MEDSAFE: USING POTASSIUM SUPPLEMENTS CAN INCREASE BLOOD POTASSIUM

Recently, the Adverse Drug Reaction Monitoring Center (CARM)/Medsafe received a report of hyperkalemia in an elderly patient with chronic kidney disease. This patient is taking a supplement containing potassium to support bones and joints. This product is believed to be a contributing factor to hyperkalemia in patients. This is the fourth report that CARM has received in which an herbal supplement or preparation is suspected of being the cause of hyperkalemia.

1. Hyperkalemia

Hyperkalemia is defined as a serum potassium concentration greater than 5.3 mmol/L and is generally more common in the elderly and patients with renal impairment.

Hyperkalemia usually has no specific symptoms. Some cases have symptoms such as:

- Nausea and vomiting

- Muscle pain and weakness

- Paresthesia

-Rank

- Electrocardiogram (ECG) changes, palpitations, and arrhythmias.

Severe hyperkalemia (≥7.0 mmol/L or ≥5.4 mmol/L with symptoms or concomitant ECG changes) is potentially life-threatening.

2. Medications and supplements can contribute to hyperkalemia

Medications can cause hyperkalemia through various mechanisms such as inhibition of the renin-angiotensin system or decreased potassium secretion through the kidneys. Some medications that cause hyperkalemia include angiotensin-converting enzyme inhibitors (ACEs), angiotensin II receptor inhibitors (ARBs), nonsteroidal anti-inflammatory drugs (NSAIDs), spironolacton, potassium supplements, beta-blockers, digoxin, and trimethoprim.

Some herbs in supplements contain potassium, including: nettle, primrose, turmeric, dandelion. In addition, some other potassium-containing substances may be present in the composition or excipients such as: glucosamine sulfate-potassium chloride complex.

3. Reporting in New Zealand

Between 1986 and 2023, Medsafe and CARM received 84 ADR reports of hyperkalemia. The most commonly reported suspected drugs include ACE inhibitors (21 reported), trimethoprim or cotrimoxazole (17 reported), NSAIDs (9 reported), spironolactone (6 reported), and ARBs (6 reported).

4. Recommendations when prescribing

For patients at risk of hyperkalemia, remind patients to read the ingredient list carefully and consult a health care provider before taking potassium-containing supplements.

For cases with hyperkalemia, consider medications or supplements that may be a risk factor and discontinue these medications or supplements if necessary.

For more information on managing hyperkalemia, refer to the treatment guidelines.

5. Drug labeling requirements

From March 1, 2024, if the drug has a maximum daily dose of potassium greater than 39 mg (equivalent to 1 mmol) of elemental potassium, the product information of the drug must specify the potassium content contained in each unit of dose. The Drug Ingredient Sheet and the Patient Drug Information Sheet should list the excipients as well.

                                                          Source: canhgiacduoc.org.vn