Pharmacy Clinical Pearl of the Day: Aldosterone Blockers and Hyperkalemia

Aldosterone blockers, such as spironolactone and eplerenone, can cause hyperkalemia.

Aldosterone blockers, spironolactone (Aldactone) and eplerenone, can cause hyperkalemia.

When hyperkalemia occurs, the medications that can be used in reducing K levels are:

  • Patiromer (Veltassa)
  • Lokelma (Sodium zirconium cyclosilicate)


Both spironolactone (Aldactone) and eplerenone, when started, can potentially increase potassium levels and cause hyperkalemia. Therefore, dosing for these medications is always dependent of the potassium levels:


  • If GFR≥50 ml/min, K+<5, start 12.5-25 mg daily, then increase to 25 mg BID if K<5, after 4 weeks.
  • If GFR 30-49 ml/min, 12.5 daily or QOD and increase to 12.5 to 25 mg daily.


  • For GFR≥50 ml/min, start 25 mg daily and increase to 50 mg daily.
  • If GFR 30-49 ml/min, 25 mg QOD and increase to 25 mg daily.