Potassium Plus Kelp by Vitalabs, Inc

LIKELY EFFECTIVE

• Iodine deficiency. Oral iodine supplements, including iodized salt, are effective for improving iodine status and reducing goiter size in adults and children. Iodine supplementation is also recommended during pregnancy in areas at risk for iodine deficiency. Details: Iodine deficiency is associated with several adverse outcomes. The earliest clinical symptom of iodine deficiency is low circulating thyroid hormone and thyroid stimulating hormone (TSH), followed by thyroid goiter (7135,16747,91398). Iodine deficiency and subsequent hypothyroidism can lead to anovulation, infertility, autoimmune thyroiditis, and gestational hypertension. Iodine deficiency is also associated with increased risk of thyroid cancer (16747). Clinical research shows that taking iodine supplements, including iodized salt, improves iodine status and reduces goiter size in adults with iodine deficiency (16747,55919,103071). Studies also show that taking iodine supplementation, including iodized salt, in areas of endemic iodine deficiency, reduces goiter size in children (16747,55919). When taken during pregnancy for iodine deficiency, iodine supplements and iodized salt reduce both maternal and newborn thyroid size and thyroglobulin; however, the effect on maternal TSH is inconsistent (91399,103070). Although some clinical studies and one analysis show that perinatal use of iodine has no effect on the incidence of thyroid disorders during pregnancy (91399,97240,97241), one analysis shows that iodine supplementation reduces the risk of postpartum hyperthyroidism by 68% when compared with placebo (97240). Taking iodine supplementation before 12 weeks' gestation appears to be more effective than when taken later in pregnancy. Perinatal iodine supplementation has no effect on preterm birth rate (97240,97241). Evidence is limited to females with mild-moderate iodine deficiency; the routine use of iodine supplementation during pregnancy has not been extensively studied. For example, the effect of perinatal supplementation on newborn neurocognitive development is conflicting and the evidence is generally low quality (55976,97241,105880,108706). Despite the limited evidence, iodine supplementation is recommended in areas at risk of deficiency.
• Radiation exposure. Oral potassium iodide prevents thyroid uptake of radioactive iodine. However, it does not protect against other sources of radiation. Details: Taking potassium iodide is effective for preventing the uptake of radioactive iodine by the thyroid (7517,7518). Doses of potassium iodide protect for about 24 hours. Therefore, it should be taken daily until the risk of radiation exposure no longer exists (17575,17576).

POSSIBLY EFFECTIVE

• Conjunctivitis. Ophthalmic povidone-iodine solution seems to reduce the risk of conjunctivitis in infants. It may also improve the resolution of acute conjunctivitis in adults. It is unclear if it is beneficial in patients with adenoviral conjunctivitis. Details: A meta-analysis of low-quality clinical trials shows that povidone-iodine solutions are more effective than silver nitrate for preventing neonatal conjunctivitis. However, povidone-iodine solutions are not more effective than erythromycin or chloramphenicol (56084). Povidone-iodine in combination with dexamethasone also seems to be helpful in adults. A clinical trial in patients with acute viral conjunctivitis shows that applying povidone-iodine 0.6% with dexamethasone 0.1% four times daily for 4 days improves clinical symptoms and eradiation of viral counts when compared with placebo control (103075). A small clinical study in adults with adenoviral conjunctivitis shows that administering 4-5 drops of a povidone-iodine 5% eye drop solution within 4 days of symptom onset decreases viral load, mucoid discharge, and bulbar edema and redness on day 4 of a 21-day follow-up period, but at no other time points, when compared with a single dose of artificial tears (108705). Due to the single-dose nature of this study, the effects of continued administration are unclear.
• Diabetic foot ulcers. Topical iodine seems to help with the management of diabetic foot ulcer wounds. Details: A small clinical study in patients with diabetic foot ulcers shows that topically applying cadexomer iodine ointment (Iodosorb) for 12 weeks seems to improve healing to a similar degree as using standard treatment with gentamicin solution, streptokinase, and/or dry saline gauze (2200).
• Endometritis. Topical application of iodine prior to cesarean delivery seems to reduce the risk of endometritis. Details: A meta-analysis of eight clinical trials shows that vaginally applying povidone-iodine 1% to 10% solution immediately before cesarean delivery reduces the risk of post-cesarean endometritis by 62% when compared with saline or no cleaning. It also reduces postoperative fever by 13% and wound infection by 23% (99794). These findings are consistent with other meta-analyses (56080,103076). There seems to be no difference in benefit whether povidone-iodine 1%, 5%, or 10% is used. A network meta-analysis of clinical studies in patients having cesarean delivery suggests that povidone-iodine is no better at preventing endometritis than using chlorhexidine or metronidazole; however, there may not have been sufficient power to detect a difference (103076).
• Fibrocystic breast disease. Oral iodine seems to reduce breast pain in patients with fibrocystic breast disease. Details: Preliminary clinical research in patients with fibrocystic breast disease shows that taking sodium iodide, protein bound iodide, or molecular iodine for 6 months or longer improves mastalgia and reduces breast nodules when compared with baseline or control. Molecular iodine in doses of 70-90 mcg/kg appears to be more effective and better tolerated than the other forms (2197). Another clinical study in patients with cyclic mastalgia due to fibrocystic breast disease shows that taking tablets containing molecular iodine 3000-6000 mcg daily for 5 months reduces pain, tenderness, and nodularity in patients with cyclic mastalgia when compared with placebo. However, a lower dose of 1500 mcg daily does not appear to be beneficial (55960).
• Oral mucositis. Rinsing the mouth with a povidone-iodine solution may prevent oral mucositis from radiochemotherapy. Details: Small clinical studies in patients receiving radiation and chemotherapy for cancer shows that using an oral povidone-iodine rinse seems to reduce the risk for oral mucositis when compared with using sterile water (2198,2199).
• Periodontitis. Rinsing with povidone-iodine solution in addition to scaling and root planing seems to be modestly beneficial in patients with periodontitis. Details: A meta-analysis of mostly small clinical studies in patients with chronic periodontitis suggests that rinsing with povidone-iodine 0.1% to 10% during scaling and root planing modestly reduces the periodontal pocket depth when compared with rinsing with water or saline solution (56072).
• Postoperative infection. Povidone-iodine antisepsis prevents postoperative infection when compared with inactive controls such as normal saline and water. However, it is unclear how it compares to active controls such as chlorhexidine; practice guidelines are conflicting. Details: A meta-analysis of clinical research shows that intraoperative application of povidone-iodine reduces the risk of surgical site infection by approximately 40% when compared with saline or no irrigation (56088). However, research comparing povidone-iodine with other antiseptics such as chlorhexidine is conflicting, as are official guidelines for surgical antisepsis. Many of these discrepancies seem to be related to the presence or absence of alcohol in the preparation. A meta-analysis of clinical research comparing aqueous or alcohol-based povidone-iodine shows that using alcohol-based chlorhexidine for skin antisepsis is more effective for preventing postoperative surgical site infections and may be associated with a lower overall positive culture rate. However, since evidence for both aqueous and alcohol-based solutions of povidone-iodine were included in this study, it is unclear if this may have affected outcomes (108710). The National Institute for Health and Care Excellence (NICE) Guideline recommends chlorhexidine solution as the first choice for preparing the skin for surgery, with povidone-iodine solution as a second-line option. The antiseptic solutions are recommended to be alcohol-based as long as the surgical site is not near a mucous membrane (105906). The World Health Organization (WHO) guidelines also recommend alcohol-based chlorhexidine solutions over either alcohol-based or aqueous povidone-iodine for preventing surgical site infections. However, some experts have expressed concern that these recommendations are based on faulty evidence, as some studies used povidone-iodine preparations with lower alcohol amounts than their comparator groups (105898). In fact, the guideline from the Centers for Disease Control and Prevention (CDC) does not differentiate between povidone-iodine and chlorhexidine antiseptic solutions as long as they are alcohol-based (105905).
• Thyroid storm. Oral iodine is recommended as an adjunct to standard treatment for thyroid storm. Details: The American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) recommend a multimodality approach for treating thyroid storm that includes taking five drops of a saturated solution of potassium iodine every 6 hours (15,92699).
• Thyroid nodules. Combining oral iodine with thyroxine seems to improve the resolution of thyroid nodules. Details: A clinical study in patients with benign nodular thyroid disease and possible iodine deficiency shows that taking iodized salt 200 mcg daily in addition to thyroxine 1.5 mcg/kg daily after surgery seems to reduce the size of the thyroid remnant by 40%, compared with a 10% reduction in patients given thyroxine alone (55927). Also, one large clinical trial in patients with nodular goiter shows that taking potassium iodide 150 mcg daily in combination with levothyroxine 50-100 mcg daily for 12 months reduces nodule volume by about 17%, compared with 7% in the group using levothyroxine alone (91392).
• Venous leg ulcers. Topical cadexomer iodine seems to improve the healing of venous leg ulcers; however, it is unclear if applying povidone-iodine is beneficial. Details: A meta-analysis of four small clinical studies in patients with venous leg ulcers shows that applying cadexomer iodine results in complete healing of ulcers in 33% of patients after 4-12 weeks, compared with only 15% of patients receiving standard care alone. However, use of cadexomer iodine was associated with more adverse effects than standard care. Furthermore, preliminary clinical research shows that applying cadexomer iodine is comparable to hydrocolloid dressing, paraffin gauze dressing, dextranomer, and silver-impregnated dressings for improving the rate of complete healing. A meta-analysis of preliminary clinical research show that povidone-iodine has comparable healing rates when compared with amoxicillin, hydrocolloid dressings, and moist or foam dressings (99798). These findings were consistent with an older version of this meta-analysis (56076).

POSSIBLY INEFFECTIVE

• Catheter-related infections. Topical povidone-iodine seems to be less effective than chlorhexidine for preventing infections from intravascular catheters. Furthermore, it does not seem to reduce the risk of catheter-related urinary tract infections. Details: One meta-analysis of clinical research shows that topical application of povidone-iodine reduces the risk of bloodstream infections when applied at the insertion site of hemodialysis central venous catheters (55883). However, disinfecting catheter insertion sites using povidone-iodine seems to be less effective for preventing blood stream infections in patients receiving central venous, pulmonary artery, or peripheral artery catheters when compared with chlorhexidine solutions (55883,55916). In addition, periurethral cleansing with povidone-iodine 10% prior to bladder catheterization, as well as bladder irrigation with povidone-iodine 2% prior to urinary catheter removal, does not seem to reduce the risk of urinary tract infections when compared with placebo (56058,56126).
• Prematurity. Maternal iodine supplementation does not seem to impact neurological development in premature infants. Details: A meta-analysis of two clinical trials in premature infants shows that adding iodine to enteral or parenteral feeds does not improve mental, visual, or auditory development or reduce the risk of death when compared with no iodine supplementation (99797).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Chyluria. It is unclear if topical iodine is beneficial in patients with chyluria. Details: A small clinical study in patients with chyluria suggests that using povidone-iodine 0.2% solution as a sclerosant in renal pelvic instillation sclerotherapy (RPIS) may be as effective as using silver nitrate 1% (55970).
• Corneal ulceration. It is unclear if topical iodine is beneficial in patients with corneal ulceration. Details: Preliminary clinical research shows that administering povidone-iodine 2.5% eye drops every two hours for two weeks in addition to standard antibiotic therapy does not reduce visual impairment in patients with corneal ulcers when compared with standard antibiotic therapy alone (55971).
• Coronavirus disease 2019 (COVID-19). It is unclear if rinsing with a povidone-iodine mouthwash and using a povidone-iodine nasal spray and ointment can reduce the spread of COVID-19. Details: A small clinical study in adults with PCR-confirmed COVID-19 shows that orally swishing and gargling 25 mL of povidone-iodine (PI) 1% solution, then, into each nostril, spraying 2.5 mL of PI 1% solution and applying one dab of PI 10% ointment, and repeating this 4 times daily for 5 days does not seem to alter the quantity of viral RNA over time when compared with control (105877). The validity of this finding is limited because all study participants achieved negative viral titers on the third day of the study.
• Cutaneous sporotrichosis. It is unclear if topical iodine is beneficial in patients with cutaneous sporotrichosis; research is conflicting. Details: Anecdotal reports and case series suggest that taking saturated solution of potassium iodide (SSKI) orally is effective for most patients when used alone or in combination with another antifungal, including terbinafine or itraconazole (17562,17563,17564,17565,17566,17567,17568,17569,17570,17571) (17572,17573). In one non-controlled clinical study, treatment with SSKI, starting with 3 drops (150 mg potassium iodide) daily and titrating up, resulted in symptom resolution in about 90% of patients after about 33 days of treatment (17561). However, some patients are not able to take SSKI due to intolerable side effects (17561,17572).
• Hyperthyroidism. It is unclear if oral potassium iodide is beneficial for patients with Graves' disease undergoing total thyroidectomy. Details: A retrospective study in patients with Graves' disease undergoing total thyroidectomy shows that preoperative administration of saturated solution of potassium iodide (SSKI) 5% does not reduce the rate of postoperative complications, such as transient or permanent hypoparathyroidism, transient recurrent laryngeal nerve (RLN) palsy, definitive RLN palsy, and cervical hematoma, when compared with no preoperative administration (108707).
• Infant development. It is unclear if maternal iodine supplementation impacts neurological development in infants. Details: Three-year follow-up data from a clinical study in infants and breastfeeding females shows that maternal supplementation of iodine 150 mcg daily improves child cognitive scores, but does not affect language or motor scores, when compared with placebo. Supplementation with a higher dose of 300 mcg daily yielded similar cognitive, language, and motor scores as the 150 mcg dose (108706). This finding aligns with the daily recommended dietary allowance (RDA) of 290 mcg during lactation, which is sometimes achieved by augmenting the diet with a 150-mcg iodine supplement (7135).
• Postoperative bleeding. It is unclear if topical iodine is beneficial in patients with postoperative bleeding. Details: A small clinical study suggests that irrigating extraction sockets with povidone-iodine 1% stops bleeding in a greater number of patients following tooth extraction when compared with a saline solution (56011).
• Rhinosinusitis. It is unclear if topical iodine is beneficial in patients with rhinosinusitis. Details: A small prospective cohort study in patients with recalcitrant chronic rhinosinusitis has found that using a povidone-iodine 0.08% nasal rinse every other day for 7 weeks in addition to standard therapy improves symptoms and reduces signs of infection when compared with baseline (103074). However, one small clinical study in patients with a history of sinus surgery and acute exacerbations of chronic sinusitis shows that receiving povidone-iodine nasal irrigations twice daily for 30 days is no different than irrigations with mupirocin or normal saline for improving nasal symptoms. However, mupirocin tended to reduce bacteria count to a greater extent than the povidone-iodine solution (105878). This finding is limited due to small study size and potential lack of power to detect differences between groups.
• Thyroid cancer. It is unclear if dietary iodine is associated with complications in patients with papillary thyroid cancer. Details: A retrospective study in patients in China with papillary thyroid cancer has found that dietary intake of iodine resulting in serum concentrations greater than 90 mcg/L is associated with a 75% increased risk of cervical lymph node metastases when compared with concentrations less than 45 mcg/L (108708). Actual dietary intake of iodine was not reported, limiting the validity of this finding.
• Ventilator-associated pneumonia (VAP). It is unclear if oral iodine rinse is beneficial for the prevention of VAP. Details: A small clinical study in patients with severe head trauma suggests that regularly rinsing the throat with 20 mL of povidone-iodine 10% solution decreases the risk for VAP when compared with using a saline rinse (56003).
• Wound healing. It is unclear if topical iodine is beneficial for wound healing. Details: A meta-analysis of clinical research shows that topical iodine, as cadexomer iodine or povidone-iodine, is superior to non-antiseptic dressings and some antiseptic agents, such as silver sulfadiazine, for reducing wound size. However, iodine seems to be less effective than local antibiotics such as rifamycin (56083). More evidence is needed to rate iodine for these uses.

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EFFECTIVE

• Hypokalemia. Oral or intravenous potassium can treat and prevent hypokalemia. Details: Administering potassium orally or intravenously is effective for treating and preventing hypokalemia (15,107970). Oral potassium 20 mEq (780 mg of elemental potassium) is typically taken once daily to prevent hypokalemia (15,95010). Oral potassium 40-100 mEq (1560-3900 mg of elemental potassium) is typically taken in 2-5 divided doses daily to treat hypokalemia (95010). Doses should be limited to 40 mEq (1560 mg of elemental potassium), and the total dose should not exceed 200 mEq (7800 mg of elemental potassium) in 24 hours (95010). Potassium supplementation and route of administration should be individualized based on serum potassium level and patient status (15,107970).

LIKELY EFFECTIVE

• Hypertension. Oral potassium, via dietary intake or supplementation, reduces blood pressure. Details: Population research has found that higher dietary potassium consumption is associated with a lower risk of developing hypertension (1310,8817,69512). Additionally, most clinical research shows that potassium, taken orally as part of the diet or as a supplement, reduces systolic blood pressure by about 3-9.5 mmHg and diastolic blood pressure by about 2-6.4 mmHg in patients with or without hypertension (3385,92104,92106,95624,107974). In most of these studies, daily intake of potassium typically ranged from about 1500-7800 mg, with the most common intake being about 2340-2540 mg daily (92104,95624). However, some research shows that taking potassium does not lower systolic or diastolic blood pressure (69541,69550,107966). Differences in the patient populations, potassium intake, and salt intake could have contributed to the conflicting results. Potassium seems to be more effective for people with hypertension, low potassium levels, high daily sodium intake, and for Black adults (3384,3385,3386,92104,92106). Some research also shows that the greatest blood pressure-lowering effects of potassium occur at doses of about 3900-7800 mg daily (95624). A meta-analysis of clinical trials using a novel computational technique to assess both potassium intake and excretion suggests that the optimal blood pressure reduction occurs when taking about 1500 mg supplemental potassium daily or an overall intake of 4500-6500 mg potassium daily (105448). This analysis is limited by the heterogeneity and short duration of the included trials. There is also interest in utilizing low-sodium, high-potassium food substitutes to treat hypertension. Research shows that using salt substitutes containing 25% to 30% potassium chloride reduces systolic and diastolic blood pressure by 3-4.6 mmHg and 1 mmHg, respectively, when compared with regular table salt (107971,107976). In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) published guidelines recommending that patients with hypertension consume 3500-5000 mg of potassium daily (95680). This intake of potassium is expected to lower systolic blood pressure by about 4-5 mmHg in patients with hypertension and by about 2 mmHg in normotensive patients (3385). Although potassium supplements and dietary potassium both seem to be beneficial, the guidelines recommend getting potassium from dietary sources, since potassium-rich diets are usually heart-healthy (95680). Additionally, the US Food and Drug Administration (FDA) has determined that foods containing at least 350 mg potassium and that are low in sodium, saturated fat, and cholesterol can state that "diets containing foods that are good sources of potassium and low in sodium may reduce the risk of high blood pressure and stroke" (1310,8817).
• Kidney stones (nephrolithiasis). Oral prescription potassium citrate reduces the risk of kidney stone recurrence. It is unclear if non-prescription potassium citrate would be beneficial. Details: The American Urological Association (AUA) recommends potassium citrate therapy for patients with recurrent calcium stones and low urinary citrate, those with recurrent calcium or calcium oxalate stones without current metabolic abnormalities, and those with uric acid or cystine stones. The citrate component reduces urine calcium excretion and increases urine citrate and urine pH, which in turn alleviates crystal growth, formation, and aggregation. Sodium citrate may also be used to prevent stone recurrence; however, due to sodium's propensity to increase urine calcium excretion, potassium citrate remains the preferred salt formulation (107972). It is important to note that potassium citrate supplements are not equivalent to prescription potassium citrate products. Dose and duration of treatment is determined by a healthcare professional and individualized based on a patient's urinary citrate levels (107975,107989). Serum potassium levels should be monitored prior to starting potassium citrate, within 2 weeks of treatment initiation, and every 12 months (107975).

POSSIBLY EFFECTIVE

• Cardiovascular disease (CVD). Eating foods high in potassium and low in sodium might reduce the risk of cardiovascular disease. It is unclear if taking potassium supplements has the same benefit. Details: Large population studies in adults without prior CVD have found that higher dietary potassium intake is associated with a lower risk of cardiovascular events (109395,109399). One study found that daily potassium intake of about 3300 mg is associated with a 13% reduction in CVD risk when compared with intake of about 1920 mg (109399). The other study found that each additional 1000 mg of daily urinary potassium excretion, which is a marker of dietary intake, is associated with an 18% reduction in CVD risk (109395). Another observational study in over 15,000 adults with history of stroke or hypertension shows that replacing regular table salt with a substitute product containing 75% sodium chloride and 25% potassium chloride for an average of 5 years decreases the rate of stroke, major cardiovascular events, or death (107976). High quality clinical trials are needed to confirm this association. The US Food and Drug Administration (FDA) has determined that foods containing at least 350 mg potassium and that are low in sodium, saturated fat, and cholesterol can state that "diets containing foods that are good sources of potassium and low in sodium may reduce the risk of high blood pressure and stroke" (1310,8817).
• Stroke. Eating foods high in potassium and low in sodium might reduce the risk of stroke. It is unclear if taking potassium supplements has the same benefit. Details: Higher dietary intake of potassium seems to be associated with a lower risk of stroke. Population research has found that increasing dietary potassium intake by 1-1.5 grams daily is associated with up to a 20% reduced risk of stroke (92105,92107). Some population research has found that higher supplemental intake of potassium is associated with a 29% reduced risk of ischemic stroke. However, supplemental potassium intake is not found to be associated with a lower risk of hemorrhagic or total stroke (92107). An observational study in over 15,000 adults with history of stroke or hypertension shows that replacing regular table salt with a substitute product containing 75% sodium chloride and 25% potassium chloride for an average of 5 years decreases the rate of stroke, major cardiovascular events, or death (107976). High quality clinical trials are needed to confirm this association. The US Food and Drug Administration (FDA) has determined that foods containing at least 350 mg potassium and that are low in sodium, saturated fat, and cholesterol can state that "diets containing foods that are good sources of potassium and low in sodium may reduce the risk of high blood pressure and stroke" (1310,8817).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Dental hypersensitivity. It is unclear if topical potassium improves dental hypersensitivity. Details: One meta-analysis of clinical research shows that using a dentifrice containing 5% potassium nitrite reduces dentin sensitivity when compared with a dentifrice that does not contain potassium nitrite (69549). Other clinical research published in a systematic review shows that potassium-containing toothpastes might reduce dentin sensitivity more than controls that do not contain potassium. However, these toothpastes might be less effective than other active toothpastes, such as those containing sodium monofluorophosphate, and the effect may result from a placebo effect, since the mechanism of action of potassium is unclear (69456).
• Diabetes. It is unclear if increasing dietary potassium reduces the risk of diabetes. Details: A meta-analysis of 7 large population studies has found that consuming dietary potassium 3300-3500 mg daily is associated with a 20% reduction in the risk of diabetes when compared with consumption below 1000 mg daily. Results were similar when studies that measured potassium intake with a dietary questionnaire were analyzed separately from those that measured intake based on urinary potassium excretion (110776). However, the validity of this finding is limited by the heterogeneity of the included studies. Furthermore, despite use of data from various databases, most studies included in the analysis were conducted by the same author.
• Impaired glucose tolerance (prediabetes). It is unclear if oral potassium improves glycemic control in prediabetes. Details: A small clinical study in Black patients with prediabetes shows that taking extended-release potassium (Klor-Con M10, Cardinal Health) 40 mEq daily as potassium chloride for 3 months does not improve glucose tolerance when compared with placebo. Although fasting glucose levels were slightly reduced in the potassium group when compared with placebo, both groups experienced a worsening of glucose intolerance, with no change in insulin levels or glycated hemoglobin (98533).
• Osteoporosis. Although there is interest in using oral potassium for osteoporosis, there is insufficient reliable information about the clinical effects of potassium for this condition.
• Physical performance. It is unclear if oral potassium improves physical performance in older adults. Details: Observational research in older adults has found that decreased dietary potassium intake and increased dietary sodium intake over 5 years is associated with worsened physical performance (105450).
• Systemic lupus erythematosus (SLE). It is unclear if oral potassium is beneficial in patients with SLE. Details: Observational research in patients with SLE has found that increased dietary potassium intake is not associated with improvements in disease activity scores or markers of cardiovascular disease, including lipid levels and blood pressure, when compared with low dietary potassium intake. However, higher potassium intake does seem to reduce the odds of having elevated levels of C-reactive protein, a marker of inflammation, in these patients (109397). More evidence is needed to rate potassium for these uses.

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LIKELY SAFE ...when used orally and appropriately. Iodine is safe in amounts that do not exceed the tolerable upper intake level (UL) of 1100 mcg daily (7135,103070). Higher doses can be safely used with appropriate medical monitoring (2197,7080). In some regions of the world, such as Japan, daily dietary intake is estimated to be as high as 5,280-13,800 mcg without adverse outcomes (16747). ...when used topically and appropriately, as a 2% solution. A 2% iodine solution is an FDA-approved prescription product (15).

POSSIBLY UNSAFE ...when used orally in high doses. Tell patients to avoid prolonged use of doses exceeding the UL of 1100 mcg daily without proper medical supervision. There is concern that higher intake can increase the risk of side effects such as thyroid dysfunction, as well as thyroiditis, thyroid papillary cancer, thyrotoxicosis, and atrial fibrillation (7135,55962,56013). However, in some regions of the world such as Japan, daily dietary intake is estimated to be as high as 5,280-13,800 mcg without adverse outcomes (16747).

CHILDREN: LIKELY SAFE
when used orally and appropriately (7135). Iodine is safe in amounts that do not exceed the tolerable upper intake level (UL) of 200 mcg daily for children 1-3 years, 300 mcg daily for children 4-8 years, 600 mcg daily for children 9-13 years, and 900 mcg daily for adolescents (7135). ...when used topically as a 2% solution (15). Iodine is an FDA-approved prescription product.

CHILDREN: POSSIBLY UNSAFE
when used orally in doses exceeding the UL (7135,108709). Higher intake can cause thyroid dysfunction (7135) and may be associated with a modest reduction in intelligence (108709).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally and appropriately. Iodine is safe in amounts that do not exceed the tolerable upper intake level (UL) of 1100 mcg daily in those 18 years and older or 900 mcg daily in those 14-18 years of age (7135,103070). Iodine needs increase during pregnancy and lactation and adequate intakes should begin as soon as a patient is aware of the pregnancy, or earlier in areas of potential deficiency (17920). ...when used topically as a 2% solution (15). Iodine is an FDA-approved prescription product.

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally in doses exceeding the UL. Higher intake can cause thyroid dysfunction (7135). Also, higher intakes during pregnancy cause increased iodine levels in breast milk and infant blood samples. Higher iodine intake during pregnancy has also been associated with an increased risk of congenital hypothyroidism and reduced mental and physical development in the offspring (56089,91390,91394,91395).

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LIKELY SAFE ...when used orally in doses up to 100 mEq total potassium daily, not to exceed 200 mEq in a 24-hour period (95010,107989). Oral potassium chloride and potassium citrate are FDA-approved prescription products (95010,107989). Larger doses increase the risk of hyperkalemia (15). ...when administered intravenously (IV) at appropriate infusion rates (95011). Parenteral potassium is an FDA-approved prescription product (15,95011). A tolerable upper intake level (UL) for potassium has not been established; however, potassium levels should be monitored in individuals at increased risk for hyperkalemia, such as those with kidney disease, heart failure, and adrenal insufficiency (100310,107966).

CHILDREN: LIKELY SAFE
when used orally and appropriately in dietary amounts. A tolerable upper intake level (UL) has not been established for healthy individuals (6243,100310).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in dietary amounts of 40-80 mEq daily (15). A tolerable upper intake level (UL) has not been established for healthy individuals (100310).

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AMIODARONE (Cordarone) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Combining iodine with amiodarone might cause excessively high iodine levels.  Details Amiodarone contains 37.3% iodine and can increase iodine levels. Concomitant use with iodine might increase the risk of having excessive iodine levels and adversely affecting thyroid function (7135,17574). Monitor thyroid function.

ANTITHYROID DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Iodine might alter the effects of antithyroid drugs.  Details Iodine in high doses has been reported to cause both hyperthyroidism and hypothyroidism, depending on the individual's past medical history. Taking iodine while using antithyroid drugs could alter the effects of the antithyroid drugs (2138,17574).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Combining iodine with lithium might have additive hypothyroid effects.  Details Lithium can inhibit thyroid function. Several case reports suggest that concomitant use of lithium and potassium iodide can reduce thyroid function in otherwise healthy adults (17574). Monitor thyroid function.

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ACE INHIBITORS (ACEIs) Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Likely •  Level of Evidence = C Using ACEIs with high doses of potassium increases the risk of hyperkalemia.  Details ACEIs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion (95628). Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia (15,23207). However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels (95628).

ANGIOTENSIN RECEPTOR BLOCKERS (ARBs) Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Likely •  Level of Evidence = C Using ARBs with high doses of potassium increases the risk of hyperkalemia.  Details ARBs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion (95628). Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia (15,23207). However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels (95628).

POTASSIUM-SPARING DIURETICS Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Likely •  Level of Evidence = C Concomitant use increases the risk of hyperkalemia.  Details Using potassium-sparing diuretics with potassium supplements increases the risk of hyperkalemia (15).

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General ...Orally, iodine is well tolerated when taken in amounts that do not exceed the tolerable upper intake level (UL) or when used therapeutically with appropriate medical monitoring (2197,7080,7135).
Most Common Adverse Effects:
Orally: Abdominal upset, diarrhea, goiter, headache, hyperthyroidism, hypothyroidism, metallic taste, nausea, rhinorrhea, thyroid adenoma.
Topically: Burns, dermatitis, irritation.
Serious Adverse Effects (Rare):
All ROAs: Hypersensitivity reactions such as anaphylaxis and angioedema.

Dermatologic ...Orally, taking iodine chronically or in large amounts has been reported to cause acneform skin lesions called iododerma (2138). In one case, a patient developed iododerma after consuming a specific product (Hoxsey's Brown Tonic) containing an unspecified quantity of potassium iodide. After several months of consumption, the patient developed acneform skin lesions on the nose, cheeks, and upper back and presented with a urine iodine level of 7,455,647 ug/L (reference range: 34-523 ug/L). After discontinuation of potassium iodide, the lesions resolved gradually over the course of several weeks (95431).
Topically, iodine may stain skin, irritate tissues, and cause sensitization in some individuals (15,56106). Iodine burns are associated with application of 7% hydroalcoholic solution (15). Povidone-iodine may cause contact dermatitis or irritant reactions in some people. However, patch testing with potassium iodide is usually negative in these patients, indicating that contact dermatitis caused by topical iodine does not indicate a propensity for reaction to oral potassium iodide (93001).

Endocrine ...Prolonged use and/or large oral doses of iodine intake can cause thyroid gland hyperplasia, thyroid adenoma, goiter, and hypothyroidism (15,56013,56089,91397,91398,99793,99795). In another case report, an infant presented with reversible hypothyroidism at birth because the mother had consumed excessive seaweed soup during and after pregnancy, which resulted in excessive iodine consumption (99795). Iodine has also been linked to rare cases of adverse events. In one case report, a 56-year-old male developed thyrotoxic hypokalemic paralysis thought to be related to excessive intake of iodine (91401).
Topically, using povidone-iodine (PI) 1% solution as a gargle and nasal spray, in addition to intranasal application of PI 10% ointment over 5 days, can precipitate subclinical hypothyroidism, with elevated thyroid stimulating hormone (TSH) and normal thyroid hormone levels. TSH levels seem to normalize about 7-12 days after stopping topical PI application (105877).

Gastrointestinal ...Orally, the commonly reported adverse effects of a saturated solution of potassium iodide (SSKI) are nausea (14%), abdominal pain (14%), metallic taste (4%), and diarrhea (4%) (17561). These side effects can be minimized by avoiding quick dosage increases (17574). Taking iodine chronically or in large amounts has also been reported to cause soreness in teeth and gums, burning in mouth and throat, increased salivation, swelling of parotid and submaxillary glands, inflammation of the respiratory tract, gastric upset, and diarrhea (15,2138).
Intranasally, applying povidone-iodine 1% solution along with a 10% ointment can cause unpleasant nasal tingling (105877).

Immunologic ...People who are allergic to iodine-containing foods or drugs are sometimes stated to have "iodine allergy", but the actual allergen is another agent such as seafood proteins or radiocontrast media (93001). However, some people can be hypersensitive to iodine when used orally. Symptoms of hypersensitivity can include angioedema, cutaneous and mucosal hemorrhage, fever, arthralgia, lymph node enlargement, eosinophilia, urticaria, erythema, and thrombotic thrombocytopenic purpura (15,17561). Other reported side effects include potassium toxicity, metabolic acidosis, pustular psoriasis, and vasculitis (17574). However, such sensitivity is very rare (93001). Orally, iodine hypersensitivity can cause fatal periarteritis (15).

Neurologic/CNS ...Orally, common side effects of a saturated solution of potassium iodide (SSKI) have included headache (7%) (17561). Side effects can be minimized by avoiding quick dosage increases (17574).
High intake of iodine may be associated with adverse cognitive outcomes in children. Observational research in children aged 7-14 years has found that those consuming drinking water with iodine concentrations above 900 mcg/L daily, which exceeds the tolerable upper intake level, is associated with a 1.6-point reduction in intelligence level when compared with those consuming water with iodine concentrations below 300 mcg/L (108709).

Ocular/Otic ...Orally, taking iodine chronically or in large amounts has been reported to cause eye irritation and eyelid swelling (15,2138).

Pulmonary/Respiratory ...Orally, common side effects of a saturated solution of potassium iodide (SSKI) included rhinorrhea (11%) (17561). Side effects can be minimized by avoiding quick dosage increases (17574). Taking iodine chronically or in large amounts has also been reported to cause coryza, sneezing, cough, and pulmonary edema (15,2138). Ophthalmically, povidone-iodine 5% solution 3 drops administered in each eye has been reported to slow respiration by about 18 seconds (range 4 to 96 seconds) when compared with saline control in children ages 2-17 years undergoing strabismus surgery (103077).

Renal ...When povidone-iodine was used in renal pelvic instillation sclerotherapy, one patient (2%) had significant flank pain during treatment (55970).

(Read more about IODINE)

General ...Orally or intravenously, potassium is generally well-tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, belching, diarrhea, flatulence, nausea, and vomiting.
Serious Adverse Effects (Rare):
All ROAs: High potassium levels can cause arrhythmia, heart block, hypotension, and mental confusion.

Cardiovascular ...Orally or intravenously, high potassium levels can cause hypotension, cardiac arrhythmias, heart block, or cardiac arrest (15,16,3385,95011,95626,95630).

Gastrointestinal ...Orally or intravenously, high doses of potassium can cause, nausea, vomiting, abdominal pain, diarrhea, and flatulence (95010,95011). Bleeding duodenal ulcers have also been associated with ingestion of slow-release potassium tablets (69625,69672).

Neurologic/CNS ...Orally or intravenously, high potassium levels can cause paresthesia, generalized weakness, flaccid paralysis, listlessness, vertigo, or mental confusion (15,16,3385,95011).

(Read more about POTASSIUM)