5 Potassium Citrate Interactions to Watch Out for

Kidney stones can often be passed on their own, but sometimes a medication is needed to help break them down. Potassium citrate (Urocit-K) is one such medication. This prescription-only medication can treat and prevent certain types of kidney stones. It works by making your urine less acidic, allowing your kidneys to get rid of uric acid. Less uric acid means fewer kidney stones. 

But as a medication that contains potassium, it may interact with other medications that affect potassium levels. Below, we’ll discuss five possible potassium citrate interactions and how you might manage them.

1. Potassium-sparing diuretics like spironolactone (Aldactone)

Diuretics (water pills) are medications that help get rid of extra fluid in the body. Besides fluid, many diuretics also get rid of electrolytes, such as potassium and sodium. But one group of diuretics gets rid of fluid without getting rid of potassium. These are called potassium-sparing diuretics. Examples include:

• Spironolactone (Aldactone)

• Eplerenone (Inspra)

• Triamterene (Dyrenium)

• Amiloride (Midamor)

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Potassium citrate and these medications can increase potassium levels in your blood (hyperkalemia). Hyperkalemia symptoms are often unnoticeable. But it’s possible to experience nausea, fatigue, and muscle weakness. More seriously, you may experience heart palpitations, vomiting, or shortness of breath.

Hyperkalemia can cause serious heart problems, but it's rare. It's not recommended to take potassium-sparing diuretics and potassium citrate at the same time.

Good to know: Your potassium levels will be checked before and during treatment. You may also need to complete a heart test called an electrocardiogram (also known as ECG or EKG). If you have heart problems, kidney problems, or acidosis (too much acid in the blood), you may need more frequent monitoring.

2. Potassium supplements

Taking potassium citrate with other potassium-containing products can cause hyperkalemia. Some are available over the counter (OTC), and some are available with a prescription. Common potassium supplements include:

• Potassium citrate (OTC and prescription)

• Potassium chloride (OTC and prescription)

• Potassium gluconate (OTC)

• Potassium bicarbonate (prescription)

OTC potassium products contain less potassium than their prescription counterparts. Still, they may increase your potassium levels when combined with potassium citrate. Potassium may also be an ingredient in many multivitamins and supplements.

If you’re taking potassium citrate, you may want to avoid other potassium products. Give the prescriber of your medication a list of all the medications and OTC products you take. They can check to see whether you’re getting potassium from any other sources.

3. Blood pressure medications like lisinopril (Zestril) and losartan (Cozaar)

Some types of blood pressure medications can increase potassium levels. These include:

• Angiotensin-converting enzyme (ACE) inhibitors, like lisinopril (Zestril), enalapril (Vasotec), and benazepril (Lotensin)

• Angiotensin II receptor blockers (ARBs), like losartan (Cozaar), valsartan (Diovan), and olmesartan (Benicar)

• Angiotensin receptor-neprilysin inhibitor (ARNI), like sacubitril / valsartan (Entresto)

• Direct renin inhibitor, like aliskiren (Tekturna)

These medications lower the amount of potassium that’s removed from the body in the urine. This can lead to hyperkalemia. One way they do this is by blocking aldosterone, a hormone that usually helps get rid of potassium. 

If you take any of these medications, you may need to keep taking them even if you’re taking potassium citrate. If this is the case, your potassium levels may be monitored more closely. You might also try being mindful about how much potassium you’re getting from foods.

4. NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are common medications that treat pain, fever, and inflammation. Many NSAIDs are available OTC, but they still have risks. Like potassium citrate, NSAIDs can be hard on your stomach. So if you take both of them, you may be more likely to have gastrointestinal (GI) side effects, such as heartburn or stomach upset.

Hyperkalemia is another concern. NSAIDs can increase your blood levels of potassium. They do this by decreasing the production of aldosterone and a substance called prostaglandin. This reduces the amount of potassium removed through the urine.

Hyperkalemia may be more common with certain NSAIDs, such as celecoxib (Celebrex). Other NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), can also cause hyperkalemia. But it may be less likely.

If you’re taking NSAIDs and potassium citrate, make sure to let your prescriber know. They can help you weigh the risks versus benefits of using both medications. Hyperkalemia is more likely if you have existing kidney damage. So tell your prescriber if you have any kidney problems.

5. Anticholinergic medications like dicyclomine (Bentyl)

Anticholinergic medications can slow down the movement of food and medications through the GI tract. Examples include:

• Glycopyrrolate (Robinul)

• Hyoscyamine (Levsin)

• Solifenacin (Vesicare)

• Oxybutynin 

• Benztropine 

• Dicyclomine (Bentyl)

It’s possible that anticholinergic medications can cause potassium citrate to stay in the GI tract longer. This may lead to irritation. More seriously, this could cause bleeding or ulcers.

We don’t have any recent studies on potassium citrate and anticholinergics. But some research shows that people receiving potassium chloride and anticholinergic medications in a hospital are more likely to have a GI bleed than people who don’t take anticholinergic medications.

Depending on your risk for GI irritation and bleeding, you may need to avoid mixing these medications. But many medications have anticholinergic properties. So talk to your prescriber about whether any of your medications are anticholinergic.

When should you seek care for potassium citrate interactions?

If you have muscle weakness, nausea, or fatigue while taking potassium citrate, call your prescriber. These can be side effects of a potassium citrate interaction. If you have any signs of a GI bleed, such as stomach pain or dark, tarry stool, stop taking potassium citrate and let your provider know right away. If you experience heart palpitations, vomiting, or chest pain, this may be life-threatening. Seek emergency care or call 911.

The best way to manage potassium citrate interactions is to avoid them if possible. Give your prescriber and pharmacist a list of medications and OTC products you take. They can check for interactions and determine whether you need to make any changes to your medications.

It won’t always be possible to avoid potassium citrate interactions. In this case, you will be monitored more closely.

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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:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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