected effect of any of them. In fact, according to a recent review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy 1, the primary concerns with these types of medications are related to other potential side effects, such as hypoglycemia with metformin, or the need for monitoring with certain medications, but hyperkalemia is not highlighted as a risk. If you're experiencing symptoms that might suggest hyperkalemia (such as muscle weakness, numbness, or irregular heartbeat) while taking these medications, you should contact your healthcare provider for evaluation, as the cause is likely unrelated to these specific medications and could indicate another underlying condition like kidney dysfunction. Key points to consider include:

• Monitoring renal function and electrolytes, especially in patients with pre-existing kidney issues or those taking medications that could affect potassium levels 1.
• Being aware of the potential for hyperkalemia with certain medications not listed here, such as mineralocorticoid receptor antagonists, which can increase the risk of hyperkalemia, particularly in patients with chronic kidney disease (CKD) or those taking other medications that affect potassium levels 1.
• Recognizing that empagliflozin (Jardiance) may actually slightly lower potassium levels in some patients, which could be beneficial in certain clinical contexts.

From the Research

Medications and Hyperkalemia

The medications listed are atorvastatin (40mg), Zyrtec (10mg) (cetirizine), sertraline (100mg), metformin (500mg daily), Flonase (fluticasone), Jardiance (25mg) (empagliflozin), vitamin D, and folic acid. To determine if any of these medications can cause hyperkalemia, we need to examine the potential of each to influence potassium levels.

Potential Causes of Hyperkalemia

• Atorvastatin: There is no direct evidence to suggest that atorvastatin causes hyperkalemia 2.
• Zyrtec (cetirizine): No evidence suggests that Zyrtec causes hyperkalemia 2.
• Sertraline: There is no indication that sertraline causes hyperkalemia 2.
• Metformin: Metformin is not typically associated with causing hyperkalemia; however, it can affect renal function, which might indirectly influence potassium levels 2.
• Flonase (fluticasone): As a corticosteroid, fluticasone can have systemic effects, but it is not commonly associated with hyperkalemia 2.
• Jardiance (empagliflozin): Empagliflozin, an SGLT2 inhibitor, is not directly linked to hyperkalemia but can affect kidney function and potentially influence electrolyte balance 2.
• Vitamin D and Folic Acid: While vitamin D and folic acid are essential for various bodily functions, they are not typically associated with causing hyperkalemia. However, folic acid is used to treat hyperhomocysteinemia, which is prevalent in patients with renal failure, and there's a complex relationship between folate metabolism and homocysteine levels in uremia 3. Dietary supplements, including those containing potassium, can be under-recognized causes of hyperkalemia, especially in patients with chronic kidney disease 4.

Conclusion on Medication-Induced Hyperkalemia

Based on the provided evidence, none of the listed medications are directly implicated in causing hyperkalemia as a common side effect. However, the use of certain medications, especially those affecting the renin-angiotensin-aldosterone system or kidney function, can increase the risk of hyperkalemia, particularly in patients with pre-existing kidney issues or those taking multiple medications that can influence potassium levels 5, 6. Monitoring and awareness of potential drug interactions and effects on electrolyte balance are crucial in managing patients on multiple medications.