Hyperkalemia, chronic:
Oral: Initial: 10 g 3 times daily for up to 48 hours, followed by 10 g once daily; adjust dose by 5 g daily at ≥1-week intervals as needed based on serum potassium levels. Usual dosage range: 5 g once every other day to 15 g once daily; maximum maintenance dose: 15 g/day.
Hyperkalemia, severe/emergent (adjunctive agent) (off-label use): Note: May be used for severe/emergent hyperkalemia (in combination with other acute therapies) to facilitate the elimination of potassium (KDIGO [Clase 2020]; Palmer 2021).
Oral: Initial: 10 g 3 times daily for up to 48 hours (KDIGO [Clase 2020]; Kosiborod 2015; Mount 2021; Peacock 2020).
Mild to severe impairment: There are no specific dosage adjustments provided in the manufacturer’s labeling.
Hemodialysis, intermittent (thrice weekly): Initial: 5 g once daily on nondialysis days (an initial dose of 10 g once daily on nondialysis days may be considered in patients with serum potassium level >6.5 mEq/L); adjust dose at 1-week intervals based on predialysis serum potassium measured after the long interdialytic interval and desired target range; maintenance: 5 to 15 g once daily on nondialysis days.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
Serum potassium below desired target range or for clinically significant hypokalemia: Decrease dose or discontinue therapy.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Lokelma: 5 g (1 ea, 11 ea, 30 ea); 10 g (1 ea, 11 ea, 30 ea)
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Lokelma: 5 g (3 ea, 30 ea); 10 g (3 ea, 30 ea)
Oral: Empty entire contents of the packet(s) into a glass with ≥3 tablespoons (45 mL) of water. Stir well and drink immediately; if powder remains in the glass, add water, stir and drink immediately; repeat until no powder remains. Administer other oral medications ≥2 hours before or 2 hours after dose.
Hyperkalemia, chronic: Treatment of hyperkalemia in adults.
Hyperkalemia, severe/emergent
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Cardiovascular: Edema (4% to 16%)
1% to 10%: Endocrine & metabolic: Hypokalemia (3% to 4%)
There are no contraindications listed in the US manufacturer's labeling.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to sodium zirconium cyclosilicate or any component of the formulation.
Concerns related to adverse effects:
• Edema: Mild to moderate edema has been reported and was more common in patients not on dialysis or treated with higher doses. Monitor for signs of edema, especially in patients on sodium-restricted diet or who are prone to fluid overload (eg, heart failure, renal disease).
Disease-related concerns:
• GI motility disorders: Avoid use in patients with severe constipation, bowel obstruction or impaction, including abnormal postoperative bowel motility disorders (may be ineffective and may worsen GI conditions).
Special populations:
• Hemodialysis patients: May be at increased risk of hypokalemia due to associated conditions (eg, diarrhea, decreased oral intake); monitor serum potassium and adjust dose accordingly.
Dosage form specific issues:
• Sodium: Each 5 g dose contains ~400 mg sodium. Adjust dietary sodium intake as needed.
Other warnings or precautions:
• Abdominal x-rays: Sodium zirconium cyclosilicate has radio-opaque properties; may appear as an imaging agent on abdominal x-ray.
None known.
Clopidogrel: Sodium Zirconium Cyclosilicate may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Separate the administration of sodium zirconium cyclosilicate and clopidogrel by at least 2 hours. Risk D: Consider therapy modification
Dabigatran Etexilate: Sodium Zirconium Cyclosilicate may decrease the serum concentration of Dabigatran Etexilate. Management: Separate the administration of sodium zirconium cyclosilicate and dabigatran by at least 2 hours. Risk D: Consider therapy modification
Warfarin: Sodium Zirconium Cyclosilicate may increase the serum concentration of Warfarin. Management: Separate the administration of sodium zirconium cyclosilicate and warfarin by at least 2 hours. If simultaneous administration is required, monitor for signs and symptoms of warfarin toxicity (eg, elevated INR, bleeding). Risk D: Consider therapy modification
Sodium zirconium cyclosilicate is not systemically absorbed, therefore, exposure to the fetus would not be expected.
Sodium zirconium cyclosilicate is not systemically absorbed, therefore, distribution into breast milk would not be expected.
Serum potassium; signs/symptoms of edema
Note: Reference ranges may vary depending on the laboratory.
Serum potassium: Adults: 3.5 to 5 mEq/L.
Sodium zirconium cyclosilicate is a potassium binder that preferentially exchanges potassium for hydrogen and sodium. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, lowering serum potassium levels.
Onset: 1 hour
Absorption: Not systemically absorbed
Metabolism: None
Excretion: Feces
Pack (Lokelma Oral)
5 g (per each): $29.18
10 g (per each): $29.18
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