Veltassa (patiromer) dosing, indications, interactions, adverse effects, and more

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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral powder for suspension

1g/packet
8.4g/packet
16.8g/packet
25.2g/packet

Hyperkalemia

Indicated for hyperkalemia

Initial: 8.4 g PO qDay

Monitor serum potassium and adjust dose based on the serum potassium level and the desired target range

May increase or decrease dose as necessary; not to exceed 25.2 g qDay

May titrate upward at ≥1-week intervals, in increments of 8.4 g

Note: Doses exceeding 50.4 g/day have not been tested; excessive doses may result in hypokalemia; restore serum potassium if hypokalemia occurs

Dosage Modifications

Renal impairment

No dosing adjustments are needed
In clinical studies, 93% of the 666 adults had chronic kidney disease

Dosing Considerations

Limitation of use: Do not use as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action

Dosage Forms & Strengths

oral powder for suspension

1g/packet
8.4g/packet
16.8g/packet
25.2g/packet

Hyperkalemia

Indicated for hyperkalemia in patients aged ≥12 years

<12 years

Safety and efficacy not established

12-17 years

Initial: 4 g PO qDay
Monitor serum potassium and adjust dose based on the serum potassium level and the desired target range
May increase or decrease dose as necessary; not to exceed 25.2 g qDay
May titrate upward at 1-week or longer intervals, in increments of 4 g
Note: Doses exceeding 50.4 g/day vave not been tested; excessive doses may result in hypokalemia; restore serum potassium if hypokalemia occurs

Dosage Modifications

Renal impairment

No dosing adjustments are needed
All pediatric patients treated in clinical studies had chronic kidney disease

Dosing Considerations

Limitation of use: Do not use as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action

Interaction Checker

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Monitor Closely (10)

bisoprolol
patiromer will decrease the level or effect of bisoprolol by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
carvedilol
patiromer will decrease the level or effect of carvedilol by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
ciprofloxacin
patiromer will decrease the level or effect of ciprofloxacin by drug binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
levothyroxine
patiromer will decrease the level or effect of levothyroxine by drug binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
metformin
patiromer will decrease the level or effect of metformin by drug binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
mycophenolate
patiromer will decrease the level or effect of mycophenolate by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
nebivolol
patiromer will decrease the level or effect of nebivolol by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
quinidine
patiromer will decrease the level or effect of quinidine by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
telmisartan
patiromer will decrease the level or effect of telmisartan by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
thiamine
patiromer will decrease the level or effect of thiamine by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer

Minor (31)

amoxicillin
patiromer, amoxicillin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
azilsartan
patiromer, azilsartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
benazepril
patiromer, benazepril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
bumetanide
patiromer, bumetanide. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
canagliflozin
patiromer, canagliflozin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
candesartan
patiromer, candesartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
captopril
patiromer, captopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
cephalexin
patiromer, cephalexin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
dapagliflozin
patiromer, dapagliflozin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
empagliflozin
patiromer, empagliflozin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
enalapril
patiromer, enalapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
eplerenone
patiromer, eplerenone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
eprosartan
patiromer, eprosartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
finerenone
patiromer, finerenone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
fosinopril
patiromer, fosinopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
furosemide
patiromer, furosemide. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
irbesartan
patiromer, irbesartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
lisinopril
patiromer, lisinopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
losartan
patiromer, losartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
metoprolol
patiromer, metoprolol. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
moexipril
patiromer, moexipril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
olmesartan
patiromer, olmesartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
perindopril
patiromer, perindopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
quinapril
patiromer, quinapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
ramipril
patiromer, ramipril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
sacubitril/valsartan
patiromer, sacubitril/valsartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
spironolactone
patiromer, spironolactone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
torsemide
patiromer, torsemide. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
trandolapril
patiromer, trandolapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
trimethoprim
patiromer, trimethoprim. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
valsartan
patiromer, valsartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.

amoxicillin
Minor (1)patiromer, amoxicillin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
azilsartan
Minor (1)patiromer, azilsartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
benazepril
Minor (1)patiromer, benazepril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
bisoprolol
Monitor Closely (1)patiromer will decrease the level or effect of bisoprolol by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
bumetanide
Minor (1)patiromer, bumetanide. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
canagliflozin
Minor (1)patiromer, canagliflozin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
candesartan
Minor (1)patiromer, candesartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
captopril
Minor (1)patiromer, captopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
carvedilol
Monitor Closely (1)patiromer will decrease the level or effect of carvedilol by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
cephalexin
Minor (1)patiromer, cephalexin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
ciprofloxacin
Monitor Closely (1)patiromer will decrease the level or effect of ciprofloxacin by drug binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
dapagliflozin
Minor (1)patiromer, dapagliflozin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
empagliflozin
Minor (1)patiromer, empagliflozin. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
enalapril
Minor (1)patiromer, enalapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
eplerenone
Minor (1)patiromer, eplerenone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
eprosartan
Minor (1)patiromer, eprosartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
finerenone
Minor (1)patiromer, finerenone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
fosinopril
Minor (1)patiromer, fosinopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
furosemide
Minor (1)patiromer, furosemide. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
irbesartan
Minor (1)patiromer, irbesartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
levothyroxine
Monitor Closely (1)patiromer will decrease the level or effect of levothyroxine by drug binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
lisinopril
Minor (1)patiromer, lisinopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
losartan
Minor (1)patiromer, losartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
metformin
Monitor Closely (1)patiromer will decrease the level or effect of metformin by drug binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
metoprolol
Minor (1)patiromer, metoprolol. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
moexipril
Minor (1)patiromer, moexipril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
mycophenolate
Monitor Closely (1)patiromer will decrease the level or effect of mycophenolate by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
nebivolol
Monitor Closely (1)patiromer will decrease the level or effect of nebivolol by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
olmesartan
Minor (1)patiromer, olmesartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
perindopril
Minor (1)patiromer, perindopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
quinapril
Minor (1)patiromer, quinapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
quinidine
Monitor Closely (1)patiromer will decrease the level or effect of quinidine by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
ramipril
Minor (1)patiromer, ramipril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
sacubitril/valsartan
Minor (1)patiromer, sacubitril/valsartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
spironolactone
Minor (1)patiromer, spironolactone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
telmisartan
Monitor Closely (1)patiromer will decrease the level or effect of telmisartan by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
thiamine
Monitor Closely (1)patiromer will decrease the level or effect of thiamine by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration by at least 3 hr from patiromer
torsemide
Minor (1)patiromer, torsemide. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
trandolapril
Minor (1)patiromer, trandolapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
trimethoprim
Minor (1)patiromer, trimethoprim. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
valsartan
Minor (1)patiromer, valsartan. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.

1-10%

Constipation (7.2%)

Hypomagnesemia (5.3%)

Diarrhea (4.8%)

Hypokalemia, <3.5 mEq/L (4.7%)

Nausea (2.3%)

Abdominal discomfort (2%)

Flatulence (2%)

Contraindications

Hypersensitivity to patiromer or its components

Cautions

Avoid use with severe constipation, bowel obstruction, or impaction, including abnormal postoperative bowel motility disorders; patiromer may be ineffective with these conditions present and may worsen GI conditions

Patients with a history of bowel obstruction or major GI surgery, severe GI disorders, or swallowing disorders were not included in clinical trials

Binds to magnesium in the colon, which can lead to hypomagnesemia; monitor serum magnesium; consider magnesium supplementation if low serum magnesium levels observed

Drug interaction overview

Patiromer may potentially bind to some oral co-administered medications, which could decrease their GI absorption and efficacy
Binding to other oral medications not listed below may occur if taken too close to patiromer
Administer other oral medications at least 3 hr before or after patiromer administration
Clinically important interactions
- Separate administration by at least 3 hr
- Angiotensin II blockers (ARBs; ie, telmisartan only)
- Beta-blockers (ie, bisoprolol, carvedilol, nebivolol)
- Antibiotics (ie, ciprofloxacin only)
- Levothyroxine
- Metformin
- Mycophenolate mofetil
- Quinidine
- Thiamine
No observed clinically important interactions
- No separation of dosing is required for these drugs
- Angiotensin-converting enzyme (ACE) inhibitors (ie, benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril)
- ARBs (ie, azilsartan, candesartan, irbesartan, losartan, olmesartan, valsartan)
- Beta-blockers (ie, metoprolol)
- Loop diuretics (ie, furosemide, bumetanide, torsemide)
- Antibiotics (ie, trimethoprim, amoxicillin, cephalexin)
- Mineralocorticoid receptor antagonists (ie, eplerenone, finerenone, spironolactone)
- Neprilysin inhibitors (ie, sacubitril)
- SGLT2 inhibitors (ie, canagliflozin, dapagliflozin, empagliflozin)

Pregnancy

Not absorbed systemically following oral 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.

Mechanism of Action

Binds and removes potassium from the GI tract, particularly the colon

Patiromer is a nonabsorbed, cation exchange polymer that contains a calcium-sorbitol counterion

Absorption

Not systemically absorbed

Quantitative whole-body autoradiography analysis in rats demonstrated that radioactivity was limited to the GI tract, with no detectable level of radioactivity in any other tissues or organs

Elimination

Excretion: Feces

Oral Suspension Preparation

Prepare each dose immediately before administering

Measure 1/3 cup of water and pour half of water into a glass; empty the entire contents of the packet(s) into the glass and stir

Add remaining half of water and stir the mixture thoroughly

Powder will not dissolve and mixture will look cloudy; add more water to mixture as needed for desired consistency

Drink mixture immediately; if some powder remains in the glass after drinking, add more water, stir, and drink immediately; repeat as needed to ensure the entire dose is administered

Other beverages or soft foods (eg, applesauce, yogurt, pudding) may be use instead of water to prepare mixture by following the above steps

Consider the potassium content of liquids or soft foods used to prepare the mixture as part of the dietary recommendations on potassium intake for each patient

Oral Administration

Prepare oral suspension (see above) and drink immediately after preparation

Do not heat (eg, microwave) or add to heated foods or liquids

Do not take in its dry form

May decrease absorption of some oral coadministered medications, which could decrease their GI absorption; separate administration by at least 3 hr (see Drug Interactions)

Storage

Unopened packets

Refrigerate at 2-8ºC (36-46ºF)
If stored at room temperature (25ºC [77ºF]), use within 3 months of being taken out of the refrigerator
Avoid exposure to excessive heat >40ºC (>104ºF)

BRAND	FORM.	UNIT PRICE	PILL IMAGE
Veltassa oral -	25.2 gram powder
Veltassa oral -	16.8 gram powder
Veltassa oral -	8.4 gram powder
Veltassa oral -	8.4 gram powder
Veltassa oral -	8.4 gram powder

Patient Handout

A Patient Handout is not currently available for this monograph.

Formulary

FormularyPatient Discounts

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View explanations for tiers and restrictions

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.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

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

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