From the Guidelines
Patiromer is a highly effective treatment for chronic hyperkalemia, allowing for the maintenance of normokalemia in patients with advanced chronic kidney disease (CKD) and resistant hypertension, as well as those with diabetes and CKD, including those with heart failure receiving renin-angiotensin-aldosterone system inhibitors (RAASis) 1.
Mechanism of Action
Patiromer works by binding potassium in the gastrointestinal tract, primarily in the colon, and facilitating its elimination through feces. It exchanges calcium ions for potassium in the GI tract, preventing potassium absorption and thereby reducing serum potassium levels. This mechanism makes it particularly useful for patients with chronic kidney disease, heart failure, or those on RAAS inhibitors who often develop hyperkalemia.
Dosing and Administration
The typical dosing regimen starts at 8.4 g once daily, which can be titrated up to 25.2 g daily based on serum potassium levels, with dose adjustments recommended at one-week intervals 1. Patiromer comes as a powder for oral suspension that should be mixed with water and taken with food. Patients should take patiromer at least 3 hours before or after other oral medications to prevent potential drug interactions.
Efficacy and Safety
Patiromer has been shown to effectively maintain normokalemia in patients with chronic hyperkalemia, including those with advanced CKD and resistant hypertension, as well as those with diabetes and CKD, including those with heart failure receiving RAASis 1. Common side effects include constipation, hypomagnesemia, and abdominal discomfort. Regular monitoring of serum potassium and magnesium levels is necessary during treatment to ensure efficacy and safety.
Clinical Considerations
Patiromer may be particularly useful in patients with chronic kidney disease, heart failure, or those on RAAS inhibitors who often develop hyperkalemia 1. The use of patiromer may allow for the continuation and optimization of RAASi therapy in patients with hyperkalemia, which is important for reducing mortality and morbidity in patients with cardiovascular disease 1. However, the costs of patiromer may influence its use in clinical practice for some patients 1.
From the FDA Drug Label
Veltassa is indicated for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older. The recommended starting dose of Veltassa varies with age and is shown below. Monitor serum potassium and adjust the dose of Veltassa based on the serum potassium level and the desired target range The dose may be increased or decreased, as necessary, to reach the desired serum potassium concentration, up to a maximum dose of 25.2 grams once daily in adults and pediatric patients aged 12 years and older.
Patiromer works by binding to potassium in the gastrointestinal tract and removing it from the body, thereby lowering serum potassium levels.
- The mechanism of action is based on the exchange of calcium for potassium, which helps to reduce potassium levels in the blood.
- Dosing is adjusted based on serum potassium levels and the desired target range.
- The maximum dose is 25.2 grams once daily in adults and pediatric patients aged 12 years and older 2.
From the Research
Mechanism of Action
- 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.
Efficacy in Chronic Hyperkalemia
- Patiromer has been shown to reduce serum potassium levels and the risk of recurrent hyperkalemia in patients with chronic kidney disease (CKD) and/or diabetic nephropathy with or without heart failure (HF) 4, 3, 5.
- Clinical trials have demonstrated that patiromer can maintain normokalemia in patients with HF and a propensity for hyperkalemia, enabling concomitant administration and up-titration of spironolactone 4, 3.
- Patiromer has been effective in decreasing serum potassium, preventing recurrence of hyperkalemia, and reducing RAASi discontinuation 4.
Safety and Tolerability
- Patiromer is generally well tolerated, with a low risk of hypokalaemia 3, 5.
- The most common adverse events associated with patiromer are GI disorders and hypomagnesaemia, which are generally of mild or moderate severity 3.
- Patiromer has been shown to be safe and effective for up to 1 year of treatment, with no major serious adverse events reported 5.
Comparison to Other Treatments
- Patiromer may be a preferred option to treat hyperkalemia compared to current sodium polystyrene sulfonate (SPS) therapy, due to its efficacy and safety profile 4.
- Patiromer has been compared to other potassium-binding agents, such as sodium zirconium cyclosilicate (ZS-9), and has been shown to be effective in reducing serum potassium levels 4, 5.