From the Guidelines
Diuretics, particularly thiazide diuretics (like hydrochlorothiazide) and loop diuretics (such as furosemide, bumetanide, and torsemide), are the most common medications that cause hypokalemia, as they increase urinary potassium excretion. According to the most recent and highest quality study 1, these medications can lead to hypokalemia, especially in elderly patients.
Medications that Cause Hypokalemia
The following medications can cause hypokalemia:
- Diuretics: + Thiazide diuretics (e.g., hydrochlorothiazide) + Loop diuretics (e.g., furosemide, bumetanide, and torsemide)
- Other medications: + Beta-agonists (e.g., albuterol and salmeterol) + Insulin (high doses) + Laxatives and enemas (when overused) + Certain psychiatric medications (e.g., antipsychotics) + High-dose corticosteroids (e.g., prednisone, dexamethasone)
Monitoring and Recommendations
Patients taking these medications should be monitored for symptoms of hypokalemia, such as muscle weakness, cramping, or irregular heartbeat, and may need potassium supplementation or medication adjustments if levels drop significantly 1. The mechanism varies by drug class, but generally involves either increased potassium excretion, intracellular shifting of potassium, or decreased potassium intake or absorption.
Key Considerations
It is essential to note that the use of potassium-sparing diuretics, such as triamterene, amiloride, and spironolactone, should be monitored by repeated measurements of serum creatinine and potassium, as they can cause hyperkalemia, especially when combined with ACE inhibitors or in patients with chronic kidney disease 2.
From the FDA Drug Label
As with any effective diuretic, electrolyte depletion may occur during Furosemide tablets therapy, especially in patients receiving higher doses and a restricted salt intake Hypokalemia may develop with Furosemide tablets, 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. In published studies, clinically significant hypokalemia has been consistently less common in patients who received 12. 5 mg of hydrochlorothiazide than in patients who received higher doses. Nevertheless, periodic determination of serum electrolytes should be performed in patients who may be at risk for the development of hypokalemia. Patients should be observed for signs of fluid or electrolyte disturbances, i. e. hyponatremia, hypochloremic alkalosis, and hypokalemia and hypomagnesemia. Hypokalemia may develop, especially with brisk diuresis when severe cirrhosis is present, during concomitant use of corticosteroid or adrenocorticotropic hormone (ACTH) or after prolonged therapy.
Medications that cause hypokalemia (low potassium levels) include:
- Furosemide 3
- Hydrochlorothiazide 4 These medications may cause hypokalemia, especially in certain situations such as brisk diuresis, inadequate oral electrolyte intake, or concomitant use of other medications.
From the Research
Medications that Cause Hypokalemia
The following medications have been associated with hypokalemia (low potassium levels):
- Diuretics, particularly thiazide diuretics, which can cause potassium depletion 5, 6, 7, 8
- Loop diuretics, such as furosemide, which can also lead to potassium loss 7, 9
- Vancomycin, an antibiotic that can cause hypokalemia, especially when used in combination with other medications that increase the risk of potassium depletion 9
Patient Risk Factors
Certain patient populations are at higher risk of developing hypokalemia when taking these medications, including:
- The elderly 5, 8
- Women 6
- Patients with edematous states 5
- Patients taking high doses of diuretics or multiple diuretics 5, 7
- Patients with low dietary potassium intake 8
Prevention and Treatment
Prevention and treatment of hypokalemia may involve: