Sodium zirconium cyclosilicate

Administration[1]

  • Type: Potassium binder, antidote
  • Dosage Forms: 5 g (1 ea, 30 ea); 10 g (1 ea, 30 ea), empty contents into glass with 45 mL of water
  • Routes of Administration: Oral
  • Common Trade Names: Lokelma

Adult Dosing

Hyperkalemia

10 g TID PO for up to 48 hours, then 10 g once daily

Pediatric Dosing

Special Populations

Pregnancy Rating

  • unlikely to affect fetus as not absorbed

Lactation risk

  • unlikely to be in breast milk as not absorbed

Renal Dosing

None

Hepatic Dosing

None

Contraindications

  • Allergy to class/drug
  • Avoid in GI motility disorders

Adverse Reactions

Serious

Common

  • Mild to moderate edema
  • Hypokalemia

Pharmacology

  • Metabolism: none
  • Excretion: feces

Mechanism of Action

  • Highly selective, oral potassium removing agent
  • Non-absorbed zirconium silicate that captures potassium in exchange fro hydrogen and sodium
  • Increases fecal potassium excretion through binding K+ in GI tract

Comments

  • Onset of action at 1.0 hour and median time to achieving normal potassium levels at 2.2 hours, with 92% achieving normal potassium within 48 hours.
  • Not used as an emergency treatment for life threatening hyperkalemia due to delayed onset of action
  • Available at Harbor-UCLA, but not yet widely available in the community
  • If asked by nephrology to give Kayexalate, kindly suggest Lokelma instead

See Also

Hyperkalemia

References

  1. Packham, D. K., Rasmussen, H. S., Lavin, P. T., El-Shahawy, M. A., Roger, S. D., Block, G., … Singh, B. (2015). Sodium zirconium cyclosilicate in hyperkalemia. The New England Journal of Medicine, 372(3), 222–231.