Potassium chloride

Pharmacological properties

potassium - one of the most important intracellular cations, is involved in many physiological processes; It provides normal muscle contraction, transmission of nerve impulses and carbohydrate metabolism. potassium cation is vital for the normal functioning of the body.

Pharmacokinetics Potassium chloride is rapidly absorbed after ingestion: approximately 90% of the potassium from food is absorbed. Potassium is mainly secreted by the kidneys; it is secreted by the distal tubules, where it is replaced by sodium or hydrogen ions. Kidney excretion of sodium cannot be limited even when the concentration of ions in the body decreases. A small amount of potassium is excreted with feces and sweat.

Potassium chloride in capsules of prolonged action is contained in granules, provides a slow release. After the capsule is destroyed, the granules disperse and gradually release the active substance when passing through the digestive tract. These two factors prevent the creation of too high a temporary concentration of potassium chloride and thus reduce the likelihood of side effects on the digestive tract.

Indications

Prevention and treatment of hypokalemia.

Application

The dose and duration of the course of treatment for each patient is selected individually.

Usually the daily dose for adults is 2-3 capsules (16-24 mmol K⁺) for prevention and 5–12 capsules (40–96 mmol K⁺) for the treatment of patients with hypokalemia with regular monitoring of the level of potassium in the blood plasma.

If the daily dose exceeds 2 capsules, it should be divided into several doses. Swallow capsules whole during or after meals.

Elderly patients. Changing the dosage for elderly patients is not necessary.

Caution is required in patients with renal or hepatic insufficiency. Studies in patients with liver failure have not been conducted.

Contraindications

• Hypersensitivity to the active substance or any components of the drug. hyperkalemia caused by certain diseases and drugs, for example, in the case of potassium-sparing diuretics or APF inhibitors, in case of adrenocortical insufficiency, renal failure, acidosis, diabetic ketoacidosis, after tissue injury (see interactions). oligoanuric and uremic stages of arthritis; retention uremic stage of arrester; adrenal cortex insufficiency (Addisons disease); inhibition of the function of the digestive tract of organic or functional origin; structural or functional disorders affecting the passage of the drug through the digestive tract.

Side effects

There is no modern clinical documentation that would allow us to group the side effects of this drug by the frequency of their occurrence.

Metabolism and digestive disorders. Unknown: hyperkalemia (with a risk of sudden death). Hyperkalemia should be avoided by constantly monitoring the level of potassium in the blood plasma (see SPECIAL INSTRUCTIONS).

From the cardiovascular system. Rarely, tachycardia may occur.

From the digestive tract. Nausea, vomiting, flatulence, abdominal pain, discomfort, diarrhea, burning sensation in the stomach and esophagus, constipation, minor erosive changes in the small intestine. In some cases, gastrointestinal bleeding, gastroduodenal ulcers (for solid oral forms of potassium chloride), perforation and obstruction, mainly in the presence of contributing risk factors, may occur (see CONTRAINDICATIONS and SPECIAL INSTRUCTIONS). The risk of gastroduodenal ulcers increases with the use of potassium chloride in high doses.

If such factors are suspected, the drug should be stopped immediately, and the cause of the symptoms should be investigated.

The severity of these symptoms as consequences of intestinal irritation can be reduced mainly due to the simultaneous ingestion of food and the drug.

On the part of the skin and its derivatives Unknown: hypersensitivity reactions, including skin rashes.

From the skeletal muscles and connective tissue. Muscle weakness can rarely occur.

special instructions

The drug should be used with caution, since the level of potassium deficiency is not always determined correctly, and excessive use of potassium preparations can cause potassium intoxication. therefore, during treatment it is recommended to regularly determine the level of potassium in the blood plasma and conduct an ecg, especially in patients with cardiovascular and renal diseases.

The use of Caldium during pregnancy requires a careful assessment of the risk / benefit ratio.

An existing digestive tract ulcer or a history of its presence requires special care, since in some cases after taking potassium chloride preparations of slow release, bleeding in the digestive tract, ulcers, intestinal perforation, and stenosis can occur.

For elderly patients or persons with impaired renal function, the drug should be prescribed with caution; a dose reduction may be required. Regular monitoring of potassium in the blood is especially important.

The sudden withdrawal of the Caldium drug during combination therapy with digitalis glycosides requires special care, since developing hypokalemia increases the toxicity of digitalis glycosides.

In rare cases, when hypokalemia is combined with metabolic acidosis, other potassium salts are recommended for replenishing potassium levels (e.g. citrate, gluconate, bicarbonate).

In some patients, magnesium deficiency caused by the use of diuretics prevents the alignment of intracellular potassium deficiency, so hypomagnesemia should be corrected simultaneously with hypokalemia.

Use during pregnancy and lactation. Pregnancy. The period of pregnancy is not an absolute contraindication to the use of the drug. The drug is used during pregnancy only in cases where, according to the doctor, the expected benefit for the mother exceeds the possible risk to the fetus.

There were no controlled clinical trials during pregnancy, but based on experience, in case of a thorough assessment of the risk / benefit ratio, the drug can be used during pregnancy (see SPECIAL INSTRUCTIONS).

Due to inhibition of gastrointestinal tract function during pregnancy, solid dosage forms of potassium for oral administration should be prescribed to pregnant women with great caution and only in exceptional cases. Caldium, a solid oral dosage form of potassium, quickly releases a large number of micropellets from the primary dosage form, which are then gradually distributed into the intestinal contents. This limits the risk associated with taking solid dosage forms that retain their relatively large size when passing through the gastrointestinal tract (i.e., matrix tablets) and can cause adverse reactions from the gastrointestinal tract caused by local release of a large amount of the active substance and / or mechanical action of the unchanged drug forms.

Lactation. The drug is used during lactation only in cases where, according to the doctor, the expected benefit for the mother outweighs the possible risk to the baby.

The concentration of potassium ions in breast milk is about 13 mmol / L. As long as the potassium level in the body is not too high, a potassium supplement does not or only slightly affects the potassium content in breast milk.There is no evidence that oral administration of potassium by a breast-feeding woman can cause any side effects in breast-fed infants.

The ability to influence the reaction rate when driving vehicles and working with other mechanisms. The drug does not affect the ability to drive vehicles or work with mechanisms.

Children. It is not recommended to use the drug in children.

Interactions

When combined with other drugs that interact with the drug, you should periodically monitor the level of potassium in the blood plasma.

An increase in plasma potassium concentration can occur with the simultaneous use of Caldium with potassium salts, potassium-sparing diuretics, ACE inhibitors (e.g. captopril, enalapril), angiotensin II receptor inhibitors, proton pump inhibitors, indomethacin, GCS, heparin, cardiac glycosides , other drugs containing potassium, nephrotoxic drugs (cisplatin, aminoglycosides).

Potassium-sparing diuretics. The combined use of potassium chloride with potassium-sparing diuretics such as amiloride, canrenone, spironolactone, triamteren (alone or in combination) is contraindicated (see CONTRAINDICATIONS). In patients with renal insufficiency, the risk of developing fatal hyperkalemia is potentially increased.

ACE inhibitors. The combined use of potassium chloride with ACE inhibitors is not recommended, except in cases of hypokalemia. The simultaneous use of such drugs increases the risk of lethal hyperkalemia, especially in patients with renal failure. In individuals using ACE inhibitors, potassium levels should be increased only under control.

Cardiac glycosides. With extreme caution, potassium chloride with cardiac glycosides should be used, since hyperkalemia reduces the inotropic activity of cardiac glycosides (digoxin) and can cause disturbances in atrioventricular conduction. When taking digitalis glycoside, P-blockers, heparin, cyclosporine, regular monitoring of potassium levels in the blood is required.

NSAIDs. With caution, potassium chloride should be used along with NSAIDs, anticholinergics, since adverse reactions from the digestive tract can be more pronounced. With their combined use, the level of potassium in the blood plasma should be monitored.

Calcium. With the combined use of potassium chloride with parenteral calcium preparations, arrhythmias may occur.

Sodium chloride. A diet rich in sodium chloride increases potassium excretion.

The simultaneous use of angiotensin II receptor blockers, a direct inhibitor of renin aliskiren, can cause an increase in the level of potassium in the blood.

The simultaneous use of foods and plants rich in potassium (for example, dandelion leaves and root, banana, tomato, orange juice) can increase the risk of hyperkalemia.

Overdose

In case of an overdose, symptoms of hyperkalemia may occur. Symptoms of an overdose of potassium chloride may include: muscle weakness, sensory disturbances, limb paresthesias, apathy, confusion, shortness of breath, atonic paralysis, decreased hell, shock, cardiac arrhythmias and heart block (e.g. av blockade). in case of severe overdose (more than 6.0 mmol / l), cardiac arrest is possible. elevated potassium levels give a characteristic ECG form (high sharp t wave, depression of the st segment, disappearance of the p wave, increase in the q – t segment, expansion of the qrs complex).

Treatment. For the treatment of overdose, gastric lavage, the introduction of physiological solution, glucose, insulin can be used, or forced diuresis, peritoneal dialysis or hemodialysis may be required.

Storage conditions

At a temperature not exceeding 30 ° c.