Drug reference
Prevention of hypokalaemia (patients with normal diet) ▶BY MOUTH ▶Adult: 2–4 g daily in divided doses Electrolyte imbalance ▶BY INTRAVENOUS INFUSION ▶Adult: Dose dependent on deficit or the daily maintenance requirements
PDF page 1141
Plasma-potassium concentration above 5 mmol/litre
PDF page 1141
▶With intravenous use Seek specialist advice in very severe potassium depletion or difficult cases ▶With oral use Cardiac disease. elderly. hiatus hernia (with modified-release preparations). history of peptic ulcer (with modified-release preparations). intestinal stricture (with modified-release preparations)
PDF page 1141
Kay-Cee-L ® contains 1 mmol/mL each of K+ and Cl-. Potassium Tablets ▶With oral use Do not confuse Effervescent Potassium Tablets BPC 1968 with effervescent potassium chloride tablets. Effervescent Potassium Tablets BPC 1968 do not contain chloride ions and their use should be restricted to hyperchloraemic states.
PDF page 1142
SAFE PRACTICE Blood and nutrition Potassium overdose can be fatal. Ready-mixed infusion solutions containing potassium should be used. Exceptionally, if potassium chloride concentrate is used for preparing an infusion, the infusion solution should be thoroughly mixed. Local policies on avoiding inadvertent use of potassium chloride concentrate should be followed. NHS NEVER EVENT: MIS-SELECTION OF A STRONG POTASSIUM SOLUTION (JANUARY 2018) Patients should not be inadvertently given a strong potassium solution (10% potassium w/v) intravenously, rather than the intended medication.
PDF page 1141
→Appendix 1: potassium chloride
PDF page 1141
GENERAL SIDE-EFFECTS Hyperkalaemia SPECIFIC SIDE-EFFECTS ▶With oral use Abdominal cramps. diarrhoea. gastrointestinal disorders. nausea. vomiting
PDF page 1141
Avoid in severe impairment. Dose adjustments Smaller doses must be used in the prevention of hypokalaemia, to reduce the risk of hyperkalaemia. Monitoring Close monitoring required in renal impairment—high risk of hyperkalaemia.
PDF page 1141
▶Regular monitoring of plasma-potassium concentration is essential in those taking potassium supplements. ▶With intravenous use ECG monitoring should be performed in difficult cases.
PDF page 1141
▶With oral use Potassium salts are preferably given as a liquid (or effervescent) preparation, rather than modified- release tablets; they should be given as the chloride (the use of effervescent potassium tablets BPC 1968 should be restricted to hyperchloraemic states). ▶With intravenous use Potassium chloride concentrate must be diluted with not less than 50 times its volume of sodium chloride intravenous infusion 0.9% or other suitable diluent and mixed well. Ready-mixed infusion solutions should be used where possible; alternatively, potassium chloride concentrate as ampoules containing 1.5 g (K+ 20 mmol) in 10 mL, is thoroughly mixed with 500 mL of sodium chloride 0.9% intravenous infusion and given slowly over 2 to 3 hours with specialist advice and ECG monitoring in difficult cases. For peripheral intravenous infusion, the concentration of potassium should not usually exceed 40 mmol/L. Higher concentrations of potassium chloride may be given in very severe depletion, but require specialist advice.
PDF pages 1141, 1142
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: modified-release tablet, oral solution, solution for injection, infusion, solution for infusion Modified-release tablet CAUTIONARY AND ADVISORY LABELS 25, 27 ▶Potassium chloride (Imported) Potassium chloride 600 mg Kaleorid LP 600mg tablets | 30 tablet P s Duro-K 600mg tablets | 100 tablet P s Solution for infusion ▶Potassium chloride (Non-proprietary) Potassium chloride 150 mg per 1 ml Potassium chloride 15% (potassium 20mmol/10ml) solution for infusion 10ml ampoules | 10 ampoule P £7.00–£10.00 | 20 ampoule P £6.50–£11.24 Potassium chloride 200 mg per 1 ml Potassium chloride 20% (potassium 13.3mmol/5ml) solution for infusion 5ml ampoules | 10 ampoule P £8.00 Oral solution CAUTIONARY AND ADVISORY LABELS 21 ▶Kay-Cee-L (Geistlich Sons Ltd) Potassium chloride 75 mg per 1 ml Kay-Cee-L syrup sugar-free | 500 ml p £8.77 DT = £8.77 Infusion ▶Potassium chloride (Non-proprietary) Potassium chloride 30 mg per 1 ml Potassium chloride 3% (potassium 40mmol/100ml) infusion 100ml bags | 1 bag P s Potassium chloride 3% (potassium 20mmol/50ml) infusion 50ml bags | 1 bag P s Metabolic disorders 2.1 Acute porphyrias Acute porphyrias Overview The acute porphyrias (acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and 5-aminolaevulinic acid dehydratase deficiency porphyria) are hereditary disorders of haem biosynthesis; they have a prevalence of about 1 in 75 000 of the population. Great care must be taken when prescribing for patients with acute porphyria, since certain drugs can induce acute porphyric crises. Since acute porphyrias are hereditary, relatives of affected individuals should be screened and advised about the potential danger of certain drugs. g Where there is no safe alternative, drug treatment for serious or life-threatening conditions should not be withheld from patients with acute porphyria. Where possible, the clinical situation should be discussed with a porphyria specialist for advice on how to proceed and monitor the patient. In the UK clinical advice can be obtained from the National Acute Porphyria Service or from the UK Porphyria Medicines Information Service (UKPMIS)—see details below. l Haem arginate p. 1121 is administered by short intravenous infusion as haem replacement in moderate, severe, or unremitting acute porphyria crises. In the United Kingdom the National Acute Porphyria Service (NAPS) provides clinical support and treatment with haem arginate from two centres (University Hospital of Wales and King’s College Hospital). To access the service telephone (029) 2074 7747 and ask for the Acute Porphyria Service. Drugs unsafe for use in acute porphyrias g The following list contains drugs on the UK market that have been classified as ‘unsafe’ in porphyria because they have been shown to be porphyrinogenic in animals or in vitro, or have been associated with acute attacks in patients. Absence of a drug from the following lists does not necessarily imply that the drug is safe. For many drugs no information about porphyria is available. l An up-to-date list of drugs considered safe in acute porphyrias is available from the UKPMIS, see Useful resources below. Further information may be obtained from: porphyria.eu/ and also from: The UK Porphyria Medicines Information Service (UKPMIS) University Hospital of Wales CF14 4XW Cardiff (029) 2074 2979/3877 Quite modest changes in chemical structure can lead to changes in porphyrinogenicity but where possible general statements have been made about groups of drugs; these should be checked first. Unsafe Drug Groups (check first) . Anabolic steroids . Antidepressants, MAOIs (contact UKPMIS for advice) . Antidepressants, Tricyclic and related (contact UKPMIS for advice) . Barbiturates (includes primidone and thiopental) . Contraceptives, hormonal (for detailed advice contact UKPMIS or a porphyria specialist) . Hormone replacement therapy (for detailed advice contact UKPMIS or a porphyria specialist) . Imidazole antifungals (applies to oral and intravenous use; topical antifungals are thought to be safe due to low systemic exposure) . Non-nucleoside reverse transcriptase inhibitors (contact UKPMIS for advice) . Progestogens (for detailed advice contact UKPMIS or a porphyria specialist) . Protease inhibitors (contact UKPMIS for advice) . Sulfonamides (includes co-trimoxazole and sulfasalazine) . Sulfonylureas (glipizide and glimepiride are thought to be safe) . Taxanes (contact UKPMIS for advice) . Triazole antifungals (applies to oral and intravenous use; topical antifungals are thought to be safe due to low systemic exposure) Unsafe Drugs (check groups above first) . Aceclofenac . Alcohol . Amiodarone . Aprepitant . Artemether with lumefantrine . Bexarotene . Bosentan . Busulfan . Carbamazepine . Chloral hydrate (although evidence of hazard is uncertain, manufacturer advises avoid) . Chloramphenicol . Chloroform (small amounts in medicines probably safe) . Clemastine . Clindamycin . Cocaine . Danazol . Dapsone . Diltiazem . Disopyramide . Disulfiram . Ergometrine . Ergotamine . Erythromycin . Etamsylate . Ethosuximide . Etomidate . Flutamide . Fosaprepitant . Fosphenytoin . Griseofulvin . Hydralazine . Ifosfamide . Indapamide . Isometheptene mucate . Isoniazid (safety uncertain, contact UKPMIS for advice) . Ketamine . Mefenamic acid (safety uncertain, contact UKPMIS for advice) . Meprobamate . Methyldopa . Metolazone . Metyrapone . Mifepristone . Minoxidil (safety uncertain, contact UKPMIS for advice) . Mitotane . Nalidixic acid . Nitrazepam . Nitrofurantoin . Orphenadrine . Oxcarbazepine . Oxybutynin . Pentazocine . Pentoxifylline . Pergolide . Phenoxybenzamine . Phenytoin . Pivmecillinam . Pizotifen . Porfimer . Raloxifene . Rifabutin (safety uncertain, contact UKPMIS for advice) . Rifampicin . Riluzole . Risperidone . Spironolactone . Sulfinpyrazone . Tamoxifen . Temoporfin . Thiotepa . Tiagabine . Tibolone . Topiramate . Toremifene . Trimethoprim . Valproate . Verapamil . Xipamide Useful Resources Acute porphyrias safe list. UK Porphyria Medicines Information Service. 2017. www.wmic.wales.nhs.uk/specialist-services/drugs-in-porphyria BLOOD AND RELATED PRODUCTS › HAEM DERIVATIVES Blood and nutrition
PDF pages 1142, 1143
Patient or carers should be given advice on how to administer potassium chloride Blood and nutrition modified-release tablets. Salt substitutes A number of salt substitutes which contain significant amounts of potassium chloride are readily available as health food products (e.g. LoSalt ® and Ruthmol ®). These should not be used by patients with renal failure as potassium intoxication may result. l LESS SUITABLE FOR PRESCRIBING Modified-release tablets are less suitable for prescribing. Modified-release preparations should be avoided unless effervescent tablets or liquid preparations inappropriate.
PDF page 1142
2–4 g daily in divided doses
First-line fragment. Read the complete Indications and Dose section above.
PDF page 1141
Dose dependent on deficit or the daily
First-line fragment. Read the complete Indications and Dose section above.
PDF page 1141
