Are Medicines That Lower Potassium Right for You?

This article is for people who have hyperkalemia (high potassium level in the blood), or anyone who wants to learn more about hyperkalemia. The goal of this patient education activity is to help patients understand ways to manage their hyperkalemia.

You will learn:

• What hyperkalemia is, and how to talk to your doctor about it

• What medicines can treat hyperkalemia

• How potassium binders work to lower potassium levels

• How medicines that treat hyperkalemia can affect your quality of life

• Questions to ask your doctor

Potassium plays an important role in helping your heart and other muscles work properly, but it's a balancing act. Too much potassium in your blood -- known as hyperkalemia -- can cause serious heart problems. It can also affect how your nerves and muscles work. In general, potassium levels should be between 3.5 and 5.0 millimoles per liter (mmol/L). A potassium level more than 5.5 mmol/L means you have hyperkalemia.

Reasons Why You May Have Hyperkalemia The following conditions can cause hyperkalemia:

• Chronic kidney disease

• Diabetes

• Congestive heart failure

Patients may also have hyperkalemia from taking heart failure or blood pressure medicines, which change potassium levels.

When discussing hyperkalemia with your doctor, be prepared to provide information about your medical history, diet, and use of medicines. Make sure you tell your doctor about all the medicines you are taking, including over-the-counter products, such as herbs and nutritional supplements.

Your doctor may order a blood test to check your potassium level, as well as an electrocardiogram (ECG) to check your heart rhythm. Most patients will have to repeat these tests to help monitor their hyperkalemia.

Treatments include lifestyle changes and medicines. Your doctor may recommend:

• Cutting down on or avoiding high-potassium foods, or eating a low-potassium diet (about 2000 milligrams [mg] of potassium per day)

• Stopping, switching, or reducing the doses of medicines you are taking that may be causing hyperkalemia

• Taking a diuretic (water pill) or sodium polystyrene sulfonate (Kayexalate^®), unless you have chronic kidney disease

• Using a potassium-binding medicine

• Starting an intravenous (IV) medicine or dialysis (which filters blood through a machine to remove potassium) if your potassium levels are very high

Water pills cause you to urinate more. This helps to remove potassium from your body. Water pills include:

• Bumetanide (Bumex^®)

• Ethacrynic acid (Edecrin^®)

• Furosemide (Lasix^®)

• Torsemide (Demadex^®)

• Chlorothiazide (Diuril^®)

• Chlorthalidone (Thalitone^®)

• Hydrochlorothiazide (Microzide^®)

• Metolazone (Zaroxolyn^®)

• Indapamide (Lozol^®)

Potassium binders are a new medicine that help balance the amount of potassium in your blood. The 2 potassium binders are:

• Patiromer (Veltassa^®)

• Sodium zirconium cyclosilicate (Lokelma^®)

These medicines work by binding to extra potassium in your intestines so that the potassium does not make it into the bloodstream. The extra potassium is eliminated in your stool.

Potassium binders come in a powder that you mix with water, and drink. You cannot take other medicines 2 to 3 hours before or 2 to 3 hours after taking a potassium binder, depending on which medicine your doctor prescribes.

Potassium binders can be taken at the same time as other medicines used to treat diabetes, high blood pressure, or heart failure. In the past, people with these conditions had to stop taking their medicines when taking medicines to treat hyperkalemia.

And some patients may be able to stop dialysis and take a potassium binder. This allows them to take control of their treatment at home.

Side effects from potassium binders and sodium polystyrene sulfonate are usually mild. Intestinal side effects include constipation, diarrhea, nausea, and gas. More serious side effects from sodium polystyrene sulfonate include fast heartbeat, muscle weakness, or swelling.

Let your doctor know if you have any side effects.

Some questions you may want to ask your doctor include:

• Why should I care about high potassium levels?

• Will I always have high potassium levels?

• What medicines am I taking that could cause hyperkalemia?

• What medicines can I take to lower my potassium level?

• What side effects from these medicines should I expect?

• What other steps can I take to control my hyperkalemia?

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