12 Medications That Can Cause High Potassium Levels

Potassium is a mineral that helps your nerves and muscles work properly. It acts as an electrolyte, helping to balance fluids and move nutrients in and out of your cells. From maintaining your blood pressure to helping your heart beat normally, potassium plays an important role in your overall health.

But when potassium levels get too high, known as hyperkalemia, it can sometimes cause serious health problems. For example, it can affect your heart’s ability to stay in rhythm, potentially leading to an arrhythmia (irregular heartbeat). Other possible symptoms include weakness, nausea, and tingling sensations, although many people have no symptoms at all.

There are many possible causes of high potassium levels, including certain medications and supplements. Below, we'll cover which medications can raise your potassium and what you can do to lower your risk.

Medications that can cause high potassium levels

A normal potassium level in the blood is between 3.5 and 5 milliequivalents per liter (mEq/L). A level above 5 mEq/L is considered high, while a level of 6 mEq/L or higher is considered dangerously high.

Several types of medications can raise potassium levels as a side effect. Some affect how your kidneys remove potassium from your body, while others change how potassium moves in and out of your cells.

The following medications and supplements can cause high potassium levels:

• Potassium supplements, such as potassium chloride (Klor-Con) and potassium citrate (Urocit-K)

• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril) and enalapril (Vasotec)

• Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan)

• Beta blockers, such as propranolol (Inderal LA, Innopran XL) and carvedilol (Coreg)

• Aldosterone antagonists, such as spironolactone (Aldactone) and eplerenone (Inspra)

• Potassium-sparing diuretics, such as amiloride (Midamor) and triamterene (Dyrenium)

• Direct renin inhibitors, such as aliskiren (Tekturna)

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve)

• Certain immunosuppressants, such as Cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf)

• Sulfamethoxazole / trimethoprim (Bactrim, Septra)

• Heparin

• Certain herbal supplements, such as milkweed and dandelion

Keep in mind, this isn’t a complete list of possible substances that can raise your potassium levels. Providing your prescriber and pharmacist with a list of medications and over-the-counter (OTC) products you take can lower your risk of dangerously high potassium.

Here, we’ll discuss 12 oral medications that can cause high potassium levels.

1. Potassium supplements

Taking potassium supplements can cause high potassium levels. Some potassium supplements are available OTC, but others require a prescription. The table below shows examples of potassium supplements and whether they're available OTC, by prescription, or both.

Potassium is also included in many multivitamins and supplements. Be sure to check the product ingredients for added potassium.

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

2. ACE inhibitors

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

• Lisinopril

• Enalapril

• 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 high potassium from ACE inhibitors is relatively low. For example, a large study found that high potassium occurred in about 6% of people taking an ACE inhibitor or angiotensin II receptor blocker (ARB). Less than 1% of people had dangerous levels of potassium. But it’s important to note this study was for people with normal kidney function.

If you have kidney problems, your risk of high potassium while taking an ACE inhibitor is greater. The risk is also greater if you’re living with diabetes or take other medications that increase potassium.

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, valsartan, and olmesartan (Benicar).

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

It’s not clear whether ACE inhibitors or ARBs are more likely to cause high potassium. Some studies suggest ACE inhibitors are more likely to cause high potassium but other studies suggest there isn’t a difference. Regardless, the risk itself is one reason ACE inhibitors and ARBs shouldn’t be taken together.

4. Beta blockers

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

• Carvedilol

• Propranolol

• Metoprolol tartrate (Lopressor)

• Atenolol (Tenormin)

While beta blockers aren’t as known for causing high potassium as other blood pressure medications, they can increase potassium levels in some cases.

If you have high potassium levels from a beta blocker, your prescriber may recommend that you avoid eating a lot of high potassium-containing foods. You may also need to avoid taking potassium supplements while taking a beta blocker.

5. Potassium-sparing diuretics

Potassium-sparing diuretics are a type of water pill that helps your kidneys remove extra fluid from your body. They’re used to treat high blood pressure and fluid buildup caused by certain medical conditions, such as heart failure. Amiloride and triamterene are two examples of potassium-sparing diuretics.

Unlike other types of diuretics, these medications reduce the amount of potassium your kidneys remove through your urine. This can cause high levels of potassium to build up in your blood.

6. Spironolactone

Spironolactone is part of a group of medications called aldosterone antagonists. It’s also considered a potassium-sparing diuretic.

Spironolactone can treat several medical conditions, including high blood pressure and acne. It also treats edema (excess fluid) from conditions such as kidney disease and heart failure.

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

7. Aliskiren

Aliskiren is another medication used to treat high blood pressure. It belongs to a group of medications called direct renin inhibitors.

Aliskiren works by blocking renin, an enzyme that helps your body make a hormone called angiotensin II. This lowers aldosterone levels, which can cause your kidneys to remove less potassium through your urine. As a result, high levels of potassium can build up in your blood.

8. NSAIDs

NSAIDs are medications used to relieve pain, inflammation, and fever. Common examples include ibuprofen and naproxen. Some NSAIDs are available OTC, while others require a prescription.

NSAIDs can increase potassium levels by reducing blood flow to your kidneys. They can also lower aldosterone levels, causing your kidneys to remove less potassium through urine.

Your risk of developing high potassium while taking NSAIDs may be higher if you’re living with kidney problems or take other medications that raise potassium levels. Taking NSAIDs regularly or at higher doses may increase your risk, too.

If you have high potassium levels, talk to your healthcare team before taking an NSAID, even if it's available OTC.

9. Cyclosporine and tacrolimus

Cyclosporine and tacrolimus help prevent the body from rejecting organ transplants. Both medications can be hard on your kidneys and may cause kidney problems. They can also affect the release of renin. As mentioned, renin is an enzyme that helps your body make aldosterone. Lower aldosterone levels can cause your kidneys to remove less potassium through your urine.

You may develop high potassium if you take cyclosporine or tacrolimus. If you're taking either medication, your transplant team will likely monitor your kidney function and potassium levels regularly. This is especially true if you take other medications that increase potassium. Be sure to keep up with any appointments for blood work during treatment.

10. Sulfamethoxazole / trimethoprim

Sulfamethoxazole / trimethoprim is a combination antibiotic that treats several types of bacterial infections, such as urinary tract infections.

The trimethoprim component can raise potassium levels by reducing the amount of potassium your kidneys remove through your urine. This can cause high levels of potassium to build up in your blood.

High potassium 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 have a higher risk of hyperkalemia while taking sulfamethoxazole / trimethoprim. This is partly because kidney function tends to decline with age, making it harder for the body to remove extra potassium. Your prescriber may monitor your potassium levels while you're taking this antibiotic, especially if you have other risk factors.

11. Heparin

Heparin is a blood thinner used to prevent and treat blood clots. It's usually given as an injection under the skin or through a vein.

Heparin can cause high potassium by lowering the production of aldosterone. This can cause your kidneys to remove less potassium through your urine, allowing potassium to build up in your blood. The risk of high potassium levels may increase with long-term heparin treatment.

Your risk of high potassium may be higher if you take heparin along with other medications that raise potassium. Your healthcare team will likely monitor your potassium levels before and during heparin treatment, especially if you have other risk factors.

Good to know: Low molecular weight heparin (LMWH) medications, such as enoxaparin (Lovenox), are similar to heparin. But they’re less likely to cause high potassium levels.

12. Certain 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’re living with kidney disease, you’re at a greater risk of high potassium from herbal products. This is because your kidneys aren’t working as well to remove potassium from the body. In this case, your healthcare team will likely encourage you to avoid herbal products altogether.

Regardless of whether or not you have existing kidney issues, talk to your healthcare team before taking herbal products. They can help you determine whether they’re safe to take based on your other medications and health conditions.

Beyond medications, what else can cause high potassium levels?

Medications aren't the only cause of high potassium levels. Certain health conditions and dietary factors can also cause potassium to build up in your body.

Other possible causes of high potassium include:

• Kidney problems: Your kidneys help remove extra potassium from your body. If they're not working properly, potassium can build up in your blood.

• Diabetes: Uncontrolled blood glucose (sugar) levels can cause potassium to move out of your cells and into your blood, raising potassium levels.

• Addison's disease: This condition causes your body to make too little aldosterone, making it harder for your kidneys to remove potassium.

• Tissue damage: Severe burns, injuries, or muscle breakdown can release potassium from damaged cells into your blood.

• Too much potassium in your diet: Eating large amounts of potassium-rich foods or using potassium-based salt substitutes can contribute to high potassium, especially if you’re living with kidney problems.

If your potassium levels are high, your healthcare team can help determine the cause and recommend the best way to manage it.

What steps can you take to prevent or manage high potassium?

There are several steps you can take to prevent high potassium:

• Review your medications with your healthcare team. Give your prescriber and pharmacist a list of all the medications and OTC products you take, including multivitamins and herbal supplements. Update this list whenever you start a new medication. They can check whether any of your medications raise potassium levels or interact with one another. If needed, your prescriber may adjust your medications to lower your risk.

• Know the symptoms of high potassium. High potassium levels don't always cause noticeable symptoms. But possible signs include muscle weakness, tingling, and nausea. Contact your healthcare team right away if you notice these symptoms. Seek emergency care if you experience heart palpitations, shortness of breath, or severe weakness.

• Keep up with regular appointments. If you take medications that can raise potassium levels, your healthcare team will likely recommend regular blood tests. These tests can help catch high potassium levels before they become dangerous.

• Ask about your diet. Certain medications may require you to limit potassium-rich foods, such as avocados, bananas, and dried apricots. Check with your healthcare team before making changes to your diet.

If you develop high potassium, your healthcare team will recommend ways to lower your levels. This may include adjusting your medications or prescribing a medication that helps your body remove extra potassium. Severe high potassium will likely require treatment in a hospital. Be sure to follow your healthcare team's treatment plan.

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Written by:

Sheila McAdoo, PharmD

Sheila McAdoo, PharmD, is a licensed pharmacist in Virginia and New York. She has worked in the pharmacy industry for 14 years.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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