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  • CLASSES

    Alkalinizing Agents
    Carbohydrate IV Solutions and Additives, more than 10%
    Electrolytes with Carbohydrate Solutions
    Potassium Supplements
    Sodium Chloride Solutions with Potassium
    Supplemental Dietary Agents

    DEA CLASS

    OTC, Rx

    DESCRIPTION

    Primary intracellular cation; meats, seafoods, fruits, and vegetables contain substantial amounts; guidelines recommend serum potassium concentrations >= 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias.

    COMMON BRAND NAMES

    Cena K, Effer-K, Epiklor, K Plus, K Plus Care ET, K-Dur, K-Lor, K-Lyte, K-Sol, K-Tab, K-Vescent, Kaon-CL, Kay Ciel, Klor-Con, Klor-Con EF, Klor-Con M10, Klor-Con M15, Klor-Con M20, Klotrix, Micro-K, Micro-K Extencaps, Slow-K

    HOW SUPPLIED

    Cena K/Kaon-CL/Kay Ciel/K-Sol/Potassium Chloride Oral Sol: 15mL, 20mEq, 40mEq
    Effer-K/K Plus Care ET/Klor-Con EF/K-Lyte/K-Vescent/Potassium Bicarbonate/Potassium Bicarbonate, Potassium Chloride Oral Tab Effrv: 25mEq, 10-0.84g, 20-1.68g, 25-1.5g
    Epiklor/K Plus/Kay Ciel/K-Lor/Klor-Con/K-Sol/Potassium Chloride Oral Pwd F/Recon: 20mEq, 25mEq
    K-Dur/Klor-Con/Klor-Con M10/Klor-Con M15/Klor-Con M20/Klotrix/K-Tab/Potassium Chloride/Slow-K Oral Tab ER: 8mEq, 10mEq, 15mEq, 20mEq
    Klor-Con/Micro-K/Micro-K Extencaps/Potassium Chloride Oral Cap ER: 8mEq, 10mEq
    Potassium Acetate/Potassium Chloride/Potassium Chloride, Dextrose/Potassium Chloride, Dextrose, Sodium Chloride/Potassium Chloride, Sodium Chloride Intravenous Inj Sol: 1mL, 2mEq, 4mEq, 10mEq, 20mEq, 30mEq, 40mEq, 50mL, 100mL, 10-5-0.225%, 10-5-0.3%, 10-5-0.45%, 20-0.45%, 20-0.9%, 20-5%, 20-5-0.2%, 20-5-0.225%, 20-5-0.3%, 20-5-0.45%, 20-5-0.9%, 30-5%, 30-5-0.225%, 30-5-0.45%, 40-0.9%, 40-5%, 40-5-0.225%, 40-5-0.45%, 40-5-0.9%
    Potassium Oral Tab: 83mg, 99mg

    DOSAGE & INDICATIONS

    For the treatment of hypokalemia and hypokalemia prevention.
    For the treatment of hypokalemia or digoxin toxicity (arrhythmias or ECG changes) associated with hypokalemia.
    NOTE: Hypokalemia is generally defined as a serum potassium concentration < 3.5 mEq/L; however, serum potassium concentrations do not always correlate with cellular potassium levels. The National Council on Potassium in Clinical Practice recommends that serum potassium concentrations >= 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias.
    NOTE: Although extremely variable and based on clinical conditions of the patient, serum potassium decreases an average of 0.3 mmol/L for each 100-mmol reduction in total body stores. To avoid inducing hyperkalemia when correcting potassium loss, it is recommended to utilize the low end of this estimate and administer a moderate dose (orally, if possible) over a period of days to weeks to fully correct the potassium deficit. Among patients in an intensive care unit treated for acute hypokalemia, 20 mEq/hr potassium chloride IV resulted in a mean increase in the serum potassium concentration of 0.25 mmol/L.
    Intravenous dosage (chloride)

    NOTE: Infusion rate, maximum doses, and maximum concentration may differ according to institutional guidelines and specific patient condition (see Administration).

    Adults with a serum potassium concentration > 2.5 mEq/L

    Per product labeling, administer at a rate not to exceed 10 mEq/hour IV with a 24-hour dose not to exceed 200 mEq. An initial dose of 20—40 mEq IV has been recommended. If an infusion rate exceeding 10 mEq/hr is needed, infuse via a central vein in the presence of continuous cardiac monitoring. Multiple doses may be required to normalize serum potassium. Check serum potassium concentration after administration of 60—80 mEq (within 1—4 hours after administration) before further potassium is administered. 

    Adults with a serum potassium concentration < 2 mEq/L and ECG changes and/or muscle paralysis

    Per product labeling, in critical situations and under continuous cardiac monitoring, potassium may be cautiously administered via a central vein at a rate up to 40 mEq/hr IV not to exceed 400 mEq IV in 24 hours. Initial doses of up to 40—80 mEq have been recommended. Multiple doses may be required to normalize serum potassium. Check serum potassium concentration after administration of 60—80 mEq (within 1—4 hours after administration) before further potassium is administered. Infusion rates exceeding 20 mEq/hr are rarely needed.

    Geriatric

    See adult dosage. Because elderly patients are more likely to have renal dysfunction, the dose should be individualized based on the degree of renal impairment and clinical goals.

    Children

    0.25—0.5 mEq/kg/dose IV. Doses up to 1 mEq/kg IV have been used in critical situations with appropriate monitoring; do not exceed adult doses. Usual infusion rates are 0.25—0.5 mEq/kg/hr. The maximum infusion rate is 1 mEq/kg/hr; do not exceed recommended adult maximum infusion rates. Continuous cardiac monitoring (i.e., continuous ECG) is recommended for higher doses (i.e., > 0.5 mEq/kg) and faster infusion rates.

    Oral dosage (bicarbonate, chloride, citrate, and gluconate)
    Adults

    40—100 mEq/day PO, given in 2—4 divided doses, is used for the treatment of potassium depletion. Adjust dosage according to clinical need and tolerance. Maximum single dose is 20 mEq. The dose should be taken after a meal. Do not exceed 100 mEq/day.

    Geriatric

    See adult dosage. Because elderly patients are more likely to have renal dysfunction, the dose should be individualized based on the degree of renal impairment and clinical goals.

    Oral dosage (chloride and citrate solutions, and gluconate elixir)
    Children

    2—5 mEq/kg/day PO in divided doses.

    For the prevention of hypokalemia.
    NOTE: Hypokalemia is generally defined as a serum potassium concentration < 3.5 mEq/L; however, serum potassium concentrations do not always correlate with cellular potassium levels. The National Council on Potassium in Clinical Practice recommends that serum potassium concentrations >= 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias. In addition, the Council recommends potassium supplementation for patients with potential for diuretic-induced potassium loss (e.g., thiazide or loop diuretics), patients with high sodium intake (or unwilling to reduce salt intake), and patients with reduced GI intake (e.g., GI disturbances, laxative abuse).
    Oral dosage (bicarbonate, chloride, citrate, and gluconate salts)
    Adults

    20 mEq/day PO, given in 1—2 divided doses, is recommended for the prevention of hypokalemia. Maximum single dose is 20 mEq. The dose should be taken after a meal. Adjust dosage according to clinical need and tolerance.

    Geriatric

    See adult dosage. Because elderly patients are more likely to have renal dysfunction, the dose should be individualized based on the degree of renal impairment and clinical goals.

    Children

    1—2 mEq/kg/day PO in 1—2 divided doses.

    MAXIMUM DOSAGE

    Adults

    Per the manufacturer 100 mEq/day PO and up to 400 mEq IV in 24 hours for critical situations.

    Elderly

    Per the manufacturer 100 mEq/day PO and up to 400 mEq IV in 24 hours for critical situations.

    Adolescents

    100 mEq/day PO; do not exceed adult doses.

    Children

    2 mEq/kg/day PO; do not exceed adult doses.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    Dosage should be modified depending on clinical response. Monitor serum potassium levels.

    Renal Impairment

    Dosage should be modified depending on clinical response and degree of renal impairment, but no quantitative recommendations are available. Monitor serum potassium levels and renal function carefully to avoid development of hyperkalemia.

    ADMINISTRATION

    Oral Administration

    NOTE: In oral dosing for hypokalemia, potassium chloride is the salt of choice due to better GI absorption than other potassium salts.
    All oral dosage forms: Administer with a full glass of water (or other liquid) with or immediately after food.

    Oral Solid Formulations

    Effervescent tablets: Do NOT crush or chew. Dissolve in one-half glass (120 mL) of cold water or juice and drink slowly.
    Extended-release tablets: Swallow whole; do NOT crush or chew. Do not allow to dissolve in the mouth. For patients with difficulty swallowing, the following tablets may be broken in half and each half taken separately with a glass of water: Klor-Con M10, Klor-Con M15, Klor-Con M20, K-Dur, and similar generic tablets. Additionally, these formulations can be made into an aqueous solution by placing the whole dose in a glass or cup containing 120 mL of water. Allow 2 minutes for tablets to dissolve and then stir for approximately 30 seconds. Swirl the suspension and drink immediately. To ensure administration of the entire dose, add 30 mL of water to the glass or cup, swirl, and consume immediately; repeat with a final 30 mL water.
    Extended-release capsules: Swallow whole; do NOT crush or chew. Do not allow to dissolve in the mouth. For patients with difficulty swallowing, Micro-K Extencaps (microencapsulated potassium chloride) and similar generic capsules may be opened and sprinkled over soft food or mixed with juice. The soft food, such as applesauce or pudding, should be swallowed immediately without chewing and followed with a glass of cool water or juice to ensure complete swallowing of the microcapsules. The food used should not be hot and should be soft enough to be swallowed without chewing. Any microcapsule/food mixture should be used immediately and not stored for future use.

    Oral Liquid Formulations

    Oral solution: Mix each 15 mL with at least 180 mL of water or juice before taking. Oral solution is sugar-free and contains 5% alcohol.
    Powder for oral solution: Dissolve in one-half glass (120 mL) of cold water or juice and drink slowly.

    Extemporaneous Compounding-Oral

    To minimize fluid volume, the injection may be administered orally, after mixing with infant formula.

    Injectable Administration

    Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

    Intravenous Administration

    Dilution
    Potassium injection must be diluted prior to administration. Injection of concentrated potassium solution has been instantaneously fatal.
    The preferred diluent for intravenous potassium is saline. Diluents containing dextrose should be avoided, as they may worsen hypokalemia by stimulating insulin release that will cause intracellular shifting of potassium.
    Peripheral line: Potassium infusion via a peripheral vein may cause burning pain and phlebitis at the infusion site. For continuous infusion of potassium, the concentration should not exceed 80 mEq/L for peripheral line infusion in adults. The usual maximum recommended concentration in pediatric patients with a peripheral line is 40 mEq/L. In severe hypokalemia, up to 80 mEq/L has been used.
    Central line: For continuous infusion of potassium, the concentration should not exceed 120 mEq/L in adults. The maximum recommended concentration in pediatric patients with a central line is 20 mEq/100 mL (200 mEq/L).
     
    Intravenous infusion
    Maximum concentrations and recommended infusion rates may differ according to institution and patient care setting; potassium injections should NEVER be administered by IV push.
    When administering intravenous potassium solutions, do not use flexible plastic containers in series connections. Such use could result in air embolism due to residual air drawn being drawn from 1 container before administration of the fluid from a secondary container is complete.
    For adults, infuse at a rate of 10 mEq/hour. If an infusion rate exceeding 10 mEq/hour is necessary, infuse via a central line to minimize infusion-related burning and phlebitis and use continuous cardiac monitoring to monitor for signs of hyperkalemia. Infusion rates exceeding 20 mEq/hour are rarely needed. In emergent cases of hypokalemia, infusion rates as high as 40 mEq/hour have been used.
    In pediatric patients, the usual rate of potassium administration is 0.25 to 0.5 mEq/kg/hour ; however, rates as high as 1 mEq/kg/hour (Max: 40 mEq/hour) may be warranted under certain clinical conditions. Higher infusion rates should be infused via a central catheter. Continuous cardiac monitoring (i.e., continuous ECG) is recommended for higher doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour).

    STORAGE

    Generic:
    - Store in a cool, dry place
    Cena K :
    - Protect from light
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    Effer-K:
    - Store at room temperature (between 59 to 86 degrees F)
    Epiklor:
    - Protect from light
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    K Plus:
    - Protect from light
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    K Plus Care ET :
    - Store at room temperature (between 59 to 86 degrees F)
    Kaon-CL:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Kay Ciel :
    - Protect from light
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    K-Dur:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    K-Lor:
    - Protect from light
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    Klor-Con:
    - Protect from light
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    Klor-Con EF:
    - Store at room temperature (between 59 to 86 degrees F)
    Klor-Con M10:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Klor-Con M15:
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    Klor-Con M20:
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    Klotrix:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    K-Lyte:
    - Store at room temperature (between 59 to 86 degrees F)
    K-Sol :
    - Protect from light
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    K-Tab:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    K-Vescent :
    - Store at room temperature (between 59 to 86 degrees F)
    Micro-K:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Micro-K Extencaps:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Slow-K:
    - Protect from light
    - Protect from moisture
    - Store at controlled room temperature (between 68 and 77 degrees F)

    CONTRAINDICATIONS / PRECAUTIONS

    General Information

    Potassium salts are contraindicated in patients with known hypersensitivity to any potassium formulation.

    Adrenal insufficiency, burns, dehydration, diabetic ketoacidosis, geriatric, hyperkalemia, metabolic acidosis, premature neonates, renal disease, renal failure, renal impairment

    Potassium salts are contraindicated in patients with hyperkalemia since a further increase in serum potassium concentration in such patients can produce cardiac arrest. Due to the risk of developing hyperkalemia, potassium supplementation should be used with caution in patients with adrenal insufficiency (untreated Addison's disease); acute dehydration; systemic metabolic acidosis such as diabetic ketoacidosis; in patients receiving salt substitutes, potassium-sparing diuretics (e.g., amiloride, spironolactone, triamterene), ACE inhibitors, angiotensin II antagonists, cyclosporine, or tacrolimus; or in patients with renal disease, renal failure, or renal impairment. Potassium supplements should also be used cautiously in patients with severe burns because these patients are prone to hyperkalemia secondary to tissue breakdown and renal insufficiency. Serum potassium concentrations and renal function should be monitored closely in patients at risk for hyperkalemia. Because geriatric patients are more likely to have decreased renal function, potassium salts should be dosed cautiously based on an assessment of renal function and therapeutic goals. Additionally, monitor other electrolyte concentrations, fluid balance, and acid base balance during long term parenteral potassium therapy or whenever the clinical condition of the patient warrants such monitoring. NOTE: Injectable potassium formulations contain aluminum (content varies with formulation). Thus, aluminum may reach toxic concentrations with prolonged administration in patients with renal impairment. Premature neonates are at particular risk for aluminum toxicity because of immature renal function and they require large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with renal impairment, including neonates, who receive parenteral aluminum at rates greater than 4 to 5 mcg/kg/day may accumulate aluminum at concentrations associated with central nervous system and bone toxicity. Tissue loading may occur at lower administration rates.

    Atrial fibrillation, atrial flutter, AV block, cardiac arrhythmias, digitalis toxicity, heart failure, ventricular arrhythmias, ventricular fibrillation, ventricular tachycardia

    Potassium supplements should be monitored closely in patients with cardiac arrhythmias (e.g., atrial fibrillation, atrial flutter, digitalis toxicity (except due to documented hypokalemia), and ventricular arrhythmias including ventricular fibrillation and ventricular tachycardia), including patients receiving digoxin or other antiarrhythmic therapy. Patients with other cardiac disorders, such as heart failure or AV block, also require close monitoring when receiving potassium salts. Clinical practice guidelines recommend that serum potassium concentrations >= 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias to minimize complications of potassium depletion. In addition, potassium supplementation is recommended for patients at risk for developing hypokalemia and associated complications. Potassium supplementation is specifically recommended for patients with potential for diuretic-induced potassium loss (e.g., receiving thiazide or loop diuretics), patients with high sodium intake (unwilling to reduce salt intake), and patients with reduced GI intake (e.g., GI disturbances, laxative abuse). Continuous cardiac monitoring (i.e., continuous ECG) is recommended for children receiving higher IV doses (i.e., more than 0.5 mEq/kg/dose) and faster infusion rates (i.e., more than 0.3 mEq/kg/hour).

    Esophageal stricture, gastroparesis, GI obstruction, ileus, peptic ulcer disease

    Oral solid dosage forms of potassium salts are contraindicated in patients in whom there is a risk of delayed passage through the GI tract. Patients with gastroparesis, peptic ulcer disease, or GI obstruction, esophageal stricture, or ileus should not receive oral solid dosage forms of potassium supplements due to the potential for gastrointestinal irritation. Esophageal obstruction or compression associated with enlarged left atrium is also a contraindication for potassium oral solid dosage forms due to reports of delayed tablet passage, causing esophageal stricture and ulceration; potassium supplementation, when indicated in such patients, should be given as a liquid preparation. In addition, drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts.

    Pregnancy

    There are no adequate, well controlled studies with potassium salts in pregnant women and animal reproduction studies have not been conducted. Therefore, it is unknown whether potassium salts can cause fetal harm when administered during pregnancy. Use potassium salts during pregnancy only if the potential benefit justifies the potential risk to the fetus.

    Breast-feeding

    Although data are limited, potassium salts appear to be safe and effective to use during breast-feeding to help meet maternal nutritional requirements. The normal potassium ion content of human milk is about 13 mEq/L. Because exogenous potassium becomes part of the body potassium pool, so long as body potassium is not excessive, potassium supplementation should have little or no effect on the concentration in human milk.

    Hepatic disease, metabolic alkalosis, respiratory alkalosis

    Use potassium acetate with caution in patients with metabolic alkalosis or respiratory alkalosis. Patients with severe hepatic disease or hepatic impairment may have decreased excretion or utilization of acetate.

    Extravasation, thrombophlebitis

    When administering concentrated intravenous potassium solutions, use caution to avoid paravenous administration or extravasation. These solutions may be associated with tissue damage, which may be severe and include vascular, nerve, and tendon damage, leading to surgical intervention, including amputation. Secondary complications, such as pulmonary embolism and thrombophlebitis, have been reported as an effect of tissue damage from potassium chloride.

    Muscle channelopathy

    Use potassium salts with caution in patients with potassium-aggravated skeletal muscle channelopathy, such as hyperkalemic periodic paralysis, paramyotonia congenita, and potassium-aggravated myotonia/paramyotonia.

    ADVERSE REACTIONS

    Severe

    arrhythmia exacerbation / Early / Incidence not known
    ventricular fibrillation / Early / Incidence not known
    AV block / Early / Incidence not known
    asystole / Rapid / Incidence not known
    hyperkalemia / Delayed / Incidence not known
    muscle paralysis / Delayed / Incidence not known
    bradycardia / Rapid / Incidence not known
    cardiac arrest / Early / Incidence not known
    GI bleeding / Delayed / Incidence not known
    esophageal stricture / Delayed / Incidence not known
    GI obstruction / Delayed / Incidence not known
    odynophagia / Delayed / Incidence not known
    GI perforation / Delayed / Incidence not known
    esophageal ulceration / Delayed / Incidence not known
    tissue necrosis / Early / Incidence not known
    anaphylactoid reactions / Rapid / Incidence not known
    skin necrosis / Early / Incidence not known
    angioedema / Rapid / Incidence not known
    thrombosis / Delayed / Incidence not known
    aluminum toxicity / Delayed / Incidence not known

    Moderate

    confusion / Early / Incidence not known
    hypotension / Rapid / Incidence not known
    dyspnea / Early / Incidence not known
    dysphagia / Delayed / Incidence not known
    esophagitis / Delayed / Incidence not known
    skin ulcer / Delayed / Incidence not known
    hypervolemia / Delayed / Incidence not known
    erythema / Early / Incidence not known
    chest pain (unspecified) / Early / Incidence not known
    phlebitis / Rapid / Incidence not known
    metabolic acidosis / Delayed / Incidence not known
    metabolic alkalosis / Delayed / Incidence not known
    hyperglycemia / Delayed / Incidence not known
    glycosuria / Early / Incidence not known

    Mild

    hyporeflexia / Delayed / Incidence not known
    weakness / Early / Incidence not known
    paresthesias / Delayed / Incidence not known
    fatigue / Early / Incidence not known
    anxiety / Delayed / Incidence not known
    diarrhea / Early / Incidence not known
    nausea / Early / Incidence not known
    vomiting / Early / Incidence not known
    abdominal pain / Early / Incidence not known
    flatulence / Early / Incidence not known
    injection site reaction / Rapid / Incidence not known
    fever / Early / Incidence not known
    infection / Delayed / Incidence not known
    chills / Rapid / Incidence not known
    rash (unspecified) / Early / Incidence not known

    DRUG INTERACTIONS

    Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Acetaminophen; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Acetaminophen; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Acrivastine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Aliskiren: (Moderate) Due to the risk of hyperkalemia, drugs that increase serum potassium concentration, such as potassium salts or salt substitutes containing potassium should be used cautiously in patients taking aliskiren. Electrolytes should be routinely monitored in patients receiving aliskiren.
    Aliskiren; Amlodipine: (Moderate) Due to the risk of hyperkalemia, drugs that increase serum potassium concentration, such as potassium salts or salt substitutes containing potassium should be used cautiously in patients taking aliskiren. Electrolytes should be routinely monitored in patients receiving aliskiren.
    Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Due to the risk of hyperkalemia, drugs that increase serum potassium concentration, such as potassium salts or salt substitutes containing potassium should be used cautiously in patients taking aliskiren. Electrolytes should be routinely monitored in patients receiving aliskiren.
    Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Due to the risk of hyperkalemia, drugs that increase serum potassium concentration, such as potassium salts or salt substitutes containing potassium should be used cautiously in patients taking aliskiren. Electrolytes should be routinely monitored in patients receiving aliskiren.
    Aliskiren; Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. (Moderate) Due to the risk of hyperkalemia, drugs that increase serum potassium concentration, such as potassium salts or salt substitutes containing potassium should be used cautiously in patients taking aliskiren. Electrolytes should be routinely monitored in patients receiving aliskiren.
    Alkalinizing Agents: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Aluminum Hydroxide: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
    Aluminum Hydroxide; Magnesium Carbonate: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
    Aluminum Hydroxide; Magnesium Hydroxide: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
    Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
    Aluminum Hydroxide; Magnesium Trisilicate: (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
    Amiloride: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Amiloride; Hydrochlorothiazide, HCTZ: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Aminosalicylate sodium, Aminosalicylic acid: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Amlodipine; Benazepril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Amlodipine; Olmesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Amlodipine; Telmisartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Amlodipine; Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Ammonium Chloride: (Major) Citric acid; potassium citrate; sodium citrate and ammonium chloride should not be coadministered as they have opposing actions. It would be illogical to administer an acidifying agent (ammonium chloride) with a urinary alkalinizer (citric acid; potassium citrate; sodium citrate). (Major) It would be illogical to administer potassium salts, a systemic alkalinizer, concurrently with ammonium chloride, an acidifying agent.
    Amphetamines: (Major) Concurrent use of amphetamines with urinary alkalinizing agents (e.g., sodium lactate, sodium acetate, potassium citrate, citric acid; sodium citrate, and tromethamine) should be avoided if possible. Urinary alkalinizers diminish the urinary excretion of amphetamines by increasing the proportion of non-ionized amphetamines, resulting in increased renal tubular reabsorption of the amphetamines. The half-life and therapeutic actions of amphetamines will be prolonged. The amphetamine dose should be adjusted accordingly if avoiding co-use is not possible. Monitor for high blood pressure, increased heart rate, nervousness, palpitations, insomnia, or changes in moods and behaviors.
    Angiotensin II receptor antagonists: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Angiotensin-converting enzyme inhibitors: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Anticholinergics: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Aspirin, ASA: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Butalbital; Caffeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Caffeine; Dihydrocodeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Carisoprodol: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Dipyridamole: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Omeprazole: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Oxycodone: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Aspirin, ASA; Pravastatin: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Atropine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Atropine; Difenoxin: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids. (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy.
    Atropine; Diphenoxylate: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids. (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy.
    Atropine; Edrophonium: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Atropine; Hyoscyamine; Phenobarbital; Scopolamine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Azelastine; Fluticasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Azilsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Azilsartan; Chlorthalidone: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Beclomethasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Belladonna Alkaloids; Ergotamine; Phenobarbital: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Belladonna; Opium: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Benazepril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Benazepril; Hydrochlorothiazide, HCTZ: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Benzphetamine: (Major) Urinary alkalinizers, such as potassium citrate diminish the urinary excretion of benzphetamine. These medications increase the proportion of non-ionized amphetamines, resulting in increased renal tubular reabsorption of these compounds. The half-life and therapeutic actions of benzphetamine will be prolonged in the presence of potassium citrate. This combination should be avoided.
    Benztropine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Betamethasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Bismuth Subsalicylate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Brompheniramine; Hydrocodone; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Brompheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Budesonide: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Budesonide; Formoterol: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Calcium Carbonate: (Severe) Avoid coadministration due to the risk of metabolic alkalosis. Some antacids, like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
    Calcium Carbonate; Magnesium Hydroxide: (Severe) Avoid coadministration due to the risk of metabolic alkalosis. Some antacids, like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
    Calcium Carbonate; Risedronate: (Severe) Avoid coadministration due to the risk of metabolic alkalosis. Some antacids, like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
    Calcium; Vitamin D: (Severe) Avoid coadministration due to the risk of metabolic alkalosis. Some antacids, like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
    Candesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Candesartan; Hydrochlorothiazide, HCTZ: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Captopril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Captopril; Hydrochlorothiazide, HCTZ: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Carbetapentane; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Carbinoxamine; Hydrocodone; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Carbinoxamine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Cetirizine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Chlordiazepoxide; Clidinium: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Chlorpheniramine; Hydrocodone; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Chlorpheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Chlorpropamide: (Moderate) Urinary alkalinizing agents may increase the excretion of chlorpropamide by increasing renal clearance. Monitor for decreased efficacy of chlorpropamide (i.e., increased blood glucose) during coadministration. (Moderate) Urinary alkalinizing agents, like potassium citrate, may increase the excretion of chlorpropamide by increasing renal clearance. Monitor for decreased efficacy of chlorpropamide (i.e., increased blood glucose) during coadministration.
    Choline Salicylate; Magnesium Salicylate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Chondroitin; Glucosamine: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Ciclesonide: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Citric Acid; Potassium Citrate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Citric Acid; Potassium Citrate; Sodium Citrate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Colchicine: (Moderate) Colchicine is an alkaloid and its action is potentiated by alkalinizing agents like potassium citrate. The colchicine dose may need adjustment. (Moderate) The action of colchicine is potentiated by alkalinizing agents. The colchicine dose may need adjustment.
    Corticosteroids: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Corticotropin, ACTH: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Cortisone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Cyclosporine: (Moderate) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as cyclosporine. Concurrent use can cause severe and potentially fatal hyperkalemia, especially in patients with other risk factors for hyperkalemia (i.e., severe renal impairment). Monitor potassium concentrations during concurrent therapy.
    Darifenacin: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Deflazacort: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Desloratadine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Dexamethasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Dextromethorphan; Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Dextromethorphan; Quinidine: (Major) Alkalinizing agents such as potassium citrate can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. (Major) Urinary alkalinization increases the renal tubular reabsorption of quinidine, resulting in higher quinidine serum concentrations which may lead to toxicity. Avoid citric acid; potassium citrate; sodium citrate administration to any patient receiving treatment with quinidine.
    Dicyclomine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Digoxin: (Minor) Potassium levels should be monitored closely in patients receiving digoxin and potassium supplementation. Both hypokalemia and hyperkalemia increase the risk of digoxin toxicity. Some patients at increased risk are patients with renal impairment, patients on diuretics, and patients who are on potassium-sparing medications concurrently. Monitor renal function, potassium concentrations, and digoxin concentrations and clinical response during concurrent treatment.
    Dihydrocodeine; Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Donepezil; Memantine: (Moderate) Increases in urinary pH may decrease elimination of memantine, resulting in drug accumulation and potential toxicity. (Moderate) Urinary alkalinizing agents may decrease the elimination of memantine, resulting in drug accumulation and potential toxicity. The clearance of memantine is reduced by about 80% under alkaline urine conditions at pH 8. Memantine should be used with caution with drugs known to increase urinary pH.
    Drospirenone; Estradiol: (Moderate) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. The concurrent use of potassium-containing products may increase the risk of hyperkalemia, especially in the presence of renal impairment. Monitor serum potassium if potassium is used concurrently with drospirenone, particularly during the 1st month of treatment.
    Drospirenone; Ethinyl Estradiol: (Moderate) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. The concurrent use of potassium-containing products may increase the risk of hyperkalemia, especially in the presence of renal impairment. Monitor serum potassium if potassium is used concurrently with drospirenone, particularly during the 1st month of treatment.
    Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. The concurrent use of potassium-containing products may increase the risk of hyperkalemia, especially in the presence of renal impairment. Monitor serum potassium if potassium is used concurrently with drospirenone, particularly during the 1st month of treatment.
    Enalapril, Enalaprilat: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Enalapril; Felodipine: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Enalapril; Hydrochlorothiazide, HCTZ: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Ephedrine: (Moderate) The renal elimination of ephedrine susceptible to changes in urinary pH. Potassium citrate is a urinary alkalinizing agent. Concomitant administration of ephedrine with urinary alkalinizers may increase the likelihood of adverse reactions.
    Eplerenone: (Severe) Eplerenone should not be used concomitantly with potassium salts or supplements (including dietary salt substitutes containing potassium) because of the increased risk of developing hyperkalemia. The use of eplerenone in hypertensive patients treated with these medications is contraindicated. When potassium use for replacement purposes is medically necessary, use together with extreme caution, as both drugs increase serum potassium concentrations. Patients at risk for hyperkalemia include elderly patients or patients with impaired renal function. Patients should have serum potassium and other electrolyte concentration determinations at periodic intervals.
    Eprosartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Eprosartan; Hydrochlorothiazide, HCTZ: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Fesoterodine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Fexofenadine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Flavoxate: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Flecainide: (Moderate) Urinary alkalinization can decrease the renal clearance of flecainide, resulting in an increased elimination half-life and AUC for flecainide.
    Fludrocortisone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Flunisolide: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Fluticasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Fluticasone; Salmeterol: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Fluticasone; Umeclidinium; Vilanterol: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Fluticasone; Vilanterol: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Food: (Severe) Foods, seasonings, or medicines containing high potassium or sodium content, such as dietary salt substitutes, 'low salt' milk products (which contain potassium), or tomato juice (which has high sodium content), could increase the risk of complications of hyperkalemia or sodium excess. Regularly monitor the serum potassium and/or sodium concentration in patients taking food or medications with high potassium and/or sodium content. Muscle weakness, chest pain, or an abnormal heart rhythm can indicate hyperkalemia. Abdominal pain, diarrhea, metabolic alkalosis, nausea, vomiting, and seizures can indicate sodium excess.
    Formoterol; Mometasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Fosinopril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Fosinopril; Hydrochlorothiazide, HCTZ: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Glucosamine: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Glycopyrrolate: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Glycopyrrolate; Formoterol: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Guaifenesin; Potassium Guaiacolsulfonate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Heparin: (Moderate) In some cases, heparin can cause hyperkalemia. Chronic heparin therapy may predispose a patient to develop hyperkalemia, especially patients with renal impairment and those receiving potassium-containing medications, such a potassium salts. Monitoring of serum potassium is recommended as indicated.
    Hetastarch; Dextrose; Electrolytes: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Homatropine; Hydrocodone: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Hydrochlorothiazide, HCTZ; Irbesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Hydrochlorothiazide, HCTZ; Lisinopril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Hydrochlorothiazide, HCTZ; Losartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Hydrochlorothiazide, HCTZ; Moexipril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Hydrochlorothiazide, HCTZ; Olmesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Hydrochlorothiazide, HCTZ; Quinapril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Hydrochlorothiazide, HCTZ; Spironolactone: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Hydrochlorothiazide, HCTZ; Telmisartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Hydrochlorothiazide, HCTZ; Triamterene: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Hydrochlorothiazide, HCTZ; Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Hydrocodone; Potassium Guaiacolsulfonate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm). (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Hydrocodone; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Hydrocortisone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Hyoscyamine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Ibritumomab Tiuxetan: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Ibuprofen; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Indacaterol; Glycopyrrolate: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Iodine; Potassium Iodide, KI: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Irbesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Lisdexamfetamine: (Major) Urinary alkalinizers, such as potassium citrate, diminish the urinary excretion of amphetamines. These drug combinations should be avoided, especially in amphetamine overdose situations.
    Lisinopril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Lithium: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with lithium, especially patients who are stabilized on lithium, as urinary alkalinization increases the renal clearance of lithium. If coadministration can not be avoided, monitor lithium serum concentrations and patient clinical response very closely. Also of note, lithium clearance is increased if hypernatremia occurs. (Moderate) Moderate to significant dietary sodium changes, or changes in sodium and fluid intake, may affect lithium excretion. Systemic sodium chloride administration may result in increased lithium excretion and therefore, decreased serum lithium concentrations. In addition, high fluid intake may increase lithium excretion. For patients receiving sodium-containing intravenous fluids, symptom control and lithium concentrations should be carefully monitored. It is recommended that patients taking lithium maintain consistent dietary sodium consumption and adequate fluid intake during the initial stabilization period and throughout lithium treatment. Supplemental oral sodium and fluid should be only be administered under careful medical supervision.
    Loperamide: (Minor) Drugs that decrease GI motility, like loperamide, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts.
    Loperamide; Simethicone: (Minor) Drugs that decrease GI motility, like loperamide, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts.
    Loratadine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Losartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Magnesium Salicylate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Memantine: (Moderate) Increases in urinary pH may decrease elimination of memantine, resulting in drug accumulation and potential toxicity. (Moderate) Urinary alkalinizing agents may decrease the elimination of memantine, resulting in drug accumulation and potential toxicity. The clearance of memantine is reduced by about 80% under alkaline urine conditions at pH 8. Memantine should be used with caution with drugs known to increase urinary pH.
    Mepenzolate: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Methamphetamine: (Major) As potassium citrate is a urinary alkalinizer, use will diminish the urinary excretion of and increase the half-life of amphetamines. The interaction of amphetamines with urinary alkalinizers is well documented. Avoid concurrent use, especially in amphetamine overdose situations.
    Methenamine: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended.
    Methenamine; Sodium Acid Phosphate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended.
    Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended.
    Methscopolamine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Methylprednisolone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Moexipril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Mometasone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Naproxen; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Nebivolol; Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Olmesartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Oxybutynin: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Penicillin G: (Minor) Concomitant use of high doses of parenteral penicillin G potassium with potassium salts can cause hyperkalemia.
    Perindopril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Perindopril; Amlodipine: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Potassium Citrate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Potassium Iodide, KI: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Potassium Phosphate; Sodium Phosphate: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Potassium: (Major) There is an increased risk of developing hyperkalemia with the concurrent use of potassium salts and other products that contain a potassium salt, including citric acid; potassium citrate; sodium citrate. If these drugs must be coadministered, regularly monitor the serum potassium concentration and for signs/symptoms of hyperkalemia (muscle weakness, chest pain, or an abnormal heart rhythm).
    Potassium-sparing diuretics: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Prednisolone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Prednisone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Propantheline: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
    Quinapril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Quinidine: (Major) Alkalinizing agents such as potassium citrate can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. (Major) Urinary alkalinization increases the renal tubular reabsorption of quinidine, resulting in higher quinidine serum concentrations which may lead to toxicity. Avoid citric acid; potassium citrate; sodium citrate administration to any patient receiving treatment with quinidine.
    Quinine: (Moderate) Alkalinization of the urine by alkalinizing agents can decrease the renal clearance of quinine. Increased plasma levels of quinine following reduced clearance can increase the risk of quinine-induced toxicity.
    Ramipril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Sacubitril; Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Salicylates: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Salsalate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
    Scopolamine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Sodium Polystyrene Sulfonate: (Severe) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
    Solifenacin: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Examples of drugs that significantly decrease GI motility include the antimuscarinics. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Spironolactone: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Trimethoprim should also be used with caution with other drugs known to cause significant hyperkalemia such as potassium salts.
    Tacrolimus: (Moderate) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as tacrolimus. Concurrent use can cause severe and potentially fatal hyperkalemia, especially in patients with other risk factors for hyperkalemia (i.e., severe renal impairment). Monitor potassium concentrations during concurrent therapy.
    Telmisartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.
    Tolterodine: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Examples of drugs that significantly decrease GI motility include the antimuscarinics. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Tolvaptan: (Moderate) Coadministration of tolvaptan and hypertonic saline (e.g., 3% NaCl injection solution) is not recommended. The use of hypertonic sodium chloride in combination with tolvaptan may result in a too rapid correction of hyponatremia and increase the risk of osmotic demyelination (i.e., central pontine myelinolysis).
    Trandolapril: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Trandolapril; Verapamil: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as ACE inhibitors. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Triamcinolone: (Moderate) Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. (Moderate) Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels. Also, there have been reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizure disorder. Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids.
    Triamterene: (Major) Potassium supplements should be used with caution in patients taking drugs that may increase serum potassium levels, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. In addition, potassium sulfate is found in some bowel preps, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as potassium-sparing diuretics. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function.
    Trientine: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and trientine each inhibit oral absorption of the other, 2 hours should elapse between administration of trientine and iron doses.
    Trihexyphenidyl: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Trimethoprim: (Moderate) Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Trimethoprim should also be used with caution with other drugs known to cause significant hyperkalemia such as potassium salts.
    Trospium: (Major) Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Examples of drugs that significantly decrease GI motility include the antimuscarinics. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days. Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Results indicated that subjects administered wax-matrix tablets had the highest incidence of erosions (43%) and ulcers (11%). Evidence of GI irritation was less frequent among subjects receiving liquid (0%) and microencapsulated (10.5% erosions, 1.2% ulcers) formulations. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
    Valsartan: (Major) Potassium salts should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients. Also, use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Major) Products containing a potassium salt, including citric acid; potassium citrate; sodium citrate, should be used with caution in patients taking drugs that may increase serum potassium concentrations, such as angiotensin II receptor antagonists. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Coadministration may also result in increases in serum creatinine in heart failure patients.

    PREGNANCY AND LACTATION

    Pregnancy

    There are no adequate, well controlled studies with potassium salts in pregnant women and animal reproduction studies have not been conducted. Therefore, it is unknown whether potassium salts can cause fetal harm when administered during pregnancy. Use potassium salts during pregnancy only if the potential benefit justifies the potential risk to the fetus.

    Although data are limited, potassium salts appear to be safe and effective to use during breast-feeding to help meet maternal nutritional requirements. The normal potassium ion content of human milk is about 13 mEq/L. Because exogenous potassium becomes part of the body potassium pool, so long as body potassium is not excessive, potassium supplementation should have little or no effect on the concentration in human milk.

    MECHANISM OF ACTION

    Mechanism of Action: Potassium is actively transported into cells through a process facilitated by dextrose, insulin, and oxygen. Transport maintains a high potassium gradient across cell membranes, thus playing a vital role in electrical excitability of nerves and muscle. Relatively high intracellular potassium concentrations leads to passive diffusion out of the cell. The membrane gradient is responsible for the resting transmembrane electric potential, primarily determined by the diffusion of potassium out of the cell. Membrane depolarization will occur only when a current is applied to the nerve that exceeds the outward potassium current. This is usually accomplished by sodium rushing into the cell by fast inward channels, causing the action or 'spike' potential. Repolarization is partially but quickly attained by potassium flowing out of the cell through its own channel.Hydrogen ions are also in higher concentration inside cells. When the extracellular hydrogen ion concentration is increased, as occurs in acidosis, potassium shifts to the extracellular environment; when it is decreased, potassium ions move into the cells. Hypo- or hyperkalemia can initiate changes in concentration of other ions. In the former state, when potassium becomes depleted, as the ion leaves the cell it is exchanged with extracellular sodium and hydrogen ions to maintain electroneutrality. The redistribution of hydrogen ions causes intracellular acidosis and extracellular alkalosis. The opposite happens in hyperkalemia.Within or near the normal range of potassium balance, the ion plays a part in regulating renal synthesis of ammonia and in the pH of urine. A decrease in dietary intake of potassium stimulates renal synthesis of ammonia and increases urinary pH slightly by diminishing net acid secretion. If potassium loss is low, metabolic acidosis results. Greater potassium loss can cause systemic metabolic alkalosis and intracellular acidosis. Tubular secretion of potassium is inhibited by acidemia and stimulated by alkalemia.

    PHARMACOKINETICS

    Potassium salts are administered orally and intravenously.  Potassium first enters the extracellular fluid and is then actively transported into cells. Skeletal muscle accounts for the bulk of the intracellular store of potassium. Renal excretion of potassium normally is equal to the amount being absorbed in the diet. Potassium is freely filtered at the glomerulus and almost completely reabsorbed in the proximal tubule. Tubular secretion occurs in the late distal convoluted tubule and collecting duct, and accounts for the potassium excreted in the urine, which is about 10% of the amount filtered. Fecal elimination of potassium is minimal and plays no significant role in potassium homeostasis.
     
    Although extremely variable and based on clinical conditions of the patient, serum potassium decreases an average of 0.3 mmol/L for each 100-mmol reduction in total body stores. Among patients in an intensive care unit treated for acute hypokalemia, 20 mEq/hr potassium chloride IV resulted in a mean increase in the serum potassium concentration of 0.25 mmol/L.

    Oral Route

    Potassium salts are well absorbed in the GI tract. Potassium chloride embedded in a wax matrix (Kaon-Cl, Slow-K) is prepared in such a way as to leach the salt slowly from the tablet and gradually deliver it over a large segment of the intestine. Pathologically high concentrations of potassium chloride are unlikely with this dosage form unless passage through the GI tract is either delayed or blocked, as occurs in diabetic gastroparesis. Normally, the concentration of potassium in the GI tract is about 2—3 times that of the plasma, but almost all the dietary potassium is eventually absorbed.