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

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.