Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Lokelma: 5 g (1 ea, 11 ea, 30 ea); 10 g (1 ea, 11 ea, 30 ea)
Pharmacology
Mechanism of Action
Sodium zirconium cyclosilicate is a potassium binder that preferentially exchanges potassium for hydrogen and sodium. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, lowering serum potassium levels.
Pharmacokinetics/Pharmacodynamics
Absorption
Not systemically absorbed
Metabolism
None
Excretion
Feces
Onset of Action
1 hour
Use: Labeled Indications
Hyperkalemia: Treatment of hyperkalemia in adults.
Limitations of use: Should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
Contraindications
There are no contraindications listed in the manufacturer's labeling.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to sodium zirconium cyclosilicate or any component of the formulation.
Dosage and Administration
Dosing: Adult
Hyperkalemia: Oral: Initial: 10 g 3 times daily for up to 48 hours; adjust dose by 5 g daily at 1-week intervals as needed based on serum potassium; maintenance: 10 g once daily (range: 5 g every other day to 15 g once daily); maximum maintenance dose: 15 g/day
Dosing: Geriatric
Refer to adult dosing.
Administration
Oral: Empty entire contents of the packet(s) into a glass with ≥3 tablespoons (45 mL) of water. Stir well and drink immediately; if powder remains in the glass, add water, stir and drink immediately; repeat until no powder remains. Administer other oral medications ≥2 hours before or 2 hours after dose.
Storage
Store at 15°C to 30°C (59°F to 86°F).
Drug Interactions
Clopidogrel: Sodium Zirconium Cyclosilicate may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Separate the administration of sodium zirconium cyclosilicate and clopidogrel by at least 2 hours. Consider therapy modification
Dabigatran Etexilate: Sodium Zirconium Cyclosilicate may decrease the serum concentration of Dabigatran Etexilate. Management: Separate the administration of sodium zirconium cyclosilicate and dabigatran by at least 2 hours. Consider therapy modification
Warfarin: Sodium Zirconium Cyclosilicate may increase the serum concentration of Warfarin. Management: Separate the administration of sodium zirconium cyclosilicate and warfarin by at least 2 hours. If simultaneous administration is required, monitor for signs and symptoms of warfarin toxicity (eg, elevated INR, bleeding). Consider therapy modification
Adverse Reactions
>10%: Cardiovascular: Edema (4% to 16%), peripheral edema (8% to 11%)
1% to 10%: Endocrine & metabolic: Hypokalemia (4%)
Warnings/Precautions
Concerns related to adverse effects:
- Edema: Mild to moderate edema has been reported and was more common in patients treated with higher doses. Monitor for signs of edema, especially in patients who are prone to fluid overload (eg, heart failure, renal disease).
Disease-related concerns:
- GI motility disorders: Avoid use in patients with severe constipation, bowel obstruction or impaction, including abnormal postoperative bowel motility disorders (may be ineffective and may worsen GI conditions).
Dosage form specific issues:
- Sodium: Each 5 g dose contains ~400 mg sodium. Adjust dietary sodium intake as needed.
Monitoring Parameters
Serum potassium; signs/symptoms of edema
Pregnancy
Pregnancy Considerations
Sodium zirconium cyclosilicate is not systemically absorbed, therefore, exposure to the fetus would not be expected.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber edema (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
