Which medications commonly contribute to hyperkalaemia that I should review in my patients?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Medications commonly contributing to hyperkalaemia that should be reviewed in patients include:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Aldosterone antagonist potassium-sparing diuretics such as spironolactone and eplerenone
  • Potassium-sparing diuretics like amiloride

These medications reduce urinary potassium excretion and increase the risk of hyperkalaemia, especially in patients with heart failure or chronic kidney disease.

Additional caution is advised when these drugs are used in combination, as this further increases hyperkalaemia risk.

Monitoring serum potassium and renal function is recommended when initiating or adjusting these medications.

Educational content only. Always verify information and use clinical judgement.