Dosing & Uses
Dosage Forms & Strengths
powder for oral suspension
- 5g/packet
- 10g/packet
Hyperkalemia
Indicated for hyperkalemia
Initial: 10 g PO TID for up to 48 hr
Maintenance
- 10 g PO qDay
- May titrate based on serum potassium level and desired target range at intervals of 1 week or longer and in increments of 5 g
- Dosing may range from 5 g every other day to 15 g qDay); not to exceed 15 g/day
Dosage Modifications
Patients on chronic hemodialysis
- Starting dose: 5 g PO qDay on nondialysis days
- If potassium >6.5 mEq/L, consider starting at 10 g PO qDay on nondialysis days
- Monitor serum potassium and adjust dose based on predialysis serum potassium after the long interdialytic interval and desired target range
- During initiation and after a dose adjustment, assess serum potassium after 1 week
- Maintenance dose: 5-15 g PO qDay on nondialysis days
- Discontinue or decrease dose if serum potassium falls below desired target range based on the predialysis value after the long interdialytic interval, or if clinically significant hypokalemia develops
Dosing Considerations
Not to be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action
Monitor serum potassium and adjust dose based on the serum potassium level and desired target range
Decrease or discontinue dose if serum potassium is below desired target range
Safety and efficacy not been established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (0)
Monitor Closely (48)
- acalabrutinib
sodium zirconium cyclosilicate will decrease the level or effect of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- amphetamine
sodium zirconium cyclosilicate will increase the level or effect of amphetamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
- atazanavir
sodium zirconium cyclosilicate will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- atorvastatin
sodium zirconium cyclosilicate will increase the level or effect of atorvastatin by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate administration by at least 2 hr. Medications that are weak acids (eg, atorvastatin) are more readily absorbed with elevated gastric pH.
- axitinib
sodium zirconium cyclosilicate will decrease the level or effect of axitinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- bosutinib
sodium zirconium cyclosilicate will decrease the level or effect of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- cefditoren
sodium zirconium cyclosilicate will decrease the level or effect of cefditoren by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- cefpodoxime
sodium zirconium cyclosilicate will decrease the level or effect of cefpodoxime by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- cefuroxime
sodium zirconium cyclosilicate will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- clopidogrel
sodium zirconium cyclosilicate will decrease the level or effect of clopidogrel by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Clopidogrel active metabolite may be decreased. Separate administration by at least 2 hr.
- crizotinib
sodium zirconium cyclosilicate will decrease the level or effect of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- cysteamine
sodium zirconium cyclosilicate will decrease the level or effect of cysteamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- dabigatran
sodium zirconium cyclosilicate will decrease the level or effect of dabigatran by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate administration by at least 2 hr.
- dabrafenib
sodium zirconium cyclosilicate will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- dasatinib
sodium zirconium cyclosilicate will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- dexmethylphenidate
sodium zirconium cyclosilicate will increase the level or effect of dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
- dextroamphetamine
sodium zirconium cyclosilicate will increase the level or effect of dextroamphetamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
- erlotinib
sodium zirconium cyclosilicate will decrease the level or effect of erlotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ferric maltol
sodium zirconium cyclosilicate will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ferrous fumarate
sodium zirconium cyclosilicate will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ferrous gluconate
sodium zirconium cyclosilicate will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ferrous sulfate
sodium zirconium cyclosilicate will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- fosamprenavir
sodium zirconium cyclosilicate will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- furosemide
sodium zirconium cyclosilicate will increase the level or effect of furosemide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate administration by at least 2 hr. Medications that are weak acids (eg, furosemide) are more readily absorbed with elevated gastric pH.
- gefitinib
sodium zirconium cyclosilicate will decrease the level or effect of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- gemifloxacin
sodium zirconium cyclosilicate will decrease the level or effect of gemifloxacin by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- glyburide
sodium zirconium cyclosilicate will increase the level or effect of glyburide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- indinavir
sodium zirconium cyclosilicate will decrease the level or effect of indinavir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- itraconazole
sodium zirconium cyclosilicate will decrease the level or effect of itraconazole by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ketoconazole
sodium zirconium cyclosilicate will decrease the level or effect of ketoconazole by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ledipasvir/sofosbuvir
sodium zirconium cyclosilicate will decrease the level or effect of ledipasvir/sofosbuvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- levoketoconazole
sodium zirconium cyclosilicate will decrease the level or effect of levoketoconazole by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- mesalamine
sodium zirconium cyclosilicate will decrease the level or effect of mesalamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- methylphenidate
sodium zirconium cyclosilicate will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
- mycophenolate
sodium zirconium cyclosilicate will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- nelfinavir
sodium zirconium cyclosilicate will decrease the level or effect of nelfinavir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- neratinib
sodium zirconium cyclosilicate will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- nilotinib
sodium zirconium cyclosilicate will decrease the level or effect of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- pazopanib
sodium zirconium cyclosilicate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- ponatinib
sodium zirconium cyclosilicate will decrease the level or effect of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- posaconazole
sodium zirconium cyclosilicate will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- prasugrel
sodium zirconium cyclosilicate will decrease the level or effect of prasugrel by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- raltegravir
sodium zirconium cyclosilicate will increase the level or effect of raltegravir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- rilpivirine
sodium zirconium cyclosilicate will decrease the level or effect of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- risedronate
sodium zirconium cyclosilicate, risedronate. increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- serdexmethylphenidate/dexmethylphenidate
sodium zirconium cyclosilicate will increase the level or effect of serdexmethylphenidate/dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
- tolbutamide
sodium zirconium cyclosilicate will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
- velpatasvir
sodium zirconium cyclosilicate will decrease the level or effect of velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.
Minor (0)
Adverse Effects
>10%
Edema (4.4-16.1%)
1-10%
Hypokalemia (4.1%)
Warnings
Contraindications
None
Cautions
Avoid with severe constipation or bowel obstruction or impaction, including abnormal postoperative bowel motility disorders; safety and efficacy not studied in these patients and may be ineffective and may worsen GI conditions
Each 5-g dose of sodium zirconium cyclosilicate contains ~400 mg of sodium; in clinical trials, mild-to-moderate edema was more commonly seen in patients treated with 15 g qDay; monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure, renal disease); increase diuretic dose as needed
This agent has radio-opaque properties and, therefore, may give the appearance typical of an imaging agent during abdominal X-ray procedures
Edema
- Each 5 g contains ~400 mg of sodium, but the extent of absorption by the patient is unknown
- Edema was observed in clinical trials and was generally mild to moderate in severity and was more commonly seen in patients treated with 15 g once daily
- Monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure, renal disease)
- Advise patients to adjust dietary sodium, if appropriate
- Increase dose of diuretics as needed
Hypokalemia in patients on chronic hemodialysis
- Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia (eg, illnesses associated with decreased oral intake, diarrhea)
- Consider adjusting dose based on potassium levels in these settings
Drug interactions overview
-
Transient changes of gastric pH
- Sodium zirconium cyclosilicate transiently increases gastric pH, which can change the absorption of coadministered drugs that exhibit pH-dependent solubility, potentially leading to altered efficacy or safety of these drugs when coadministered
- In general, other oral medications whose solubility is pH-dependent should be administered at least 2 hr before or after sodium zirconium cyclosilicate
Pregnancy
Pregnancy
Not absorbed systemically following oral administration and maternal use is not expected to result in fetal exposure to the drug
Lactation
Not absorbed systemically following oral administration, and breastfeeding is not expected to result in exposure to the child
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.Pharmacology
Mechanism of Action
Potassium binder; nonabsorbed zirconium silicate that preferentially captures potassium in exchange for hydrogen and sodium
It increases fecal potassium excretion through binding of potassium in the lumen of the GI tract; binding of potassium reduces the free potassium concentration in the GI lumen, thereby lowering serum potassium level
Absorption
In a clinical study in patients with hyperkalemia in which zirconium concentrations were measured in the urine and blood, zirconium concentrations were similar in treated and untreated patients
Excretion
A vivo mass balance study in rats showed the drug was recovered in the feces with no evidence of systemic absorption
Administration
Oral Administration
Empty the entire contents of the packet(s) into a drinking glass containing ~3 tablespoons of water or more if desired
Stir well and drink immediately
If powder still remains in the drinking glass, add water, stir, and drink immediately; repeat until no powder remains to ensure the entire dose is taken
Storage
Packets: Store at 15-30°C (59-86°F)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Lokelma oral - | 10 gram powder |  | |
| Lokelma oral - | 5 gram powder |  | |
| Lokelma oral - | 5 gram powder |  | |
| Lokelma oral - | 10 gram powder |  | |
| Lokelma oral - | 10 gram powder |  | |
| Lokelma oral - | 5 gram powder |  |
Copyright © 2010 First DataBank, Inc.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
