sodium zirconium cyclosilicate (Rx)

Brand and Other Names:Lokelma
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and sodium zirconium cyclosilicate

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Edema (4.4-16.1%)

            1-10%

            Hypokalemia (4.1%)

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            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

            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

            Hyperkalemia 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
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            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.

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            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

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            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)

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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.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.