From the Guidelines
Lokelma (sodium zirconium cyclosilicate) is the preferred treatment for hyperkalemia due to its rapid onset of action, high selectivity for potassium, and favorable safety profile, as demonstrated in a study published in the Mayo Clinic Proceedings in 2021 1.
Key Characteristics of Lokelma
- The typical starting dose is 10 grams three times daily for up to 48 hours, followed by a maintenance dose of 5-10 grams once daily.
- Lokelma works by binding to potassium in the gastrointestinal tract, preventing its absorption and facilitating its elimination through stool.
- This medication begins working within one hour and can effectively lower potassium levels within 24-48 hours.
- Common side effects include edema and hypokalemia (if overused).
Advantages of Lokelma
- Rapid onset of action, with significant reductions in serum potassium levels observed within 1 hour of a single 10-g dose 1.
- Highly selective for potassium, with minimal binding to other ions such as calcium and magnesium.
- Favorable safety profile, with no serious adverse events reported in randomized trials 1.
Patient Selection
- Lokelma is particularly useful for patients with chronic kidney disease, heart failure, or those taking medications that increase potassium levels.
- Regular monitoring of potassium levels is essential while taking this medication to ensure proper dosing and effectiveness.
Comparison to Other Treatments
- Lokelma has a more favorable safety profile and faster onset of action compared to other potassium-binding agents, such as sodium polystyrene sulfonate 2.
- The National Institute for Health and Care Excellence has recommended the use of Lokelma for the treatment of acute life-threatening hyperkalemia, in conjunction with standard care 3.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Lokelma (Sodium Zirconium Cyclosilicate) Overview
- Lokelma, also known as sodium zirconium cyclosilicate, is a medication used to treat hyperkalemia, a condition characterized by high potassium levels in the blood 4.
- It works by binding to potassium in the gastrointestinal tract and facilitating its excretion through feces, thereby reducing potassium levels in the blood 4, 5.
Efficacy and Safety of Lokelma
- Studies have shown that Lokelma is effective in reducing potassium levels in patients with hyperkalemia, with a rapid onset of action 6, 7, 8.
- Compared to other potassium binders, such as sodium polystyrene sulfonate, Lokelma has been shown to have a similar efficacy in reducing potassium levels, but with a potentially better safety profile 6, 7.
- Lokelma has been associated with fewer gastrointestinal adverse effects compared to sodium polystyrene sulfonate, although it may cause other side effects such as edema 8.
Comparison to Other Potassium Binders
- A systematic review and meta-analysis found that patiromer, another potassium binder, had lower rates of hyperkalemia compared to standard of care, while Lokelma had no significant differences in terms of overall adverse effects or treatment discontinuation 8.
- A study comparing Lokelma to sodium polystyrene sulfonate found that both agents had similar reductions in serum potassium levels, but Lokelma had fewer serious adverse events 7.
Clinical Use of Lokelma
- Lokelma is indicated for the treatment of hyperkalemia in patients with chronic kidney disease or heart failure, and can be used to enable the use of renin-angiotensin-aldosterone system inhibitors, which can help slow disease progression 4, 5.
- The medication has been shown to be safe and effective for chronic use, with data available for up to one year of treatment 5.