Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral [preservative free]:
K-99: 595 mg [dye free, sugar free, yeast free]
Tablet, Oral:
Generic: 2 mEq, 2.5 mEq
Tablet, Oral [strength expressed as base]:
Generic: 80 mg
Pharmacology
Mechanism of Action
Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretion
Pharmacokinetics/Pharmacodynamics
Absorption
Well absorbed from upper GI tract
Distribution
Enters cells via active transport from extracellular fluid
Excretion
Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed
Use: Labeled Indications
Dietary supplement: Dietary potassium supplement
Contraindications
Hyperkalemia
Dosage and Administration
Dosing: Adult
Dietary supplement: Oral: One capsule/tablet daily
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Note: Doses listed as mEq of potassium (approximately 4.3 mEq potassium/g potassium gluconate; 1 mEq potassium is equivalent to 39 mg elemental potassium). Product is only available in solid dosage forms; only use in patients able to swallow whole tablets.
Normal daily requirement: Limited data available: Children and Adolescents: Oral: 1 to 2 mEq/kg/day (Kliegman 2016)
Hypokalemia, prevention for ongoing drug losses (eg, concurrent diuretic therapy): Limited data available: Children and Adolescents: Oral: 1 to 2 mEq/kg/day in 1 to 2 divided doses; should not exceed usual adult single dose: 20 mEq/dose; some patients may require a single dose up to 40 mEq/dose (Moffett 2011); some patients may require higher individual daily doses based on lab values and ongoing losses; dosing based on experience using KCl salt for potassium replacement.
Hypokalemia, treatment; mild to moderate: Limited data available: Children and Adolescents: Oral: 2 to 5 mEq/kg/day in divided doses; not to exceed 1 to 2 mEq/kg as a single dose or 20 mEq (whichever is less) (Corkins 2015; Moffett 2011); if deficits are severe or ongoing losses are great, IV potassium should be considered the preferred route of administration
Administration
Administer with a meal.
Storage
Store at room temperature.
Drug Interactions
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Monitor therapy
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy
Drospirenone: Potassium Salts may enhance the hyperkalemic effect of Drospirenone. Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Consider therapy modification
Heparin: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy
Potassium-Sparing Diuretics: Potassium Salts may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Consider therapy modification
Test Interactions
Decreased ammonia (B)
Warnings/Precautions
Concerns related to adverse effects:
- GI effects: May cause GI upset (eg, nausea, vomiting, diarrhea, abdominal pain, discomfort) and lead to GI ulceration, bleeding, perforation and/or obstruction. Oral liquid preparations (not solid) should be used in patients with esophageal compression or delayed gastric emptying.
- Hyperkalemia: Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole).
Disease-related concerns:
- Acid/base disorders: Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely.
- Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.
- Potassium-altering conditions/disorders: Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia (eg, untreated Addison's disease, heat cramps, severe tissue breakdown from trauma or burns).
- Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Contraindicated with severe impairment.
Concurrent drug therapy issues:
- Digitalis: Use with caution in digitalized patients; may be more susceptible to potentially life-threatening cardiac effects with rapid changes in serum potassium concentrations.
- Potassium-altering therapies: Use with caution in patients receiving concomitant medications or therapies that increase potassium (eg, ACEI, potassium-sparing diuretics, potassium containing salt substitutes).
Monitoring Parameters
Serum potassium and magnesium (to facilitate potassium repletion)
Pregnancy
Pregnancy Considerations
Potassium requirements are the same in pregnant and non-pregnant women. Adverse events have not been observed following use of potassium supplements in healthy women with normal pregnancies. Use caution in pregnant women with other medical conditions (eg, preeclampsia; may be more likely to develop hyperkalemia) (IOM 2004).
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience diarrhea. Have patient report immediately to prescriber signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, numbness or tingling feeling), severe constipation, abdominal edema, severe nausea, severe vomiting, severe abdominal pain, black, tarry, or bloody stools, or vomiting blood (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
