Quick answer

Ask your pharmacist or doctor before combining. Two prescription potassium labels, for chloride and citrate, say NSAIDs may make the body keep potassium and tell prescribers to monitor it closely. A naproxen label reports raised potassium with NSAIDs even in some people without kidney impairment.^1,2,3

Key facts

Both the potassium chloride and potassium citrate labels say NSAIDs may produce potassium retention by reducing renal prostaglandin E synthesis and impairing the renin-angiotensin system.^1,2
A naproxen label says increases in serum potassium, including hyperkalemia, have been reported with NSAIDs, even in some patients without kidney impairment.³
NIH's potassium sheets do not mention NSAIDs, so the documentation on this page comes from medicine labels.^4,5
The potassium chloride label says hyperkalemia is usually silent and may show up only as a high blood potassium result and changes on a heart tracing.¹

Ask your pharmacist or doctor first

The prescription potassium chloride label says NSAIDs may cause the body to keep potassium, and that potassium should be closely monitored when the two are used together.¹

On the medicine's label

How do NSAIDs increase potassium?

The two prescription potassium labels give the same account. NSAIDs may produce potassium retention by reducing the kidneys' synthesis of prostaglandin E and impairing the renin-angiotensin system, and both labels say to monitor potassium closely in people who take an NSAID with potassium.^1,2

A naproxen label describes the same effect from the NSAID's side. It says increases in serum potassium, including hyperkalemia, have been reported with NSAIDs even in some patients without kidney impairment, and in people with normal kidney function it attributes this to a state of low renin and low aldosterone.³

MedlinePlus describes ibuprofen as an NSAID that comes as both a prescription and a nonprescription medicine, used to relieve pain, fever, swelling and stiffness.⁶

Can NSAIDs cause low potassium?

The NSAID passages read for this page describe the other direction: raised potassium or potassium retention. None describes low potassium. NIH ties low potassium to other causes, among them loop and thiazide diuretics, prolonged diarrhea or vomiting and heavy sweating.^3,4

Does it matter whether the potassium is a supplement, a prescription or a salt substitute?

The labels that document this concern are for prescription potassium chloride and potassium citrate. NIH says many supplement makers limit the potassium in their products to 99 mg, about 2% of the Daily Value, and that a Supplement Facts panel lists the potassium itself, not the weight of the compound. The sources checked do not say whether amounts that small matter with NSAIDs. That is not a finding either way, so ask your pharmacist about the product you use.⁴

Salt substitutes belong on the list. NIH says many contain potassium chloride in place of some or all of the sodium chloride, with about 440 to 2,800 mg of potassium per teaspoon, and that people with kidney disease or on certain medicines should talk to a provider before using them.^4,5

What about losartan potassium and NSAIDs?

Losartan potassium is a medicine, not a potassium supplement: the label describes it as the monopotassium salt of losartan. Its NSAID warning is about the kidneys and blood pressure. In people who are elderly, volume-depleted or have reduced kidney function, the label says NSAIDs given with losartan may worsen kidney function, and that NSAIDs may weaken losartan's blood pressure effect. Separately, it says other drugs that raise potassium can lead to hyperkalemia.⁷

Ask your pharmacist or doctor first

ACE inhibitors such as lisinopril and angiotensin receptor blockers (ARBs) such as losartan reduce the potassium lost in urine and can make blood potassium too high (hyperkalemia), especially in people with kidney problems. Their labels list potassium supplements and potassium-containing salt substitutes among the risks, and the labels and MedlinePlus tell people to check with their doctor before using them.^4,5,7,8,9,10

On the medicine's label

What about potassium-sparing diuretics and NSAIDs?

The spironolactone label says NSAIDs can reduce the diuretic, natriuretic and antihypertensive effect of diuretics, and asks prescribers to watch whether the desired effect is obtained. The potassium chloride label groups NSAIDs with potassium-sparing diuretics, ARBs and ACE inhibitors as agents with potassium-sparing properties, and says potassium chloride should not be used with triamterene or amiloride. Anyone taking two or more of these should ask a pharmacist to review the whole list.^1,11

Avoid the combination unless your doctor advises it

The spironolactone label says potassium supplements taken with it may lead to severe hyperkalemia, and that patients should be advised to avoid potassium supplements and foods high in potassium, including salt substitutes.^11,12

On the medicine's label

Questions for your pharmacist

Which of my medicines make the body hold on to potassium: an NSAID, an ACE inhibitor, an ARB or a potassium-sparing diuretic?
Do I use potassium in any form, including a supplement, an electrolyte drink or a salt substitute?
How often do I take the NSAID, and have my potassium and kidney function been checked?
Is there a pain reliever that fits better with my other medicines?

Questions people ask

Can NSAIDs cause low potassium?

The NSAID passages read for this page describe raised potassium or potassium retention, not low potassium. NIH ties low potassium to other causes such as loop and thiazide diuretics and prolonged diarrhea or vomiting.^3,4

How do NSAIDs increase potassium?

The potassium chloride and potassium citrate labels say NSAIDs may cause potassium retention by reducing renal prostaglandin E synthesis and impairing the renin-angiotensin system.^1,2

Why does high potassium matter if you take NSAIDs?

The potassium chloride label says high potassium is usually silent and may be found only on a blood test or heart tracing, and it tells prescribers to monitor potassium closely when an NSAID is used with potassium.¹

Can you take potassium citrate with NSAIDs?

Ask first. The potassium citrate label says NSAIDs may produce potassium retention and that potassium should be monitored closely in people taking both.²

What about losartan potassium and NSAIDs?

The losartan label's NSAID warning is about kidney function and weaker blood pressure control, and it separately warns about other drugs that raise potassium. Ask your pharmacist about your own list.⁷

What about potassium-sparing diuretics and NSAIDs?

The spironolactone label says NSAIDs can reduce the diuretic effect, and the potassium chloride label groups NSAIDs with potassium-sparing diuretics among agents that keep potassium in the body.^1,11

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Sources

This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.