What is the dosing for Lokelma (sodium zirconium cyclosilicate)?

From the Guidelines

Lokelma (sodium zirconium cyclosilicate) should be dosed at 10 grams three times daily for the first 48 hours for initial treatment of hyperkalemia, followed by a maintenance dose of 5-10 grams once daily, as this regimen has been shown to effectively reduce serum potassium levels and maintain normokalemia over time 1.

Key Considerations

• The medication should be mixed with approximately 3 tablespoons of water, stirred well until suspended, and taken orally.
• It's essential to wait at least 2 hours between Lokelma and other oral medications to prevent potential interactions.
• Lokelma works by binding potassium in the gastrointestinal tract, exchanging sodium for potassium, which is then eliminated through the feces.
• Regular monitoring of serum potassium levels is necessary to adjust dosing appropriately and prevent hypokalemia.

Potential Side Effects

• Common side effects include edema and hypokalemia, particularly in patients at risk for fluid overload.
• Sodium zirconium cyclosilicate has not been associated with any serious adverse events in randomized trials 1.

Mechanism of Action

• Lokelma binds potassium in the gastrointestinal tract, exchanging sodium for potassium, which is then eliminated through the feces, helping to reduce serum potassium levels without systemic absorption of the medication.

Clinical Evidence

• The efficacy and safety of SZC over 12 months have also been documented, with significant reductions in serum K+ levels observed within 1 hour of a single SZC 10-g dose in patients with severe hyperkalemia 1.

From the FDA Drug Label

2.1 Recommended Dosage For initial treatment of hyperkalemia, the recommended dose of LOKELMA is 10 g administered three times a day for up to 48 hours. Administer LOKELMA orally as a suspension in water [see Dosage and Administration (2.3)]. For continued treatment, the recommended dose is 10 g once daily. Monitor serum potassium and adjust the dose of LOKELMA based on the serum potassium level and desired target range.

2.2 Dosage Adjustment for Patients on Chronic Hemodialysis For patients on chronic hemodialysis, administer LOKELMA only on non-dialysis days. The recommended starting dose is 5 g once daily on non-dialysis days. Consider a starting dose of 10 g once daily on non-dialysis days in patients with serum potassium greater than 6.5 mEq/L.

The recommended dosing for Lokelma is as follows:

• Initial treatment: 10 g three times a day for up to 48 hours
• Continued treatment: 10 g once daily
• Patients on chronic hemodialysis: 5 g once daily on non-dialysis days, or 10 g once daily on non-dialysis days if serum potassium is greater than 6.5 mEq/L The dose of Lokelma should be adjusted based on serum potassium levels and desired target range 2.

From the Research

Lokelma Dosing

• Lokelma, also known as sodium zirconium cyclosilicate, is a medication used to treat hyperkalemia, a condition characterized by high levels of potassium in the blood 3, 4, 5, 6, 7.
• The dosing of Lokelma may vary depending on the severity of hyperkalemia and the patient's response to treatment.
• According to the studies, Lokelma has been shown to be effective in reducing serum potassium levels in patients with hyperkalemia, with some studies suggesting that it may be more effective than other treatments such as sodium polystyrene sulfonate 5, 7.
• The optimal dosing regimen for Lokelma has not been established, but studies have used various doses ranging from 5-15 grams per day 6.
• It is essential to monitor serum potassium levels closely when using Lokelma to adjust the dose as needed and minimize the risk of adverse effects such as hypokalemia 6, 7.

Comparison with Other Treatments

• Lokelma has been compared to other treatments for hyperkalemia, including patiromer and sodium polystyrene sulfonate 5, 6, 7.
• Studies have shown that Lokelma may be more effective than sodium polystyrene sulfonate in reducing serum potassium levels, but the difference between the two treatments may not be significant 7.
• Patiromer and Lokelma have been shown to be equally effective in reducing serum potassium levels, but patiromer may be associated with a lower risk of edema 5, 6.

Safety and Efficacy

• Lokelma has been shown to be generally safe and well-tolerated, with common adverse effects including gastrointestinal symptoms such as constipation and diarrhea 3, 4, 5, 6, 7.
• The medication may also be associated with an increased risk of edema, particularly at higher doses 5, 6.
• Overall, the available evidence suggests that Lokelma is a effective and safe treatment option for hyperkalemia, but further studies are needed to establish the optimal dosing regimen and compare its efficacy and safety to other treatments 3, 4, 5, 6, 7.