What medication can be used to reduce hyperkalemia (elevated potassium levels)?

From the Guidelines

To reduce potassium levels in the body, the most effective medication is patiromer sorbitex calcium (Veltassa), a potassium binder, as recommended by the most recent and highest quality study 1.

Medication Options

• Loop diuretics, such as furosemide (Lasix), can be used to increase urine output and flush excess potassium from the body, with a typical starting dose of 20-40 mg taken orally or given intravenously, depending on the urgency of the situation 1.
• Potassium binders, like sodium polystyrene sulfonate (Kayexalate), can be used orally or rectally at a dose of 15-60 grams, mixed with water or syrup, to prevent potassium absorption in the intestines 1.
• Patiromer sorbitex calcium (Veltassa) is a newer potassium binder that has been shown to be effective in normalizing elevated potassium levels and preventing recurrences of hyperkalemia in patients with hyperkalemia on renin-angiotensin-aldosterone system inhibitor (RAASi) therapy 1.

Treatment Considerations

• The choice of medication depends on the severity of hyperkalemia, kidney function, and the presence of other medical conditions 1.
• Regular blood tests to monitor potassium levels and kidney function are necessary during treatment 1.
• Addressing the underlying cause of high potassium (hyperkalemia) is crucial for long-term management 1.

Important Notes

• These medications should only be used under medical supervision, as they can cause electrolyte imbalances and dehydration 1.
• The use of potassium binders, such as patiromer sorbitex calcium (Veltassa), may be beneficial in patients with hyperkalemia who are on RAASi therapy, as it can help to normalize potassium levels and prevent recurrences of hyperkalemia 1.

From the FDA Drug Label

Sodium Polystyrene Sulfonate Powder, for Suspension increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, resulting in a reduction of serum potassium levels. The practical exchange ratio is 1 mEq K per 1 gram of resin.

Polystyrene sulfonate (PO) can be used to reduce hyperkalemia (elevated potassium levels) by increasing fecal potassium excretion through binding of potassium in the gastrointestinal tract, resulting in a reduction of serum potassium levels 2.

• The medication works by exchanging sodium ions for potassium ions in the intestine, primarily in the large intestine.
• The effective lowering of serum potassium with Sodium Polystyrene Sulfonate Powder, for Suspension may take hours to days 2.

From the Research

Medications for Hyperkalemia

To reduce hyperkalemia (elevated potassium levels), several medications can be used, including:

• Insulin, usually with concomitant glucose, to lower serum potassium levels in the acute setting 3
• Albuterol to lower serum potassium levels in the acute setting 3
• Sodium polystyrene sulfonate, reserved for subacute treatment 3
• Calcium, administered to patients with hyperkalemic electrocardiography changes to prevent cardiac conduction disturbances 3, 4
• Nebulized β2-agonists, such as albuterol, to redistribute potassium ions from the bloodstream into the cells 4
• Intravenous insulin to redistribute potassium ions from the bloodstream into the cells 4, 5

Considerations for Treatment

When treating hyperkalemia, it is essential to consider the underlying cause of the condition and the patient's individual needs. For example:

• Patients with renal impairment may require careful consideration of potassium intake and excretion 6, 7
• Patients at risk of hypoglycemia, such as those with low pretreatment glucose or abnormal renal function, may require modified insulin and dextrose dosing 5
• Patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4-6 hours after administration 5