Meta Information
ID:potassium-citrate
Name:Potassium Citrate
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-07-02T06:44:03Z
Model
phase-b-newfiles-claude-opus-4.8
Interactions
Target id:
/class/potassium-sparing-diuretics
Target name:
Potassium-sparing diuretics (spironolactone, triamterene, amiloride)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Potassium-sparing diuretics block potassium excretion; adding potassium can cause severe, dangerous hyperkalemia.
Actionable advice:
Potassium supplements should not be taken with potassium-sparing diuretics unless specifically directed and monitored.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Hypokalemia should not be treated by the concomitant administration of potassium salts and a potassium-sparing diuretic (e.g., spironolactone, triamterene, or amiloride) since the simultaneous administration of these agents can produce severe hyperkalemia.
Label source:
fda_label
Action type:
avoid
Target id:
/class/ace-inhibitors
Target name:
ACE inhibitors
Severity:
major
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
ACE inhibitors reduce aldosterone and cause potassium retention; adding potassium raises the risk of hyperkalemia.
Actionable advice:
Serum potassium should be monitored closely, and supplemental potassium is often unnecessary and can be harmful with an ACE inhibitor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) including angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), spironolactone, eplerenone, or aliskiren produce potassium retention by inhibiting aldosterone production. Closely monitor potassium in patients receiving concomitant RAAS therapy.
Label source:
fda_label
Action type:
monitor
Target id:
/class/arbs
Target name:
Angiotensin receptor blockers (ARBs)
Severity:
major
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
ARBs cause potassium retention; combined with supplemental potassium this raises hyperkalemia risk.
Actionable advice:
Serum potassium should be monitored closely, and extra potassium is usually not needed with an ARB.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) including angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), spironolactone, eplerenone, or aliskiren produce potassium retention by inhibiting aldosterone production. Closely monitor potassium in patients receiving concomitant RAAS therapy.
Label source:
fda_label
Action type:
monitor
Target id:
/class/nsaids
Target name:
NSAIDs
Severity:
moderate
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
NSAIDs reduce potassium excretion by the kidney, adding to hyperkalemia risk with potassium supplements.
Actionable advice:
Serum potassium should be monitored if NSAIDs are used regularly with potassium.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Nonsteroidal anti-inflammatory drugs (NSAIDs) may produce potassium retention by reducing renal synthesis of prostaglandin E and impairing the renin-angiotensin system. Closely monitor potassium in patients receiving concomitant NSAID therapy.
Label source:
fda_label
Action type:
monitor
Target id:
/condition/renal-impairment
Target name:
Severe renal impairment / hyperkalemia
Severity:
major
Interaction type:
contraindication
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Impaired kidneys cannot excrete potassium, so supplements can cause dangerous hyperkalemia and cardiac arrest.
Actionable advice:
Potassium supplements should not be taken in significant kidney impairment or hyperkalemia without specialist supervision.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Potassium supplements are contraindicated in patients with hyperkalemia.
Label source:
fda_label
Action type:
avoid
Target id:
/class/potassium-elevators
Target name:
Trimethoprim, heparin (other potassium-raising drugs)
Severity:
moderate
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Trimethoprim (blocks renal potassium excretion) and heparin (suppresses aldosterone) can add to hyperkalemia risk with potassium.
Actionable advice:
Serum potassium should be monitored when combining. FLAG: these two are not named in the FDA potassium label - mechanism is well-established (Lexicomp-level).
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Established mechanism / class pharmacology (no single primary source quoted)
Exact phrase from label:
Trimethoprim has amiloride-like ENaC blockade and heparin suppresses aldosterone; both reduce potassium excretion. Well-established pharmacology; not in the FDA KCl label.
Label source:
Class inference
Action type:
monitor
Target id:
/intervention/methotrexate
Target name:
Methotrexate
Severity:
moderate
Interaction type:
pharmacokinetic
Nature:
conditional
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Potassium citrate raises urine pH; alkaline urine increases the renal clearance of methotrexate (renal clearance ratio rose from 0.88 at pH 5.5 to 2.62 at pH 8.4), which can lower methotrexate exposure. (Conversely, alkalinization is used deliberately to reduce methotrexate nephrotoxicity in high-dose oncology regimens.)
Actionable advice:
If you take methotrexate, tell your prescriber you are on potassium citrate; do not start or stop it around methotrexate dosing without medical guidance.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
there was a linear correlation between the ratio of renal clearances of methotrexate and creatinine and urine pH; the ratio increased from 0.88 at pH 5.5 to 2.62 at pH 8.4.
Label source:
Eur J Clin Pharmacol: Effect of urine pH and flow on renal clearance of methotrexate
Action type:
adjust_with_prescriber
Target id:
/intervention/quinidine
Target name:
Quinidine
Severity:
moderate
Interaction type:
pharmacokinetic
Nature:
conditional
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Alkaline urine markedly reduces renal excretion of quinidine (unchanged urinary quinidine falls from ~20% at urine pH <7 to ~5% when alkaline), which can raise quinidine blood levels toward toxicity.
Actionable advice:
If you take quinidine, discuss potassium citrate with your prescriber; watch for signs of quinidine excess (palpitations, visual changes, GI upset).
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
With urine pH <6.0, average quinidine excretion was 115 ± 84 mg/liter; for pH >7.5 average excretion was 13 ± 8 mg/liter (P < 0.001).
Label source:
Ann Intern Med: Quinidine Excretion in Aciduria and Alkaluria
Action type:
adjust_with_prescriber
Target id:
/class/salicylates
Target name:
Salicylates (anti-inflammatory doses)
Severity:
minor
Interaction type:
pharmacokinetic
Nature:
conditional
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Urinary alkalinizers such as potassium citrate increase renal excretion of salicylates, which can lower salicylate levels at anti-inflammatory doses. Not clinically relevant for low-dose cardioprotective aspirin.
Actionable advice:
No action needed for low-dose aspirin; if you take high-dose salicylates for pain/inflammation, mention potassium citrate to your prescriber.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Exact phrase from label:
Drugs that alkalinize the urine increase the rate of salicylate renal excretion (urine-pH pharmacology; potassium citrate is a urinary alkalinizer).
Label source:
Pharmacology reference: urine-pH effect on drug elimination
Action type:
monitor
Target id:
/class/adhd-stimulants
Target name:
Amphetamines / sympathomimetic weak bases
Severity:
moderate
Interaction type:
pharmacokinetic
Nature:
conditional
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Alkaline urine from potassium citrate reduces renal elimination of amphetamines and other weak-base stimulants, prolonging and intensifying their effect.
Actionable advice:
If you take an amphetamine-based stimulant, be alert for stronger/longer stimulant effects; raise persistent potassium-citrate use with your prescriber.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Exact phrase from label:
Drugs that alkalinize the urine reduce renal elimination of amphetamine and other weak bases (urine-pH pharmacology; potassium citrate is a urinary alkalinizer).
Label source:
Pharmacology reference: urine-pH effect on drug elimination
Action type:
monitor
Derived From
potassium
Provenance Note
Interactions duplicated from 'potassium'. Potassium salt; K+ drives interactions. Citrate additionally alkalinizes urine (minor extra effect). | citrate-specific urine-alkalinization interactions added 2026-07-02