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Potassium and Trimethoprim-Sulfamethoxazole: what the research found

PubMed indexes 8 records that name Potassium and Trimethoprim-Sulfamethoxazole together, either in the title or in an interaction, co-administration, or pharmacokinetic context. The key findings come first, in the authors’ own words, followed by every study with its design and PubMed link.

A summary of published research, not medical advice. A pharmacist can check any combination against your full list of medicines and supplements.

Key findings

What the studies concluded.

Reviews and human studies first. Each quote is the authors’ own conclusion about their study, not a NutriStack assessment, and a single study is not a consensus.

“This study is the first report to demonstrate the degree of changes in SCr, Na+ , and K+ concentrations after initiation of TMP-SMX treatment. If SCr is elevated after initiation of TMP-SMX treatment, clinicians should be aware of decreased Na+ and increased K+ concentrations. TMP may increase the risks of hyponatremia and hyperkalemia in a dose-dependent manner without altering GFR.”

Yokoyama et al. · 2022 · Human study · details

“Conclusion Adherence to Dutch guidelines was poor as serum potassium monitoring was often not performed. As intravenous co-trimoxazole usage is associated with a significant increase in mean serum potassium, monitoring is strongly recommended.”

Plantaz et al. · 2020 · Human study · details

“Conclusion Adherence to Dutch guidelines was poor as serum potassium monitoring was often not performed. As intravenous co-trimoxazole usage is associated with a significant increase in mean serum potassium, monitoring is strongly recommended.”

The research

8 studies naming Potassium and Trimethoprim-Sulfamethoxazole.

Strongest relevance first: papers naming both substances in the title, then human trials and systematic reviews.

Co-trimoxazole induced hyperkalemia and potassium monitoring in hospitalized patients.

International journal of clinical pharmacy · 2020 · PMID 33025449

Comparative StudyHuman subjects30 participants

“Conclusion Adherence to Dutch guidelines was poor as serum potassium monitoring was often not performed. As intravenous co-trimoxazole usage is associated with a significant increase in mean serum potassium, monitoring is strongly recommended.”

Plantaz et al. · From the abstract

Names both Potassium and Trimethoprim-Sulfamethoxazole in its title.

The effect of co-trimoxazole on serum potassium concentration: safety evaluation of a randomized controlled trial.

British journal of clinical pharmacology · 2017 · PMID 28192629

Multicenter StudyRandomized Controlled Trial

“Co-trimoxazole significantly increases serum potassium concentration, even in participants not using antikaliuretic drugs. While the magnitude of increase was often minor, a small proportion in our outpatient cohort developed hyperkalaemia of clinical importance.”

Chan et al. · Authors' conclusion

Names both Potassium and Trimethoprim-Sulfamethoxazole in its title.

Impact of trimethoprim on serum creatinine, sodium, and potassium concentrations in patients taking trimethoprim-sulfamethoxazole without changes in glomerular filtration rate.

Journal of clinical pharmacy and therapeutics · 2022 · PMID 35545234

Human subjects

“This study is the first report to demonstrate the degree of changes in SCr, Na+ , and K+ concentrations after initiation of TMP-SMX treatment. If SCr is elevated after initiation of TMP-SMX treatment, clinicians should be aware of decreased Na+ and increased K+ concentrations. TMP may increase the risks of hyponatremia and hyperkalemia in a dose-dependent manner without altering GFR.”

Yokoyama et al. · Authors' conclusion

Names both Potassium and Trimethoprim-Sulfamethoxazole in its title.

Co-trimoxazole induced hyperkalemia and potassium monitoring in hospitalized patients.

International journal of clinical pharmacy · 2020 · PMID 32390087

Human subjects30 participants

“Conclusion Adherence to Dutch guidelines was poor as serum potassium monitoring was often not performed. As intravenous co-trimoxazole usage is associated with a significant increase in mean serum potassium, monitoring is strongly recommended.”

Plantaz et al. · From the abstract

Names both Potassium and Trimethoprim-Sulfamethoxazole in its title.

Effect of standard-dose trimethoprim/sulfamethoxazole on the serum potassium concentration in elderly men.

The Annals of pharmacotherapy · 1996 · PMID 8729886

Human subjects

“Therapy with standard-dose TMP/SMX is associated with a slight increase in the serum potassium concentration. Routine monitoring of the serum potassium concentration in patients who are treated with standard-dose TMP/SMX therapy is unnecessary. However, TMP/SMX should be considered as a possible cause of unexplained hyperkalemia in elderly patients receiving TMP/SMX therapy.”

Witt et al. · Authors' conclusion

Names both Potassium and Trimethoprim-Sulfamethoxazole in its title.

Severe hyponatremia due to trimethoprim-sulfamethoxazole: a case report.

AME case reports · 2025 · PMID 40330924

Case Reports

“Timely identification and careful monitoring of TMP-SMX-induced hyponatremia enabled the correction of sodium levels without severe complications. Thus, this report underscores the importance of vigilant monitoring and prompt identification of hyponatremia in patients undergoing TMP-SMX treatment. Further research is warranted due to limited data on the precise mechanisms of TMP-SMX-induced hyponatremia.”

Alrasheed et al. · Authors' conclusion

Names Potassium and Trimethoprim-Sulfamethoxazole together in an interaction, co-administration, or pharmacokinetic context.

Limitations

What this evidence cannot tell you.

Search-based evidence indexes have real limits, and it is worth being explicit about them:

How to read this page

A literature summary, not guidance.

NutriStack

Track what you actually take.

NutriStack is a free iPhone app for organising a supplement routine: what you take, when, and what the published record says about it. Its exploratory interaction checker covers Potassium, Trimethoprim-Sulfamethoxazole, and several hundred other substances.

Log your routine, get reminders at the times you choose, and scan a label to add a product. The checker is a research and organisation tool, not a clinical decision aid.

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