From the Guidelines
The recommended starting dose of Veltassa (patiromer) for hyperkalemia is 8.4 grams once daily, which can be titrated up to 16.8 g or 25.2 g QD as needed, as indicated in the clinical management of hyperkalemia study published in the Mayo Clinic Proceedings in 2021 1. When initiating Veltassa, it is essential to monitor serum potassium levels regularly, typically within 1 week of starting treatment or changing the dose. Key considerations for administration include:
- Taking Veltassa orally, mixed with water or other non-alcoholic liquids
- Administering the medication with food
- Avoiding co-administration with other oral medications, if possible, to minimize potential interactions
- Ensuring adequate hydration to prevent constipation, a common side effect
- Considering magnesium supplementation if hypomagnesemia occurs The mechanism of action of Veltassa involves binding potassium in the gastrointestinal tract, preventing its absorption and lowering serum potassium levels 1. It is crucial to note that Veltassa is not indicated for emergency treatment of life-threatening hyperkalemia. Common adverse effects may include gastrointestinal disorders, such as constipation, abdominal discomfort, and diarrhea, as well as hypomagnesemia 1.
From the FDA Drug Label
2.2 Recommended Dosing and Titration The recommended starting dose of Veltassa varies with age and is shown below. Adults: The recommended starting dose of Veltassa is 8.4 grams patiromer orally once daily. The dose can be up-titrated based on serum potassium level at 1-week or longer intervals, in increments of 8.4 grams. Pediatric Patients Ages 12 years and older: The recommended starting dose of Veltassa is 4 grams patiromer orally once daily. The dose can be titrated based on serum potassium level at 1-week or longer intervals, in increments of 4 grams.
The dosing for Veltassa (patiromer) is as follows:
- Adults: 8.4 grams orally once daily, with possible titration in increments of 8.4 grams at 1-week or longer intervals.
- Pediatric Patients Ages 12 years and older: 4 grams orally once daily, with possible titration in increments of 4 grams at 1-week or longer intervals. The maximum dose is 25.2 grams once daily in adults and pediatric patients aged 12 years and older 2.
From the Research
Dosing for Veltassa (Patiromer)
- The dosing for Veltassa (patiromer) varies based on the severity of hyperkalemia and the patient's response to treatment 3.
- In patients with mild hyperkalemia, starting doses of 4.2 g, 8.4 g, and 12.6 g twice daily have been used, with reductions in serum potassium levels of 0.35,0.51, and 0.55 mEq/L, respectively, at week 4 3.
- In patients with moderate hyperkalemia, starting doses of 8.4 g, 12.6 g, and 16.8 g twice daily have been used, with reductions in serum potassium levels of 0.87,0.97, and 0.92 mEq/L, respectively, at week 4 3.
- Patiromer can be titrated to achieve and maintain serum potassium levels of 5.0 mEq/L or lower 3.
- The initial dose of patiromer used in some studies was 4.2 g or 8.4 g twice a day 4.
Titration and Maintenance
- Patiromer was titrated to achieve and maintain serum potassium levels of 5.0 mEq/L or lower in clinical trials 3.
- In one study, patients who achieved a serum potassium level of 3.8 to <5.1 mmol per liter at week 4 were eligible to enter an 8-week randomized withdrawal phase, where they were randomly assigned to continue patiromer or switch to placebo 4.
- The median increase in potassium level from baseline was greater with placebo than with patiromer, and a recurrence of hyperkalemia occurred in 60% of patients in the placebo group compared to 15% in the patiromer group through week 8 4.