11 Medications That Can Cause High Potassium Levels

Potassium is a mineral that helps move fluids and nutrients in and out of cells. It helps nerves and muscles function normally. From maintaining your blood pressure to helping your heart beat normally, it plays a big role in your overall health.

High potassium levels can cause serious health problems in rare cases. But most of the time, the problem is mild and easily treated. There are many possible causes of abnormal potassium levels, including medications and supplements. Here, we’ll discuss 11 oral medications that can cause high potassium levels.

Good to know: A potassium level in the blood that's greater than 5 milliequivalents (mEq) per liter (L) is considered high (hyperkalemia). A potassium level that’s 6 mEq/L or higher is considered especially dangerous. This can affect your heart’s ability to stay in rhythm, potentially leading to an arrhythmia.

1. Potassium supplements

Taking potassium supplements can cause hyperkalemia. Common potassium supplements are available over the counter (OTC), but some require a prescription. Examples include:

• Potassium chloride (OTC and prescription)

• Potassium citrate (OTC and prescription)

• Potassium bicarbonate (prescription)

• Potassium gluconate (OTC)

Potassium is also included in many multivitamins and supplements. That’s why it’s a good idea to give all your healthcare professionals (HCPs) a list of medications and OTC products you take, including multivitamins. They can check to see whether you’re taking any potassium products. 

If you’re taking potassium supplements and other medications that can increase your potassium levels, your HCP may check your potassium levels more regularly. In some cases, they may adjust your medication regimen.

For a list of medications that can increase potassium levels when combined with potassium supplements, refer to our GoodRx Health article on potassium citrate interactions.

2. ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors treat high blood pressure (hypertension) and heart failure, among other conditions. Examples include:

• Lisinopril (Zestril)

• Enalapril (Vasotec)

• Quinapril (Accupril)

• Benazepril (Lotensin)

Along with several other blood pressure medications, ACE inhibitors can increase potassium levels as a side effect. They do this by blocking the release of aldosterone. This is a hormone that promotes potassium removal from the body through urine.

The risk of developing hyperkalemia from ACE inhibitors is relatively low. For example, a large  study found that hyperkalemia occurred in about 6% of people taking an ACE inhibitor or angiotensin II receptor blocker (ARB). Less than 1% of people had severe hyperkalemia (potassium greater than 6 mEq/L). But this was for people with normal kidney function. 

If you have kidney problems, your risk of hyperkalemia is higher. The risk is also greater if you have diabetes or take other medications that increase potassium.

For a list of medications that can increase potassium levels when combined with ACE inhibitors, refer to our GoodRx Health article on lisinopril interactions.

3. ARBs

ARBs have a lot in common with ACE inhibitors. They treat many of the same health conditions and work similarly. Examples include losartan (Cozaar), olmesartan (Benicar), and valsartan (Diovan). 

Along with ACE inhibitors, ARBs may raise potassium levels by decreasing aldosterone. And health conditions such as kidney disease or diabetes increase your risk of hyperkalemia from ARBs.

It’s not clear whether ACE inhibitors or ARBs are more likely to cause hyperkalemia. Some studies suggest ACE inhibitors are more likely to cause hyperkalemia. But other studies suggest the opposite. Regardless, the risk of hyperkalemia is one reason ACE inhibitors and ARBs shouldn’t be combined.

For a list of medications that can increase potassium levels when combined with ARBs, refer to our GoodRx Health article on losartan interactions.

4. Beta blockers

Beta blockers are medications that treat several heart conditions. These include heart failure, arrhythmias, and chest pain. They also treat hypertension. Examples of beta blockers include:

• Atenolol (Tenormin)

• Carvedilol (Coreg) 

• Metoprolol tartrate (Lopressor)

• Propranolol (Inderal LA, Innopran XL)

While beta blockers aren’t as well-known for causing hyperkalemia compared with ACE inhibitors or ARBs, they can increase potassium levels. 

If you have high potassium levels from a beta blocker or other medications discussed in this article, you may need to decrease your intake of high potassium-containing foods. You may also need to avoid taking potassium supplements while taking a beta blocker. But your prescriber can let you know if this is necessary, as potassium-rich foods have many health benefits.

5. Spironolactone

Spironolactone (Aldactone) is part of a group of medications called aldosterone antagonists. It’s also considered a type of potassium-sparing diuretic, which we will discuss in the next section.

Spironolactone can treat several medical conditions, including hypertension and heart failure. It’s also considered a type of diuretic (water pill) and treats swelling (edema) from conditions such as kidney disease.

Spironolactone (and other aldosterone antagonists such as eplerenone) can cause hyperkalemia by preventing potassium loss through urine. If you have certain health conditions that cause high potassium levels, such as Addison’s disease, you should avoid spironolactone.

For a list of medications that can increase potassium levels when combined with spironolactone, refer to our GoodRx Health article on spironolactone interactions.

6. Potassium-sparing diuretics

Amiloride (Midamor) and triamterene (Dyrenium) are two examples of potassium-sparing diuretics. They’re used to treat some of the same medical conditions as spironolactone.

Similarly, potassium-sparing diuretics can cause hyperkalemia by preventing potassium loss in your urine. When these diuretics are taken with other diuretics such as hydrochlorothiazide (Microzide), the risk is lower. Regardless, your prescriber will monitor your potassium levels if you take diuretics such as amiloride or triamterene. This is especially true when you first start them or anytime your dose changes.

7. Aliskiren

Aliskiren (Tekturna) is part of a group of medications called direct renin inhibitors. It treats hypertension. But it works on the same system in the body as ARBs and ACE inhibitors, so it can similarly increase potassium levels. 

In most cases, the risks of combining an ACE inhibitor or ARB with aliskiren outweigh any potential benefits. This is especially true if you have kidney problems or diabetes. Aliskiren generally shouldn’t be combined with an ACE inhibitor or ARB.

8. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and celecoxib (Celebrex) treat fever, pain, and inflammation. They may also increase potassium levels by lowering aldosterone levels, along with another substance called prostaglandin. These actions reduce the amount of potassium that leaves your body through urine.

Research on whether NSAIDs cause hyperkalemia is mixed. But some studies show that NSAIDs can increase potassium levels. This may be especially true in certain groups of people, such as those with diabetes.

Hyperkalemia may be more common with certain NSAIDs such as celecoxib. But regardless of which NSAID you take, it’s a good idea to use caution if you’re taking other medications known to increase potassium.

9. Some immunosuppressants

Cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf) help the body accept organ transplants. These medications affect the release of a hormone called renin, which is needed to make aldosterone. And lower aldosterone levels prevent potassium from leaving the body through your urine.

You may experience hyperkalemia if you take cyclosporine or tacrolimus. If you’re taking one of these medications, your transplant team will likely monitor your potassium levels regularly. This is especially true if you take other medications that increase potassium. So make sure to keep up with any appointments for blood work.

For a list of medications that can increase potassium levels when combined with these immunosuppressants, refer to our GoodRx Health article on tacrolimus interactions.

10. Sulfamethoxazole / trimethoprim

Sulfamethoxazole / trimethoprim (Bactrim, Septra) is an antibiotic that treats many bacterial infections. The trimethoprim component can cause high potassium levels in the blood. 

Hyperkalemia is more likely with higher doses of sulfamethoxazole / trimethoprim. It’s also more likely if you take other medications that increase potassium levels or if you have existing kidney problems. Older adults may also be at greater risk.

For a list of medications that can increase potassium levels when combined with sulfamethoxazole / trimethoprim, refer to our GoodRx Health article on sulfamethoxazole / trimethoprim interactions.

11. Some herbal products

Some herbal products can increase potassium levels, too. These may include:

• Alfalfa

• Nettle

• Dandelion

• Milkweed

• Siberian ginseng

• Hawthorn berries

• Noni juice

• Horsetail

In some cases, the herb itself contains potassium. In other cases, the herb affects the body in a way that increases potassium levels.

If you have kidney disease, you’re at greater risk of hyperkalemia from herbal products. This is because at baseline, your kidneys aren’t working as well to remove potassium from the body. So if you have kidney disease, your nephrologist will likely encourage you to avoid herbal products altogether.

Regardless of whether you have existing kidney issues, talk to your HCP before taking herbal products. They can help you determine whether they’re safe to take. 

You can also check out  our GoodRx Health article on how to choose safe OTC supplements.

What steps can you take to prevent or manage hyperkalemia?

There are several steps you can take to prevent hyperkalemia:

• Give your prescriber and pharmacist a list of all the medications and OTC products you take. Do this every time you start a new medication. Include multivitamins and herbal products on your list. They can check to see whether any of your medications are known to cause hyperkalemia. What’s more, they can check if several of your medications carry this risk. They may make some changes to your medication regimen if this is the case.

• Know the symptoms of hyperkalemia. Hyperkalemia doesn’t always cause noticeable symptoms. However, muscle weakness, tingling, and nausea and vomiting can be signs of high potassium. Heart palpitations, confusion, or shortness of breath may be more serious symptoms. Contact your HCP immediately if you experience these. And if your symptoms feel severe, seek emergency care.

• Keep your regular appointments. If you take medications that can cause hyperkalemia, you may need regular blood tests to check your potassium levels. These tests may help you catch high potassium levels before they potentially become severe.

• Ask about your diet. With some medications, you may need to avoid eating large amounts of potassium-rich foods. These may include melons, orange juice, bananas, and more. But check with your prescriber or pharmacist before making any changes to your diet. In most cases, avoiding potassium-rich foods isn’t necessary.

• Follow your healthcare team’s instructions for managing hyperkalemia. If you have high potassium levels, your healthcare team will tell you how to manage them. Sometimes you’ll need another medication to help your body eliminate potassium. In severe cases, you may need treatment in a hospital.

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Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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