What is the dose and frequency of Kayexalate (sodium polystyrene sulfonate)?

From the Guidelines

Kayexalate should be dosed at 15 to 50 g plus sorbitol per oral or per rectum for the treatment of hyperkalemia. The dose and frequency of Kayexalate administration can vary depending on the severity of hyperkalemia and patient response.

Key Considerations

• For oral administration, the dose is typically 15 to 50 g, as outlined in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
• For rectal administration, a dose of 15 to 50 g as a retention enema is commonly used.
• Kayexalate works by exchanging sodium ions for potassium in the intestine, primarily in the colon, facilitating potassium excretion in the stool.
• Common side effects include constipation, so it's often administered with sorbitol to prevent this complication.
• However, this combination increases the risk of intestinal necrosis, particularly in post-operative patients or those with intestinal disorders.

Administration and Monitoring

• Treatment duration depends on the severity of hyperkalemia and patient response, with monitoring of serum potassium levels guiding therapy.
• Each 15 grams of Kayexalate can lower serum potassium by approximately 0.5-1.0 mEq/L.
• Due to its delayed onset of action (2-24 hours) and potential complications, newer potassium binders like patiromer or sodium zirconium cyclosilicate are increasingly preferred for non-emergent hyperkalemia management.

Alternative Dosage

• An alternative dosage of 1 g/kg up to 15 g (60 mL) every 6 h as needed for oral administration, and 1 g/kg up to 50 g every 6 h as needed for rectal administration, has been suggested 1. However, the most recent and highest quality study recommends a dose of 15 to 50 g plus sorbitol per oral or per rectum 1.

From the FDA Drug Label

The average total daily adult dose of Sodium Polystyrene Sulfonate is 15 g to 60 g, administered as a 15 g dose (four level teaspoons), one to four times daily. The average adult dose is 30 g to 50 g every six hours [for rectal administration]. The recommended dose of Kayexalate is 15 g to 60 g per day, given in divided doses of 15 g, one to four times daily for oral administration, and 30 g to 50 g every six hours for rectal administration 2.

• The dose frequency is one to four times daily for oral administration.
• The dose frequency is every six hours for rectal administration.

From the Research

Kayexalate Dose and Frequency

• The dose and frequency of Kayexalate (sodium polystyrene sulfonate) may vary depending on the patient's condition and the severity of hyperkalemia 3, 4, 5, 6, 7.
• Studies have shown that Kayexalate can be effective in reducing serum potassium levels, but its use is often limited by its potential to cause gastrointestinal side effects and other adverse reactions 3, 4, 5.
• The typical dose of Kayexalate is 15-30 grams per dose, and it can be administered orally or rectally 5.
• Some studies have compared the efficacy of Kayexalate to other potassium-lowering agents, such as patiromer and sodium zirconium cyclosilicate, and found that Kayexalate may be more effective in certain situations 5, 7.
• However, other studies have raised concerns about the safety and efficacy of Kayexalate, particularly in patients with chronic kidney disease or heart failure 3, 4, 6.

Comparison to Other Potassium-Lowering Agents

• Kayexalate has been compared to patiromer and sodium zirconium cyclosilicate in several studies, with mixed results 5, 6, 7.
• Some studies have found that patiromer and sodium zirconium cyclosilicate may be safer and more effective than Kayexalate in certain situations, particularly in patients with chronic hyperkalemia 6.
• However, other studies have found that Kayexalate may be more effective than patiromer in reducing serum potassium levels in patients with acute hyperkalemia 5.
• Sodium zirconium cyclosilicate has been shown to be effective in reducing serum potassium levels, but it may be associated with an increased risk of edema, particularly in patients with chronic kidney disease or heart failure 6.

Clinical Use and Safety

• Kayexalate should be used with caution in patients with gastrointestinal disorders or other conditions that may increase the risk of adverse reactions 3, 4, 5.
• Patients should be monitored closely for signs of adverse reactions, such as gastrointestinal symptoms or electrolyte imbalances 3, 4, 5.
• The use of Kayexalate should be individualized based on the patient's condition and medical history, and it should be used in conjunction with other treatments for hyperkalemia as needed 3, 4, 5, 6, 7.