Aldosterone antagonist and potassium sparing diuretic
Table 6 Medications that Cause Hyperkalemia * ACE inhibitors * Angiotensin receptor blockers * Antifungals * Beta-blockers * Calcium channel blockers * Antibiotics (penicillin G) * Cyclosporine * Digoxin * Aldosterone antagonist * Heparin * Hypertonic solutions (mannitol, glucose) * Non-steroidal anti-inflammatory drugs (NSAIDs) * Pentamidine * Tacrolimus * Potassium sparing diuretics
Sources: Crawford, 2014; Eliacik et al., 2015; Metheny, 2012.
The mechanism by which diuretics block the reabsorption of ions and the site of action varies; they may act at the proximal tubule (carbonic anhydrase inhibitors), loop of Henle (loop diuretics), distal tubule (thiazide diuretics), collecting tubule (potassium sparing diuretics
), or combination of these sites .
Commonly used diuretics are thiazides which are often added with potassium sparing diuretics
. Thiazide diuretics induce a diuresis by blocking sodium reabsorption in the proximal portion of distal tubule of the nephron.
The other two classes are thiazides diuretics and potassium sparing diuretics
. Thiazides inhibit the sodium chloride symporter on the distal convoluted tubule.
Caution is warranted with use of potassium citrate in the setting of chronic renal insufficiency or concomitantly with other drugs that may limit renal potassium excretion, such as potassium sparing diuretics
, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.
Frequently used medications associated with hyperkalemia include: potassium supplements, angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril), angiotensin receptor blockers (ARBs) (e.g., irbesartan), potassium sparing diuretics
(e.g., amiloride), aldosterone antagonists (e.g., spironolactone), non-steroidal anti-inflammatories (e.g., ibuprofen, naproxen) and herbal supplements (e.g., alfalfa) (Sood et al., 2007).