Can any of these medications cause hypokalemia?

Medications That Can Cause Hypokalemia in Your List

Yes, several medications on this list can cause hypokalemia, with albuterol-containing inhalers (Ipratropium-Albuterol Solution, Albuterol Sulfate HFA, and Breo Ellipta) being the primary culprits, along with Milk of Magnesia and levofloxacin as secondary concerns.

Primary Offenders: Beta-Agonist Bronchodilators

Albuterol-containing medications pose the most significant hypokalemia risk from your list:

• Ipratropium-Albuterol Solution, Albuterol Sulfate HFA Inhalation Aerosol, and Breo Ellipta (which contains vilanterol, a long-acting beta-agonist) can all cause hypokalemia through intracellular potassium shifting 1
• The FDA label specifically warns that albuterol may produce significant hypokalemia through intracellular shunting, with potential adverse cardiovascular effects 1
• Repeated dosing with albuterol in children has been associated with asymptomatic declines of 20-25% in serum potassium levels 1
• The decrease is usually transient and doesn't require supplementation in most cases, but monitoring is essential 1
• Sympathomimetics like albuterol lower serum potassium levels, though this is typically only clinically significant with overdosage 2

Secondary Concerns

Milk of Magnesia (magnesium hydroxide):

• Can cause hypokalemia through gastrointestinal losses when used excessively or chronically, as laxatives promote potassium loss through diarrhea 3, 4
• Gastrointestinal losses are a common cause of hypokalemia 3

Levofloxacin:

• Some antibiotics can cause potassium wasting, though this is less common than with other medication classes 5

Medications That Do NOT Cause Hypokalemia

The following medications from your list are not associated with hypokalemia:

• Oxybutynin, Zofran, Eliquis, Vitamin D3, Multivitamins, Antacids, B-12, Famotidine, Senna, Lidocaine patch, Gabapentin, Muscle Rub, Ferrous Sulfate, Azelastine eye drops, Acetaminophen, Methocarbamol, Oxycodone-Acetaminophen, Silver Sulfadiazine, Guaifenesin, Saccharomyces boulardii, and Tamiflu have no established association with hypokalemia 2

Amlodipine (calcium channel blocker) does not cause hypokalemia, though calcium channel blockers can worsen heart failure 6

Potassium Chloride ER Tablet is actually a potassium supplement used to treat hypokalemia, not cause it 5

Critical Monitoring Recommendations

For patients using albuterol-containing inhalers:

• Monitor serum potassium if using high doses, frequent dosing, or in combination with other medications that affect potassium 1
• The American College of Cardiology recommends regular serum potassium checks, especially for patients with cardiovascular conditions, as hypokalemia increases the risk of cardiac arrhythmias 5
• Target serum potassium concentrations in the 4.0-5.0 mEq/L range, as even modest decreases can increase risks of cardiac complications 6

Common pitfall to avoid:

• Don't assume all inhaled medications cause hypokalemia—only beta-agonist bronchodilators have this effect 1, 2
• The hypokalemia from albuterol is usually transient and asymptomatic, so avoid unnecessary potassium supplementation unless levels are persistently low 1