What is the use of Veltassa (patiromer)?

From the Guidelines

Veltassa (patiromer) is a highly effective treatment for hyperkalemia, particularly in patients with chronic kidney disease, heart failure, or those on medications that can raise potassium levels, such as ACE inhibitors or ARBs, as it enables the continuation of renin-angiotensin-aldosterone system inhibitors (RAASi) therapy, which is crucial for reducing mortality and morbidity in these patients 1.

Key Points to Consider

• Veltassa works by binding to potassium in the gastrointestinal tract, preventing its absorption and facilitating its elimination through stool, making it a valuable option for managing hyperkalemia in patients who require ongoing RAASi therapy.
• The typical starting dose of Veltassa is 8.4 grams once daily, which can be adjusted based on serum potassium levels, with a maximum dose of 25.2 grams daily, as indicated in the treatment guidelines for hyperkalemia 1.
• It is essential to take Veltassa with food and mix it with water or certain other liquids, but not with hot liquids or foods, and to separate it from other oral medications by at least 3 hours to prevent potential interactions.
• Common side effects of Veltassa include constipation, diarrhea, nausea, and abdominal discomfort, which should be monitored and managed appropriately to ensure the patient's quality of life is not compromised.
• Regular monitoring of potassium levels is necessary to ensure Veltassa is effectively managing hyperkalemia and to guide dosage adjustments, as the goal is to maintain normokalemia and prevent the recurrence of hyperkalemia.

Clinical Considerations

• In patients with hyperkalemia, an evaluation should be made of the patient's diet, use of supplements, salt substitutes, and nutraceuticals that contain potassium, as well as concomitant medications that may contribute to hyperkalemia, to identify potential causes and develop a comprehensive treatment plan 1.
• Co-administration of drugs known to promote hyperkalemia or reduce kidney function should prompt more frequent monitoring of potassium levels, and kidney function must be determined and monitored regularly.
• A low-potassium diet and loop or thiazide diuretics that increase potassium excretion may be considered to reduce the occurrence of hyperkalemia, and potassium-lowering therapy should be initiated as soon as potassium levels exceed 5 mEq/L in patients on maximum tolerated RAASi therapy 1.

From the FDA Drug Label

Veltassa is indicated for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older. Limitation of Use: Veltassa should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action [see Clinical Pharmacology (12.2)]. The main use of Veltassa is for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older.

• The recommended starting dose of Veltassa varies with age.
• Key points to consider when using Veltassa include:
  • Administering the medication at least 3 hours before or 3 hours after other oral medications.
  • Not heating Veltassa or adding it to heated foods or liquids.
  • Not taking Veltassa in its dry form.
  • Preparing each dose immediately prior to administration.
  • Monitoring serum potassium and adjusting the dose based on the serum potassium level and the desired target range 2

From the Research

Veltassa Overview

• Veltassa, also known as patiromer, is a non-absorbed, sodium-free potassium binding polymer that exchanges calcium for potassium in the gastrointestinal (GI) tract, thereby increasing faecal potassium excretion and reducing serum potassium levels 3.
• It is approved in the USA and several other countries, including those of the EU, for the treatment of hyperkalaemia in adults 3, 4.

Clinical Trials and Efficacy

• In clinical trials, patiromer reduced serum potassium levels and the risk of recurrent hyperkalaemia in patients with chronic kidney disease (CKD) and/or diabetic nephropathy with or without heart failure (HF) 3, 4.
• Patiromer maintained normokalaemia in patients with HF and a propensity for hyperkalaemia, enabling concomitant administration and up-titration of spironolactone 3.
• Clinical trials monitoring patient use for up to 1 year have shown clinically meaningful potassium reductions, sustained normokalemia, high tolerability, and without major serious adverse events 5.

Safety and Tolerability

• Patiromer was generally well tolerated, with a low risk of hypokalaemia 3, 4.
• GI disorders and hypomagnesaemia were the most common adverse events; these were generally of mild or moderate severity 3, 4.
• Commonly occurring treatment-related adverse events include mild to moderate constipation and hypomagnesaemia 4.

Expert Panel Recommendations

• An expert panel recommended patiromer as a viable option for the management of hyperkalaemia in patients with chronic kidney disease and/or heart failure and in patients who experience chronic hyperkalemia 6.
• The panel noted that hyperkalemia is a serious condition that can lead to life-threatening complications, and that patiromer appears to be a useful new option for patients with hyperkalemia 6.