patiromer (Rx)

Brand and Other Names:Veltassa

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral powder for suspension

  • 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 or longer 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

Also see Administration

Dosage Modifications

Renal impairment

  • No dosing adjustments are needed
  • Of the 666 patients treated with patiromer in clinical studies, 93% had chronic kidney disease

Dosing Considerations

Limitations of use: Should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action

Safety and efficacy not established

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Interactions

Interaction Checker

and patiromer

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                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.

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                Adverse Effects

                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%)

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                Warnings

                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)
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                Pregnancy

                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.

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                Pharmacology

                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

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                Administration

                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)
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                Images

                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

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                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.
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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.