sodium polystyrene sulfonate (Rx)

Brand and Other Names:SPS, Kayexalate, more...Kionex, Kalexate
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for oral suspension

  • 454g

oral suspension

  • 15g/60mL

rectal suspension

  • 15g/60mL

Hyperkalemia

PO: 15 g once daily or q6-12hr

Rectal: 30-50 g q6hr

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

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

and sodium polystyrene sulfonate

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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)

            Postmarketing Reports

            Intestinal necrosis

            Aspiration

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            Warnings

            Contraindications

            Hypersensitivity to polystyrene sulfonate resins

            Hypokalemia

            Obstructive bowel disease

            Neonates with reduced gut motility (postoperative or drug-induced), oral administration

            Rectal administration of suspension with sorbitol in neonates, particularly in premature infants

            Cautions

            Use caution in 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

            Large doses may result in fecal impaction, especially in the elderly

            Hypokalemia may occur monitor serum potassium frequently within each 24 hr period; ECG monitoring may be appropriate in some patients; cation exchange resins may also affect concentrations of other cations, including calcium and magnesium

            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

            Use caution with dosage forms containing propylene glycol; large amounts are potentially toxic; associated with hyperosmolality, seizures, lactic acidosis, and respiratory depression

            Do not use in patients who do not have normal bowel function, including postoperative patients who have not had a bowel movement since operation' avoid use in postoperative patients at risk of constipation or impaction until normal bowel function resumes; discontinue use if constipation occurs

            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

            In children and neonates 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

            Enema may reduce serum concentrations faster than oral administration but oral route will achieve greater reduction over several hours

            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

            Cases of acute bronchitis or bronchopneumonia caused by inhalation of sodium polystyrene sulfonate particles reported; patients with impaired gag reflex, altered level of consciousness, or patients prone to regurgitation may be at increased risk; administer product with patient in upright position

            May bind orally administered medications, which could decrease their gastrointestinal absorption and lead to reduced efficacy; administer other oral medications at least 3 hours before or 3 hours after therapy; patients with gastroparesis may require a 6 hour separation

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            Pregnancy & Lactation

            Pregnancy

            Not absorbed systemically following oral or rectal administration and maternal use is not expected to result in fetal risk

            Lactation

            Not absorbed systemically by the mother, so breastfeeding is not expected to result in risk to the infant

            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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            Administration

            Oral Preparation

            For each gram of powdered resin add 3-4 mL of water or syrup

            Do not heat solution to improve dissolution; heat impairs resin exchange

            Rectal Preparation

            Suspend dose in 100 mL of aqueous liquid (eg, water, sorbitol 25%, methylcellulose 1%, dextrose 10%)

            Oral Administration

            Shake suspension well before administering

            Administer PO or via NG tube with patient in upright position

            Do not take other oral medications within 3 hr of dosing (6 hr for patients with gastroparesis or other conditions) because of potential GI binding

            Do not mix with potassium containing liquids or food (eg, orange juice, bananas)

            Suspension may be chilled to improve palatability

            Rectal Administration

            Administer cleansing enema beforehand

            Administer sodium polystyrene sulfonate as warm emulsion (body temperature)

            Gently agitate suspension during administration

            Retain in colon for at least 30-60 min (several hours if possible)

            After completing retention, use nonsodium colonic irrigant to remove remaining resin

            Storage

            Resin powder: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)

            Freshly prepared suspension should be used within 24 hr

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