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Drug overview for EFFER-K (potassium bicarbonate/citric acid):
Generic name: POTASSIUM BICARBONATE/CITRIC ACID (poe-TAS-ee-um)
Drug class: Bicarbonates
Therapeutic class: Electrolyte Balance-Nutritional Products
Potassium supplements are used as a source of potassium, an essential nutrient cation.
No enhanced Uses information available for this drug.
Generic name: POTASSIUM BICARBONATE/CITRIC ACID (poe-TAS-ee-um)
Drug class: Bicarbonates
Therapeutic class: Electrolyte Balance-Nutritional Products
Potassium supplements are used as a source of potassium, an essential nutrient cation.
No enhanced Uses information available for this drug.
DRUG IMAGES
EFFER-K 25 MEQ TABLET EFF
EFFER-K 20 MEQ TABLET EFF
EFFER-K 10 MEQ TABLET EFF
The following indications for EFFER-K (potassium bicarbonate/citric acid) have been approved by the FDA:
Indications:
Hypokalemia prevention
Hypokalemia
Professional Synonyms:
Hypokalemia prophylaxis
Hypopotassemia prophylaxis
Hypopotassemia
Indications:
Hypokalemia prevention
Hypokalemia
Professional Synonyms:
Hypokalemia prophylaxis
Hypopotassemia prophylaxis
Hypopotassemia
The following dosing information is available for EFFER-K (potassium bicarbonate/citric acid):
Dosage of potassium supplements is usually expressed as mEq of potassium and depends on the requirements of the individual patient. The normal adult daily requirement and the usual dietary intake of potassium is 40-80 mEq; infants may require 2-3 mEq/kg or 40 mEq/m2 daily. Potassium replacement requirements can be estimated only by initial clinical condition and response, ECG monitoring, and/or plasma potassium determinations.
Prophylactic administration of potassium supplements may be necessary in some patients in order to maintain plasma potassium concentration above 3.0 mEq/L. The average oral dosage of potassium supplements for the prevention of hypokalemia is about 20 mEq daily, and the usual oral dosage of potassium for the treatment of potassium depletion is 40-100 mEq or more daily.
However, it is important to remember that dosage must be individualized for each patient. Forty mEq of potassium is provided by approximately:
3.9 g of potassium acetate 4.0 g of potassium bicarbonate 3.0
g of potassium chloride 4.3 g of potassium citrate 9.4 g of potassium gluconate 5.4
g of monobasic potassium phosphate 3.5 g of dibasic potassium phosphate
Oral potassium supplements are usually administered in 2-4 doses daily. To avoid serious hyperkalemia, replacement of potassium deficits must be undertaken gradually usually over a 3- to 7-day period depending on the severity of the deficit. Potassium dosage for adults should usually not exceed 150 mEq daily, and the dosage for young children should not exceed 3 mEq/kg daily. Close monitoring of the ECG and plasma potassium concentrations is essential during IV administration of potassium.
Prophylactic administration of potassium supplements may be necessary in some patients in order to maintain plasma potassium concentration above 3.0 mEq/L. The average oral dosage of potassium supplements for the prevention of hypokalemia is about 20 mEq daily, and the usual oral dosage of potassium for the treatment of potassium depletion is 40-100 mEq or more daily.
However, it is important to remember that dosage must be individualized for each patient. Forty mEq of potassium is provided by approximately:
3.9 g of potassium acetate 4.0 g of potassium bicarbonate 3.0
g of potassium chloride 4.3 g of potassium citrate 9.4 g of potassium gluconate 5.4
g of monobasic potassium phosphate 3.5 g of dibasic potassium phosphate
Oral potassium supplements are usually administered in 2-4 doses daily. To avoid serious hyperkalemia, replacement of potassium deficits must be undertaken gradually usually over a 3- to 7-day period depending on the severity of the deficit. Potassium dosage for adults should usually not exceed 150 mEq daily, and the dosage for young children should not exceed 3 mEq/kg daily. Close monitoring of the ECG and plasma potassium concentrations is essential during IV administration of potassium.
The acetate, bicarbonate, chloride, citrate, and gluconate salts of potassium are administered orally. Potassium chloride, potassium acetate, and potassium phosphate may be administered by slow IV infusion. Rarely, potassium-containing injections are given by hypodermoclysis, in which case potassium concentrations should not exceed 10 mEq/L in order to avoid local pain.
Whenever possible, potassium supplements should be given orally since the relatively slow absorption from the GI tract prevents sudden, large increases in plasma potassium concentrations. Oral potassium supplements should preferably be administered as liquid with or after meals with a full glass of water or fruit juice to minimize the possibility of GI irritation and a saline cathartic effect. Enteric-coated (no longer commercially available in the US) and wax matrix tablets must be swallowed and not allowed to dissolve in the mouth.
Other commercially available oral dosage forms of potassium should be dissolved and/or diluted and administered according to the instructions of the manufacturer. Potassium for injection concentrates must be diluted with a compatible IV solution prior to administration. Diluted solutions of potassium acetate, potassium chloride, and potassium phosphate for injection concentrates must be administered slowly.
Potassium injections should generally be administered only in patients with adequate urine flow. In dehydrated patients, 1 liter of potassium-free fluid should be administered prior to initiating potassium therapy. Generally, potassium concentrations in IV fluids should not exceed 40 mEq/L and the rate of administration should not exceed 20 mEq/hour.
However, higher potassium concentrations (e.g., 60-80 mEq/L) administered more rapidly occasionally may be needed initially in cases of severe hypokalemia and associated cardiac arrhythmias or for the management of diabetic ketoacidosis or the diuretic phase of acute renal failure. Local vascular intolerance may limit the ability to administer such concentrated solutions. In such cases, use of a large vein with a relatively high blood flow (e.g., femoral vein) or splitting and administering the dose in less concentrated solutions via 2 veins simultaneously can be considered.
Administration of such concentrated potassium solutions via a subclavian, jugular, or right atrial catheter should be avoided since local potassium concentrations achieved in the heart may be high and potentially cardiotoxic. The ECG should be monitored closely when the rate of IV potassium administration exceeds 20 mEq/hour. Peaking of the T wave or other ECG changes associated with hyperkalemia (see Cautions: Hyperkalemia) indicate that the rate of potassium infusion is excessive and should be reduced.
Viaflex(R) Plus containers of potassium chloride injections should be checked for minute leaks by firmly squeezing the bag. The injection should be discarded if the container seal is not intact or leaks are found or if the solution is cloudy or contains a precipitate. The injection in plastic containers should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete. Oral administration of potassium supplements or ingestion of potassium-rich foods should replace IV potassium therapy as soon as possible.
Whenever possible, potassium supplements should be given orally since the relatively slow absorption from the GI tract prevents sudden, large increases in plasma potassium concentrations. Oral potassium supplements should preferably be administered as liquid with or after meals with a full glass of water or fruit juice to minimize the possibility of GI irritation and a saline cathartic effect. Enteric-coated (no longer commercially available in the US) and wax matrix tablets must be swallowed and not allowed to dissolve in the mouth.
Other commercially available oral dosage forms of potassium should be dissolved and/or diluted and administered according to the instructions of the manufacturer. Potassium for injection concentrates must be diluted with a compatible IV solution prior to administration. Diluted solutions of potassium acetate, potassium chloride, and potassium phosphate for injection concentrates must be administered slowly.
Potassium injections should generally be administered only in patients with adequate urine flow. In dehydrated patients, 1 liter of potassium-free fluid should be administered prior to initiating potassium therapy. Generally, potassium concentrations in IV fluids should not exceed 40 mEq/L and the rate of administration should not exceed 20 mEq/hour.
However, higher potassium concentrations (e.g., 60-80 mEq/L) administered more rapidly occasionally may be needed initially in cases of severe hypokalemia and associated cardiac arrhythmias or for the management of diabetic ketoacidosis or the diuretic phase of acute renal failure. Local vascular intolerance may limit the ability to administer such concentrated solutions. In such cases, use of a large vein with a relatively high blood flow (e.g., femoral vein) or splitting and administering the dose in less concentrated solutions via 2 veins simultaneously can be considered.
Administration of such concentrated potassium solutions via a subclavian, jugular, or right atrial catheter should be avoided since local potassium concentrations achieved in the heart may be high and potentially cardiotoxic. The ECG should be monitored closely when the rate of IV potassium administration exceeds 20 mEq/hour. Peaking of the T wave or other ECG changes associated with hyperkalemia (see Cautions: Hyperkalemia) indicate that the rate of potassium infusion is excessive and should be reduced.
Viaflex(R) Plus containers of potassium chloride injections should be checked for minute leaks by firmly squeezing the bag. The injection should be discarded if the container seal is not intact or leaks are found or if the solution is cloudy or contains a precipitate. The injection in plastic containers should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete. Oral administration of potassium supplements or ingestion of potassium-rich foods should replace IV potassium therapy as soon as possible.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| EFFER-K 25 MEQ TABLET EFF | Maintenance | Adults take 1 tablet (25 meq) dissolved in 120-240 mL of cold water by oral route once daily |
| EFFER-K 20 MEQ TABLET EFF | Maintenance | Adults take 1 tablet (20 meq) by oral route 4 times per day dissolved in 3-4 ounces of cold juice or ice water and then drink |
| EFFER-K 10 MEQ TABLET EFF | Maintenance | Adults take 1 tablet (10 meq) by oral route once daily dissolved in 2-3 ounces of cold juice or ice water and then drink |
No generic dosing information available.
The following drug interaction information is available for EFFER-K (potassium bicarbonate/citric acid):
There are 0 contraindications.
There are 5 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Potassium Supplements/Potassium Sparing Diuretics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Decreased renal excretion of potassium, resulting from administration of a potassium sparing diuretic. CLINICAL EFFECTS: May observe hyperkalemia which may be severe or even fatal. PREDISPOSING FACTORS: Renal function impairment. PATIENT MANAGEMENT: If both drugs are administered, monitor potassium levels. Adjust the dose of the drugs accordingly. This combination should probably be avoided if possible. DISCUSSION: The interaction is well documented. Patients with decreased renal function are especially at risk of developing hyperkalemia from this drug combination. A commonly held belief is that a potassium sparing diuretic formulated in combination with a thiazide diuretic, such as Dyazide, will not exhibit this interaction. Although the likelihood of hyperkalemia occurring may be reduced somewhat, a danger still exists. |
ALDACTONE, AMILORIDE HCL, AMILORIDE-HYDROCHLOROTHIAZIDE, CAROSPIR, DYRENIUM, KERENDIA, SPIRONOLACTONE, SPIRONOLACTONE-HCTZ, TRIAMTERENE, TRIAMTERENE-HYDROCHLOROTHIAZID |
| Eplerenone/Potassium Supplements SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Eplerenone increases serum potassium levels.(1) CLINICAL EFFECTS: Concurrent use of eplerenone with a potassium supplement may result in hyperkalemia.(1) PREDISPOSING FACTORS: Renal impairment. PATIENT MANAGEMENT: The manufacturer of eplerenone states that the use of eplerenone for the treatment of hypertension in patients receiving potassium supplements is contraindicated.(1) DISCUSSION: The main risk of eplerenone therapy is hyperkalemia. The risk of hyperkalemia can be reduced by avoiding potassium supplements during eplerenone therapy.(1) |
EPLERENONE, INSPRA |
| Potassium Supplements/Potassium Binders SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Patiromer, sodium polystyrene sulfonate and sodium zirconium cyclosilicate bind to potassium.(1-3) CLINICAL EFFECTS: Concurrent use of potassium supplements and patiromer, sodium polystyrene sulfonate or sodium zirconium cyclosilicate may decrease the effectiveness of both agents. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients should normally not receive potassium supplements and patiromer, sodium polystyrene sulfonate or sodium zirconium cyclosilicate concurrently.(1-3) Patiromer, sodium polystyrene sulfonate or sodium zirconium cyclosilicate are indicated for management of hyperkalemia. Consider discontinuing or holding potassium supplements in patients who develop hyperkalemia requiring treatment. DISCUSSION: Patiromer, sodium polystyrene sulfonate and sodium zirconium cyclosilicate are indicated for hyperkalemia. Consider discontinuing or holding potassium supplements in patients receiving sodium polystyrene sulfonate or sodium zirconium cyclosilicate. |
KIONEX, LOKELMA, SODIUM POLYSTYRENE SULFONATE, SPS, VELTASSA |
| Delayed-Release Cysteamine Bitartrate/Bicarbonate SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Bicarbonate increases gastric pH. As gastric pH increases, the solubility of delayed-release cysteamine bitartrate may increase.(1) The exact mechanism behind the interaction between delayed-release cysteamine bitartrate and bicarbonate is unknown. CLINICAL EFFECTS: Simultaneous administration of delayed-release cysteamine bitartrate and bicarbonate may result in an early release of cysteamine bitartrate and decreased effectiveness of cysteamine bitartrate.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of delayed-release cysteamine bitartrate states that delayed-release cysteamine bitartrate should be administered at least 1 hour before or 1 hour after administration of bicarbonate.(3) DISCUSSION: Interactions between delayed-release cysteamine bitartrate and other acid reducing agents including H2-receptor antagonists and proton pump inhibitors were not noted in the clinical trials.(1,2) The interaction was only documented with co-administration of delayed-release cysteamine bitartrate and bicarbonate.(2,3) |
PROCYSBI |
| Potassium Supplements/Trimethoprim SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Trimethoprim may increase serum potassium levels by reduction in potassium elimination.(1-3) The combination of trimethoprim and potassium supplements can have an additive effect on serum potassium resulting in potentially dangerous levels. CLINICAL EFFECTS: Concurrent use of trimethoprim and potassium supplements may result in hyperkalemia, which may be severe. PREDISPOSING FACTORS: Patients who are elderly, have any degree of renal insufficiency or heart failure have an increased risk for hyperkalemia.(1-9) Concomitant use with other drugs associated with hyperkalemia risk (e.g. ACE Inhibitors, angiotensin II receptor antagonists, aldosterone antagonists, NSAIDs) and high doses of trimethoprim further increase the risk for hyperkalemia.(1-8) Interaction risk and severity is greater in patients with multiple risk factors. PATIENT MANAGEMENT: Assure adequate monitoring for hyperkalemia.(1-9) Patients receiving trimethoprim and a potassium supplement concurrently should have their serum potassium monitored at baseline and during treatment. Potassium supplementation may need to be held during antibiotic therapy, especially when other predisposing factors for hyperkalemia are present. Peak potassium increase due to trimethoprim is delayed and generally occurs after 4 or more days of therapy.(3,5,6) When possible, alternative antibiotic therapy should be considered in patients with one or more risk factors for hyperkalemia, e.g. renal impairment, heart failure, age > 65 years, and/or receiving additional meds associated with hyperkalemia risk (e.g. ACE inhibitors, angiotensin II receptor blockers, aldosterone antagonists, NSAIDs).(6) DISCUSSION: A nested case-control study evaluated the risk for hyperkalemia in 19,194 patients with newly diagnosed heart failure. Over a mean follow-up of 3.9 years 2,176 cases of hyperkalemia (96.7% with a potassium value of => 5.5 mmol/L) were identified. Study authors found that trimethoprim independently increased the risk for hyperkalemia (OR 2.82; 95% CI 1.88-4.23).(4) A retrospective cohort study evaluated the risk for hospitalization due to hyperkalemia in 393,039 elderly women (age >65 years) treated for a urinary tract infection (UTI) with trimethoprim-sulfamethoxazole (TMP-SMX) or another antibiotic (amoxicillin, ciprofloxacin, norfloxacin, nitrofurantoin). Baseline renal function was similar in all five antibiotic groups. When compared with amoxicillin, TMP-SMX use was associated with a 3.3-fold increased risk for hospitalization due to hyperkalemia. Ciprofloxacin, norfloxacin, and nitrofurantoin were not associated with a risk for hyperkalemia.(9) A prospective study of hospitalized patients evaluated the risk for hyperkalemia in patients who received standard dose TMP-SMX (<= 320 mg trimethoprim, <= 1600 mg sulfamethoxazole daily) versus a control group who received a different antibiotic for at least 5 days. The two groups were similar in age, renal function and use of potassium altering medications. Serum potassium concentration increased in TMP-SMX patients by 1.21 mmol/L (CI 1.09 - 1.32 mmol/L), a change which was statistically significant in patients with a pretreatment serum creatinine = or > 1.2. In control patients, serum potassium decreased during antibiotic therapy (change not quantitated by authors).(5) |
BACTRIM, BACTRIM DS, PRIMSOL, SULFAMETHOXAZOLE-TRIMETHOPRIM, SULFATRIM, TRIMETHOPRIM, TRIMETHOPRIM MICRONIZED |
There are 6 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Quinidine/Urinary Alkalinizers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Quinidine elimination is impaired by urinary alkalinization. CLINICAL EFFECTS: Potentiation of quinidine effects may be observed. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitoring quinidine levels and cardiac function may be indicated. The quinidine dose may need to be adjusted when a urinary alkalinizer is started or stopped. DISCUSSION: Additional documentation is necessary to confirm this potential interaction. |
NUEDEXTA, QUINIDINE GLUCONATE, QUINIDINE SULFATE |
| Angiotensin II Receptor Blocker (ARB)/Potassium Supplements SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Angiotensin II receptor blockers (ARBs) may decrease the renal excretion of potassium. CLINICAL EFFECTS: Concurrent use of potassium supplements with ARBs may result in hyperkalemia. PREDISPOSING FACTORS: Impaired renal function; diabetes mellitus. PATIENT MANAGEMENT: Monitor serum potassium and adjust the dosage accordingly in patients receiving concurrent therapy with potassium supplements and ARBs. DISCUSSION: Several studies have indicated that serum potassium levels increase when ARB therapy is initiated and decrease when the drug is lowered. Based on this data, serum potassium levels should be monitored in patients receiving potassium supplements with ARBs. |
AMLODIPINE-OLMESARTAN, AMLODIPINE-VALSARTAN, AMLODIPINE-VALSARTAN-HCTZ, ARBLI, ATACAND, ATACAND HCT, AVALIDE, AVAPRO, AZOR, BENICAR, BENICAR HCT, CANDESARTAN CILEXETIL, CANDESARTAN-HYDROCHLOROTHIAZID, COZAAR, DIOVAN, DIOVAN HCT, EDARBI, EDARBYCLOR, ENTRESTO, ENTRESTO SPRINKLE, EPROSARTAN MESYLATE, EXFORGE, EXFORGE HCT, FILSPARI, HYZAAR, IRBESARTAN, IRBESARTAN-HYDROCHLOROTHIAZIDE, LOSARTAN POTASSIUM, LOSARTAN-HYDROCHLOROTHIAZIDE, MICARDIS, MICARDIS HCT, OLMESARTAN MEDOXOMIL, OLMESARTAN-AMLODIPINE-HCTZ, OLMESARTAN-HYDROCHLOROTHIAZIDE, TELMISARTAN, TELMISARTAN-AMLODIPINE, TELMISARTAN-HYDROCHLOROTHIAZID, TRIBENZOR, VALSARTAN, VALSARTAN-HYDROCHLOROTHIAZIDE |
| Drospirenone/Potassium Supplements SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Drospirenone has antimineralocorticoid activity and may cause hyperkalemia. Potassium supplements also increase potassium levels.(1) CLINICAL EFFECTS: Concurrent use of drospirenone and potassium supplements may result in hyperkalemia.(1) PREDISPOSING FACTORS: Renal insufficiency, hepatic dysfunction, adrenal insufficiency, and use of potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, heparin, and NSAIDs may increase potassium levels.(1) PATIENT MANAGEMENT: Patients receiving drospirenone with a potassium supplement should have their serum potassium level checked during the first treatment cycle.(1) DISCUSSION: Drospirenone has antimineralocorticoid activity comparable to 25 mg of spironolactone and may result in hyperkalemia. Concurrent use of potassium-supplements also increase potassium levels.(1) |
ANGELIQ, BEYAZ, DROSPIRENONE-ETH ESTRA-LEVOMEF, DROSPIRENONE-ETHINYL ESTRADIOL, JASMIEL, LO-ZUMANDIMINE, LORYNA, NEXTSTELLIS, NIKKI, OCELLA, SAFYRAL, SLYND, SYEDA, VESTURA, YASMIN 28, YAZ, ZARAH, ZUMANDIMINE |
| Aliskiren/Potassium Supplements SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Aliskiren may decrease the renal excretion of potassium. CLINICAL EFFECTS: Concurrent use of potassium supplements with aliskiren may result in hyperkalemia. PREDISPOSING FACTORS: Impaired renal function; diabetes mellitus. PATIENT MANAGEMENT: Monitor serum potassium and adjust the dosage accordingly in patients receiving concurrent therapy with potassium supplements and aliskiren. DISCUSSION: Several studies have indicated that serum potassium levels increase when ACE inhibitors and ARB therapy is initiated and decrease when the drug is lowered. Increased potassium levels have also been seen with aliskiren. Based on this data, serum potassium levels should be monitored in patients receiving potassium supplements with aliskiren. |
ALISKIREN, TEKTURNA |
| Selected ACE Inhibitors/Potassium Supplements SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: ACE inhibitors may decrease the renal excretion of potassium. CLINICAL EFFECTS: Concurrent use of potassium supplements with ACE inhibitors may result in hyperkalemia. PREDISPOSING FACTORS: Impaired renal function; diabetes mellitus. PATIENT MANAGEMENT: Monitor serum potassium and adjust the dosage accordingly in patients receiving concurrent therapy with potassium supplements and ACE inhibitors. DISCUSSION: Several studies have indicated that serum potassium levels increase when ACE inhibitors is initiated and decrease when the drug is lowered. Based on this data, serum potassium levels should be monitored in patients receiving potassium supplements with ACE inhibitors. Selected ACE inhibitors linked to this monograph include: alacepril, cilazapril, delapril, imidapril, perindopril, spirapril, temocapril, and zofenopril. |
PERINDOPRIL ERBUMINE, PRESTALIA |
| Selected ACE Inhibitors/Potassium Supplements SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: ACE inhibitors may decrease the renal excretion of potassium. CLINICAL EFFECTS: Concurrent use of potassium supplements with ACE inhibitors may result in hyperkalemia. PREDISPOSING FACTORS: Impaired renal function; diabetes mellitus. PATIENT MANAGEMENT: Monitor serum potassium and adjust the dosage accordingly in patients receiving concurrent therapy with potassium supplements and ACE inhibitors. DISCUSSION: Several studies have indicated that serum potassium levels increase when ACE inhibitors is initiated and decrease when the drug is lowered. Based on this data, serum potassium levels should be monitored in patients receiving potassium supplements with ACE inhibitors. Selected ACE inhibitors linked to this monograph include: benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, quinapril, ramipril, and trandolapril. |
ACCUPRIL, ACCURETIC, ALTACE, AMLODIPINE BESYLATE-BENAZEPRIL, BENAZEPRIL HCL, BENAZEPRIL-HYDROCHLOROTHIAZIDE, CAPTOPRIL, CAPTOPRIL-HYDROCHLOROTHIAZIDE, ENALAPRIL MALEATE, ENALAPRIL-HYDROCHLOROTHIAZIDE, ENALAPRILAT, EPANED, FOSINOPRIL SODIUM, FOSINOPRIL-HYDROCHLOROTHIAZIDE, LISINOPRIL, LISINOPRIL-HYDROCHLOROTHIAZIDE, LOTENSIN, LOTENSIN HCT, LOTREL, MOEXIPRIL HCL, QBRELIS, QUINAPRIL HCL, QUINAPRIL-HYDROCHLOROTHIAZIDE, RAMIPRIL, TRANDOLAPRIL, TRANDOLAPRIL-VERAPAMIL ER, VASERETIC, VASOTEC, ZESTORETIC, ZESTRIL |
The following contraindication information is available for EFFER-K (potassium bicarbonate/citric acid):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 2 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Familial hyperkalemic periodic paralysis |
| Hyperkalemia |
There are 10 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Anuria |
| Azotemia |
| Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min |
| Chronic kidney disease stage 5 (failure) GFr<15 ml/min |
| Complete atrioventricular block |
| Dehydration |
| Hyporeninemic hypoaldosteronism |
| Myotonia congenita - autosomal dominant form |
| Oliguria |
| Severe heart block |
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Kidney disease with likely reduction in glomerular filtration rate (GFr) |
The following adverse reaction information is available for EFFER-K (potassium bicarbonate/citric acid):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 10 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Hyperkalemia |
| Rare/Very Rare |
|---|
|
Bloody stools Duodenal ulcer Gastrointestinal hemorrhage Gastrointestinal irritation Gastrointestinal obstruction Gastrointestinal perforation Gastrointestinal ulcer Skin rash Sore throat |
There are 5 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Acute abdominal pain Diarrhea Flatulence Nausea Vomiting |
None. |
| Rare/Very Rare |
|---|
| None. |
The following precautions are available for EFFER-K (potassium bicarbonate/citric acid):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for EFFER-K (potassium bicarbonate/citric acid):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for EFFER-K (potassium bicarbonate/citric acid)'s list of indications:
| Hypokalemia | |
| E87.6 | Hypokalemia |
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