Medications That Can Cause Hyperkalemia
Among the medications listed, sodium polystyrene sulfonate is specifically used to TREAT hyperkalemia, not cause it, while several others have potential to contribute to elevated potassium levels through various mechanisms.
Medications That May Cause Hyperkalemia
Metoprolol Succinate (Beta-Blocker)
- Beta-blockers impair potassium excretion by reducing renin release and decreasing cellular potassium uptake 1
- The combination of beta-blockers with other medications affecting potassium homeostasis dramatically amplifies hyperkalemia risk 1
- Beta-blockers may need to be temporarily discontinued or reduced in patients who develop hyperkalemia 2
Calcitriol (Vitamin D Analog)
- Vitamin D analogs can theoretically increase intestinal calcium absorption and affect electrolyte balance, though this is not a primary mechanism for hyperkalemia 3
- The risk is generally low in patients with normal renal function 3
Famotidine (H2 Blocker)
- H2 blockers are not typically associated with clinically significant hyperkalemia 3
- This medication poses minimal risk for potassium elevation 4
Medications That Do NOT Cause Hyperkalemia
Sodium Polystyrene Sulfonate (Kayexalate)
- This medication is specifically indicated for the TREATMENT of hyperkalemia, not a cause 5
- It works by exchanging sodium for potassium in the gastrointestinal tract 5
- The FDA label indicates it should be administered at least 3 hours before or after other oral medications 5
- However, sodium polystyrene sulfonate is associated with serious gastrointestinal adverse events including intestinal necrosis, particularly when used with sorbitol 5
Other Medications Listed
- Rena-Vite, Acetaminophen, Eliquis (Apixaban), Ferrous Sulfate, Milk of Magnesia, Vitamin C, Mirtazapine, BPCO Ointment, Lorazepam, Fleet Enema, Bisacodyl, and ABH Gel do not have established mechanisms for causing hyperkalemia 4, 3
Critical Clinical Context
Risk Factors That Increase Hyperkalemia Risk
- Chronic kidney disease is the most important risk factor, as impaired renal potassium excretion is the dominant cause of sustained hyperkalemia 2, 3
- Diabetes mellitus increases risk through impaired aldosterone secretion, creating functional Type 4 RTA 1
- Concurrent use of multiple medications affecting potassium homeostasis 6
Monitoring Recommendations
- For patients on beta-blockers with risk factors (CKD, diabetes, heart failure), check potassium within 7-10 days after starting or increasing doses 2
- More frequent monitoring is required in high-risk patients with history of hyperkalemia 2
- Target potassium range should be 4.0-5.0 mEq/L to minimize mortality risk 7, 2
Important Caveats
Drug Interactions
- The combination of beta-blockers with RAAS inhibitors (ACE inhibitors, ARBs) dramatically amplifies hyperkalemia risk 1
- NSAIDs should be avoided as they impair renal potassium excretion 6, 2
- Potassium supplements and salt substitutes should be eliminated in patients at risk 2
When to Intervene
- Hyperkalemia >5.5 mEq/L requires intervention, particularly in patients with cardiac disease or on multiple potassium-affecting medications 6, 2
- ECG changes (peaked T waves, widened QRS, prolonged PR interval) indicate urgent treatment regardless of potassium level 2
- Consider newer potassium binders (patiromer or sodium zirconium cyclosilicate) to enable continuation of life-saving medications like beta-blockers when needed 2, 8