What medications can cause hypokalemia?

From the Guidelines

Medications such as diuretics, particularly thiazide and loop diuretics, are well-known to cause hypokalemia due to increased potassium excretion in urine. According to the European Heart Journal study 1, diuretics like thiazides and loop diuretics can lead to hypovolemia, postural hypotension, falls, poor sleep, nocturia, dehydration, electrolyte disturbances (including hypokalemia and hyponatremia), and metabolic disturbances.

Key Medications Causing Hypokalemia

• Diuretics: thiazides and loop diuretics, which increase potassium excretion in urine 1
• Other medications may also contribute to hypokalemia, although the provided evidence does not directly link them to this condition, the primary concern remains with diuretics due to their direct effect on potassium levels.

Monitoring and Recommendations

• Monitoring renal function and electrolytes is crucial when prescribing these medications, especially in elderly patients or those with pre-existing kidney issues 1.
• The study suggests caution in patients with poor mobility, urinary incontinence, acute kidney injury, and electrolyte disturbances when using diuretics 1.
• Avoiding excessive diuresis in elderly patients with heart failure with preserved ejection fraction (HFpEF) is also recommended 1.

From the FDA Drug Label

Furosemide therapy may cause hypokalemia, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives. Hydrochlorothiazide can cause hypokalemia, especially with brisk diuresis when severe cirrhosis is present, during concomitant use of corticosteroid or adrenocorticotropic hormone (ACTH) or after prolonged therapy. Amphotericin B can cause hypokalemia, and rapid intravenous infusion has been associated with hypotension, hypokalemia, arrhythmias, and shock.

Medications that can cause hypokalemia include:

• Furosemide 2
• Hydrochlorothiazide 3
• Amphotericin B 4 These medications can lead to hypokalemia through various mechanisms, including excessive diuresis, electrolyte depletion, and renal impairment. It is essential to monitor serum electrolyte levels and adjust treatment accordingly to prevent or manage hypokalemia.

From the Research

Medications that Cause Hypokalemia

• Diuretics, particularly thiazide diuretics, are a common cause of hypokalemia, as they increase potassium excretion in the urine 5, 6, 7, 8
• Loop diuretics can also cause hypokalemia by increasing potassium loss in the urine 6
• Other medications that can contribute to hypokalemia include:
  • Beta-blockers, which can alter transmembrane potassium movement, although this is more commonly associated with hyperkalemia 9
  • Certain antibiotics, such as trimethoprim and pentamidine, which can impair renal potassium excretion 9
  • Corticosteroids, which can increase potassium excretion in the urine
• The risk of hypokalemia can be increased when multiple medications are used together, particularly when diuretics are combined with other medications that increase potassium loss or impair potassium retention 5, 7, 8

Mechanisms of Hypokalemia

• Medications can cause hypokalemia by:
  • Increasing potassium excretion in the urine (e.g., diuretics) 5, 6, 7, 8
  • Altering transmembrane potassium movement (e.g., beta-blockers) 9
  • Impairing renal potassium excretion (e.g., certain antibiotics) 9
• The degree of hypokalemia can vary depending on the medication, dose, and individual patient factors, such as renal function and dietary potassium intake 5, 6, 7, 8

Clinical Significance of Hypokalemia

• Hypokalemia can cause a range of symptoms, from mild to severe, including muscle weakness, fatigue, and cardiac arrhythmias 5, 6, 7, 8
• Severe hypokalemia can be life-threatening, particularly if it leads to cardiac arrhythmias or respiratory muscle weakness 5, 6, 7, 8
• Monitoring of serum potassium levels and adjustment of medication regimens can help prevent and manage hypokalemia 5, 6, 7, 8