Potassium Binders: Types & Side Effects

Potassium binders are a class of drugs that binds to excess potassium in your gastrointestinal tract and flushes it out from the body through your stool. Everyone needs potassium for the healthy functioning of your cells, nerves, and muscles, especially the heart muscle. While potassium can be found in a wide variety of foods like fruits, vegetables, fish, meat, and beans, but consuming too much potassium can lead to a potentially life-threatening condition known as hyperkalemia. To treat high blood levels of potassium, your doctor is likely to recommend consuming a low potassium diet. In cases of severe hyperkalemia, your doctor may also prescribe potassium binders if your diet modifications are not sufficient. Here’s everything you need to know about potassium binders and how they work.

What are Potassium Binders?

Potassium binders are a class of drugs that bind to the excess potassium in your digestive tract.(1,2) The extra potassium is then eliminated from the body through your stool. Potassium binders typically come in the form of a powder that has to be mixed with water and drink the medication along with a meal.(3,4) Some potassium binders can also be taken rectally in the form of an enema.(5,6)

There are several types of potassium binders that are made up of different ingredients. It is essential that you follow all the instructions of taking the medication carefully, and it is advisable that you take a potassium binder at least six hours before or after taking any other medicines, especially heart or kidney medications.

Your doctor will also recommend specific other measures to follow for managing your potassium levels. This may include:

  • Following a strict low-potassium diet
  • Adjusting or decreasing the dosage of any medication that might be causing the body to retain potassium
  • Prescribing a diuretic to increase urination for flushing out the extra potassium
  • Dialysis

What are the Types of Potassium Binders?

There are many types of potassium binders that your doctor may prescribe. These include:

  • Calcium polystyrene sulfonate (CPS)(7)
  • Sodium polystyrene sulfonate (SPS)(8)
  • Sodium zirconium cyclosilicate (brand names: ZS-9, Lokelma)(9)
  • Patiromer (brand name: Veltassa)(10)

ZS-9 and Patiromer are the newer types of potassium binders that are deemed to be safe to take with other medications. These newer potassium binders are usually prescribed for people with cardiovascular disease, increasing the risk of developing hyperkalemia.

Are There Any Side Effects Of Potassium Binders?

Just like any medication, potassium binders also have some side effects. Some of the common side effects of potassium binders include:

Potassium binders are also known to affect the magnesium and calcium levels in the body. If you have doubts about the side effects of these drugs, you should talk to your doctor first about the potential adverse side effects.

What Can Happen If Hyperkalemia Is Left Untreated?

There are many dangers of having too much potassium in the bloodstream and leaving the condition untreated. While some amount of potassium is needed by the body to support proper cell functioning and ensure the proper electric signaling in your heart, too much potassium can be detrimental to your health.

The kidneys are responsible for filtering out the extra potassium from the body and flush it out through the urine. Consuming more potassium than what your kidneys are capable of processing can cause hyperkalemia, a condition caused by high levels of potassium in the bloodstream. Hyperkalemia may interfere with the electrical signaling in the heart.(11)

Most people with hyperkalemia usually do not notice any symptoms. Others, though, can experience muscle weakness, tingling in the hands and feet that feel like pins and needles, and an irregular pulse. Having an irregular pulse, a condition known as arrhythmia is quite common in hyperkalemia. Your heartbeat may be too fast, too slow, or just irregular. Having an irregular heart rhythm can lead to serious complications with hyperkalemia, especially if it is left untreated.

You are at a greater risk of hyperkalemia if you have the following underlying medical conditions:

It is also possible to have hyperkalemia if you have a high potassium diet and are also taking potassium supplements. Hyperkalemia can also be caused by medications such as beta-blockers and ACE inhibitors. These medications are typically prescribed for heart disease and high blood pressure.

Your doctor is going to recommend treatments for bringing your potassium levels within a normal range again, which should be between 3.5 and 5.0 millimoles per liter (mmol/L).(12)

Remember, a sudden rise in the levels of potassium can cause shortness of breath, heart palpitations, nausea, vomiting or chest pain. If you experience any of these serious symptoms, you should consult your doctor at once, as these symptoms can be life-threatening.

Conclusion

Potassium is an essential mineral and electrolyte that our body needs. While we mostly get adequate levels of this mineral through our daily diets, sometimes there can be a buildup of potassium in the blood. This condition is known as hyperkalemia, and you are at a higher risk of this condition if you have an underlying health condition like heart disease or chronic kidney disease. Taking certain medications like ACE inhibitors and beta-blockers can also increase your risk of developing hyperkalemia.

Hyperkalemia is a potentially life-threatening disease. Most people do not experience any symptoms of this condition, making it difficult to diagnose. If you believe you could be at a higher risk of having high potassium in the blood, you must talk to your doctor and take the necessary precautions.

Hyperkalemia is a very treatable condition, and most doctors prescribe a class of medication known as potassium binder along with a low potassium diet. Potassium binders will help bring down your blood potassium levels within a healthy range as it flushes out the excess potassium through your stool. Do not start taking potassium binders without the advice of your doctor, as there can be potential side effects of taking this medication.

References:

  1. Pitt, B. and Bakris, G.L., 2015. New potassium binders for the treatment of hyperkalemia: current data and opportunities for the future. Hypertension, 66(4), pp.731-738.
  2. Palmer, B.F., 2020, February. Potassium Binders for Hyperkalemia in Chronic Kidney Disease—Diet, Renin-Angiotensin-Aldosterone System Inhibitor Therapy, and Hemodialysis. In Mayo Clinic Proceedings (Vol. 95, No. 2, pp. 339-354). Elsevier.
  3. Palmer, B.F., 2020, February. Potassium Binders for Hyperkalemia in Chronic Kidney Disease—Diet, Renin-Angiotensin-Aldosterone System Inhibitor Therapy, and Hemodialysis. In Mayo Clinic Proceedings (Vol. 95, No. 2, pp. 339-354). Elsevier.
  4. Natale, P., Palmer, S.C., Ruospo, M., Saglimbene, V.M. and Strippoli, G.F., 2020. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Cochrane Database of Systematic Reviews, (6).
  5. Rossignol, P., 2019. A new area for the management of hyperkalaemia with potassium binders: clinical use in nephrology. European Heart Journal Supplements, 21(Supplement_A), pp.A48-A54.
  6. Sandle, G.I., Gaiger, E., Tapster, S. and Goodshep, T.H.J., 1986. Enhanced rectal potassium secretion in chronic renal insufficiency: evidence for large intestinal potassium adaptation in man. Clinical Science, 71(4), pp.393-401.
  7. Yu, M.Y., Yeo, J.H., Park, J.S., Lee, C.H. and Kim, G.H., 2017. Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients. PloS one, 12(3), p.e0173542.
  8. Lepage, L., Dufour, A.C., Doiron, J., Handfield, K., Desforges, K., Bell, R., Vallée, M., Savoie, M., Perreault, S., Laurin, L.P. and Pichette, V., 2015. Randomized clinical trial of sodium polystyrene sulfonate for the treatment of mild hyperkalemia in CKD. Clinical Journal of the American Society of Nephrology, 10(12), pp.2136-2142.
  9. Packham, D.K., Rasmussen, H.S., Lavin, P.T., El-Shahawy, M.A., Roger, S.D., Block, G., Qunibi, W., Pergola, P. and Singh, B., 2015. Sodium zirconium cyclosilicate in hyperkalemia. New England Journal of Medicine, 372(3), pp.222-231.
  10. Weir, M.R., Bakris, G.L., Bushinsky, D.A., Mayo, M.R., Garza, D., Stasiv, Y., Wittes, J., Christ-Schmidt, H., Berman, L. and Pitt, B., 2015.
  11. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. New England Journal of Medicine, 372(3), pp.211-221.
  12. Evans, K.J. and Greenberg, A., 2005. Hyperkalemia: a review. Journal of Intensive Care Medicine, 20(5), pp.272-290.
  13. Rastegar, A., 1990. Serum potassium. In Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Butterworths.

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