From the Guidelines
Diuretics, particularly loop diuretics (furosemide, bumetanide, torsemide) and thiazide diuretics (hydrochlorothiazide, chlorthalidone), are the most common medications that deplete potassium levels in the body, as they increase urinary excretion of potassium 1.
Key Points to Consider
- The risk of electrolyte depletion is markedly enhanced when 2 diuretics are used in combination, and potassium deficits can be corrected by the short-term use of potassium supplements or, if severe, by the addition of magnesium supplements 1.
- Concomitant administration of ACEIs alone or in combination with potassium-retaining agents (such as spironolactone) can prevent electrolyte depletion in most patients with HF who are taking a loop diuretic 1.
- Other medications that can lower potassium include laxatives when used excessively, certain antibiotics like amphotericin B and aminoglycosides, high-dose penicillins, insulin (which shifts potassium into cells), beta-agonists like albuterol, theophylline, and high-dose steroids 1.
- Patients taking these medications should be aware of symptoms of low potassium (hypokalemia) such as muscle weakness, cramps, irregular heartbeat, and fatigue, and regular monitoring of potassium levels is important for patients on these medications, especially those taking diuretics 1.
Recommendations for Clinical Practice
- Potassium supplementation or consumption of potassium-rich foods may be recommended by healthcare providers for patients on these medications to maintain normal potassium levels 1.
- Close observation and follow-up, including surveillance by the patient and their family, can reduce the likelihood of nonadherence and lead to the detection of changes in body weight or clinical status early enough to allow the patient or a healthcare provider an opportunity to institute treatments that can prevent clinical deterioration 1.
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. 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 deplete potassium:
- Furosemide 2
- Hydrochlorothiazide 3 and 3 Key factors that contribute to potassium depletion:
- High doses of the medication
- Restricted salt intake
- Brisk diuresis
- Inadequate oral electrolyte intake
- Presence of cirrhosis
- Concomitant use of corticosteroids, ACTH, licorice, or laxatives
From the Research
Medications that Deplete Potassium
- Thiazide diuretics, such as hydrochlorothiazide, can cause potassium depletion, leading to hypokalemia 4, 5
- Loop diuretics, such as furosemide, can also cause potassium depletion, especially when used in high doses or in combination with other medications that increase the risk of potassium depletion 4, 6, 7
- The risk of potassium depletion is higher in certain patient groups, such as women, black people, and those with certain medical conditions, such as heart failure or chronic kidney disease 5, 7
Mechanisms of Potassium Depletion
- Thiazide diuretics can cause potassium depletion by increasing the excretion of potassium in the urine, which can lead to hypokalemia 4, 5
- Loop diuretics can also cause potassium depletion by increasing the excretion of potassium in the urine, especially when used in high doses or in combination with other medications that increase the risk of potassium depletion 4, 6, 7
Prevention and Treatment of Potassium Depletion
- Reducing the dose of diuretics and potassium supplementation can help prevent and treat potassium depletion 5
- Combining diuretics with potassium-sparing diuretics or blockers of the renin-angiotensin system can also help reduce the risk of potassium depletion 5, 8
- Lowering salt intake and increasing intake of vegetables and fruits can help reduce blood pressure and prevent potassium depletion 5