Last month, at age 71, Diane had 3 stents placed into her heart. As I looked over her medication list, I asked her, “Any medication changes?”
“My heart doctor changed my lisinopril to another medicine. Oh, and I’m not taking those big potassium pills anymore.”
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“Hmm… Here’s the record of your visit with your cardiologist. He did change your lisinopril to losartan, but that’s all. It says here that he wants you to stay on your water pills and potassium tablets.”
“I thought the losartan was my potassium pill. See, it says losartan potassium on the pill bottle.”
“Yes, that IS confusing. Some medicine names now include the words sodium, potassium, or sulfate. This means that the medication contains a tiny amount of sodium, potassium, or sulfate, helping it to stay potent.”
“Despite what that label says, your new medicine actually contains very little potassium. Your water pills and potassium pills go together, and you need to keep taking your potassium pills.”
Water is not all that people lose when taking a “water pill” or diuretic. Besides the water, diuretics remove essential minerals like sodium, magnesium, and potassium from your body. Potassium supplements are described either by weight in milligrams (mg) or chemically by milliequivalents (mEq).
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Most prescription forms of potassium are labeled as mEq and are available as either 10 mEq or 20 mEq tablets. Unfortunately, most prescription potassium pills are large. They can be awkward or hard to swallow, leading some folks to try smaller, nonprescription potassium pills instead.
One common over-thecounter (OTC) potassium is 595 mg potassium gluconate. This may sound like a lot, but it isn’t. There’s only 99 mg of elemental potassium in each tablet, with the rest being gluconate. A potassium gluconate tablet with 99 mg of potassium has only 2.5mEq of potassium. You’ll need to take 4 tablets of OTC potassium gluconate to match the potassium in one prescription tablet of 10mEq potassium chloride.
The average American adult gets about 2,600 mg of potassium daily through their diet, nearly 400 mg less than recommended. This is considered a public health concern for the general U.S. population. How much potassium can you gain by eating a banana or drinking an 8-ounce glass of orange juice every day? Eating a medium-sized banana gives you 422 mg of potassium, and an 8-ounce glass of orange juice contains 473 mg of potassium.
One potato with the skin has 610 mg of potassium, with sweet potatoes containing 694 mg potassium. Leafy green vegetables and foods like tomatoes that grow on vines are good potassium sources. So are milk and yogurt. More information on the potassium content of foods is available in the online resource Dietary Guidelines for Americans 2020-2025, at www.dietaryguidelines.gov.
Eating bananas and drinking orange and tomato juice regularly may not be enough to keep your potassium level balanced.
People taking “water pills” every day may need more potassium than they can get by eating bananas and oranges. One easy and inexpensive way to get more potassium is to use a salt substitute made with potassium.
Salt substitutes such as Nu Salt® or Morton Salt Substitute® are sodiumfree. They contain potassium chloride salt crystals instead of sodium chloride salt crystals. There are also low-sodium salt substitutes like Morton’s Lite Salt, with a 50-50 sodium to potassium chloride ratio. Both sodium-free and low sodium salt substitutes are concentrated sources of potassium.
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Switching from a typical table salt made with sodium chloride to a salt substitute with potassium chloride can dramatically increase your potassium intake. People with kidney disease should avoid using a salt substitute containing potassium. But for people taking a water pill, switching to a salt substitute can be more effective than taking OTC potassium tablets and easier to swallow than prescription potassium pills.
Here Are 4 Tips to Getting Just Enough Potassium:
1. Eat potassium-rich foods. Sweet potatoes, white potatoes, and 8 ounces of low-fat or non-fat yogurt have more potassium than bananas. Low-sodium V-8 has nearly twice the potassium that orange juice has.
2. Switch your salt. Nu-Salt® has 795mg of potassium in each ¼ teaspoon. That’s 20mEq of potassium, more than many prescription strength potassium tablets. Morton Salt Substitute® has 610 mg of potassium per ¼ teaspoonful, which is (15mEq) of potassium.
3. Check with your doctor. Certain heart medicines like lisinopril, losartan, and spironolactone encourage potassium to stay in your body. Ask your doctor before switching to a salt substitute containing potassium.
4. Avoid potassium if you have kidney problems. Discuss potassium-rich foods and salt with your doctor.
Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. 2022 Louise Achey
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