Version May 2024
Dietary supplement: OTC labeling: Oral: One capsule/tablet daily.
Hypokalemia (mild to moderate), treatment (alternative agent) (off-label use):
Note: All doses in this monograph are expressed as mEq of potassium (1 mEq = 1 mmol potassium). Typically, potassium chloride is preferred because it corrects serum potassium concentrations more quickly than other salts and hypochloremia may develop with potassium gluconate use (Asmar 2012; Cohn 2000). Individualize dosing based on serum potassium levels and clinical factors (eg, underlying cause, presence of symptoms, concomitant medications, ongoing potassium losses). Concurrent hypomagnesemia requires correction to facilitate potassium repletion (Clase 2020; Kraft 2005). General guidance is provided below; refer to institutional protocols.
Mild to moderate (serum potassium 3 to 3.4 mEq/L): Oral: Initial: 10 to 20 mEq 2 to 4 times daily; base subsequent dosing on serum potassium monitoring (Asmar 2012; Cohn 2000; Kraft 2005; Mount 2022).
There are no dosage adjustments provided in the manufacturer's labeling. If using for treatment of hypokalemia, initiate therapy at the low end of the dosing range, particularly if on other medications known to increase potassium levels; monitor potassium level frequently.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Potassium gluconate: Pediatric drug information")
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
There are no dosage adjustments provided in the manufacturer's labeling. Reduce initial dose by at least 50% in adult patients with renal impairment (Kraft 2005). Do not use with renal failure.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Hyperkalemia
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), if available, 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.
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).
1 g potassium gluconate = elemental potassium 167 mg = potassium 4.3 mEq = potassium 4.3 mmol
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
Yes
Tablets (Potassium Gluconate Oral)
2 mEq (per each): $0.06
2.5 mEq (per each): $0.04
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Administer with a meal.
Oral: Sustained release and wax matrix tablets should be swallowed whole, do not crush or chew; administer with food
Dietary supplement: Dietary potassium supplement
Hypokalemia (mild to moderate), treatment (alternative agent)
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy
AMILoride: Potassium Salts may enhance the hyperkalemic effect of AMILoride. Management: Amiloride and potassium supplements should not be used except in severe or refractory cases of hypokalemia. If coadministered, monitor serum potassium closely as rapid increases in potassium are possible. Risk D: Consider therapy modification
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy
Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in select patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Finerenone: Potassium Salts may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Spironolactone: Potassium Salts may enhance the hyperkalemic effect of Spironolactone. Risk X: Avoid combination
Triamterene: Potassium Salts may enhance the hyperkalemic effect of Triamterene. Risk X: Avoid combination
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).
Potassium is excreted into breast milk (IOM 2004).
Electrolytes (including serum potassium, bicarbonate, and magnesium), acid/base status.
Note: Reference ranges may vary depending on the laboratory
Serum potassium: 3.5 to 5.2 mEq/L
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
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
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