sodium polystyrene sulfonate (Rx)Brand and Other Names:SPS, Kayexalate, more...Kionex, Kalexate

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for oral suspension

  • 454g

oral suspension

  • 15g/60mL

rectal suspension

  • 15g/60mL
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Hyperkalemia

PO: 15 g once daily or q6-12hr

Rectal: 30-50 g q6hr

Administration

PO: Powdered resin as suspension in water or syrup; for each 1 g of powdered resin, add 3-4 mL of water/syrup; do not refrigerate

Rectal: Powdered resin in 100-200 mL of aqueous vehicle (eg, 25% sorbitol, 10% dextrose, 1% methylcellulose or water), warmed to body temperature; administer cleansing enema first, and retain enema in colon for more than 45 mins if possible

Position patient carefully when administering to avoid aspiration

Lithium Overdose (Off-label)

30 g in sorbitol q4hr; monitor for hypokalemia

Dosage Forms & Strengths

powder for oral suspension

  • 454g

oral suspension

  • 15g/60mL

rectal suspension

  • 15g/60mL
more...

Hyperkalemia

PO: 1 g/kg q6hr PRN; alternatively, use exchange ratio of 1 mEq K+ to 1 g of resin for lower dose (oral use not recommended in patients < 1 month old)  

Rectal: 1 g/kg q2-6hr PRN; alternatively, use exchange ratio of 1 mEq K+ to 1 g of resin for lower dose

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Interactions

Interaction Checker

sodium polystyrene sulfonate and

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            GI disturbance

            Constipation

            Hypokalemia

            Hypocalcemia

            Hypomagnesemia

            Sodium retention

            Nausea

            Vomiting

            Frequency Not Defined

            GI concretions (bezoars) after oral use

            GI tract ulceration or necrosis, which could lead to perforation

            Fecal impaction after rectal administration (especially in children)

            Acute bronchitis or bronchopneumonia associated with inhalation of polystyrene particles (rare)

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            Warnings

            Contraindications

            Hypersensitivity to polystyrene sulfonate resins

            Hypokalemia

            Obstructive bowel disease

            Neonates: Reduced gut motility (postoperative or drug-induced), oral administration

            Cautions

            Congestive heart failure, severe hypertension, marked edema (due to sodium content; 1 g contains 100 mg of sodium, 1/3 of which is delivered to body)

            Best when used in non-life-threatening hyperkalemia

            Monitor electrolytes

            In severe hyperkalemia, consider more immediate treatment modalities (eg, dialysis, IV calcium, bicarbonate, glucose, and insulin)

            Products can contain as much as 20 g of sorbitol per 15 g of sodium polystyrene

            Do not use in patients who do not have normal bowel function, including postoperative patients who have not had a bowel movement since operation

            Do not mix PO dose with banana or orange juice (potassium-rich)

            If there is clinically significant constipation, discontinue until normal bowel motion; do not use magnesium-containing laxatives or sorbitol

            Children and neonates: With rectal administration, excessive dosage or inadequate dilution could result in impaction of resin

            Premature and low-birth-weight infants: Risk of digestive hemorrhage or colonic necrosis

            Risk of colonic necrosis and other serious GI adverse events (eg, bleeding, ischemic colitis, perforation), most frequently with concomitant use of sorbitol

            Concomitant administration of sorbitol is not recommended

            Risk factors for GI adverse events include prematurity, history of intestinal disease or surgery, hypovolemia, and renal insufficiency or failure

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown if excreted; exercise caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Cation exchange resin, sodium ions partially released from polystyrene and replaced by potassium

            Absorption

            Bioavailability: Nonabsorbable ion-exchange resin

            Onset: 2-24 hr

            Duration: 4-6 hr

            Elimination

            Excretion: Feces

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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