From the Guidelines
Kayexalate (sodium polystyrene sulfonate) should be dosed at 15-50 grams orally or rectally for the treatment of hyperkalemia, as recommended by the most recent guidelines 1. The dose of Kayexalate can vary depending on the severity of hyperkalemia and the patient's response to treatment.
- For oral administration, the standard dose is 15 grams 1-4 times daily mixed in water or a small amount of juice.
- For rectal administration, 30-50 grams as a retention enema is commonly used. Each gram of Kayexalate exchanges approximately 1 mEq of potassium, and the medication should be given with sorbitol to prevent constipation and fecal impaction, though premixed formulations should be used cautiously due to risk of intestinal necrosis 1. Treatment duration depends on serum potassium levels, which should be monitored regularly.
- Common side effects include constipation, diarrhea, nausea, and electrolyte imbalances.
- Kayexalate works by exchanging sodium ions for potassium ions in the intestine, thereby reducing potassium absorption and promoting its excretion. It should be used cautiously in patients with heart failure, hypertension, or edema due to its sodium content, and should be avoided in patients with intestinal obstruction or recent intestinal surgery 1. The most recent study from 2021 1 provides the most up-to-date information on the dosing and administration of Kayexalate, and its potential side effects and interactions.
- The study highlights the importance of careful management of Kayexalate administration, particularly in patients with certain medical conditions or taking other medications.
- The use of Kayexalate has been associated with adverse events, including intestinal ischemia and colonic necrosis, and its nonselective binding properties may lead to hypocalcemia and hypomagnesemia 1.
From the FDA Drug Label
The average total daily adult dose of Sodium Polystyrene Sulfonate Powder, for Suspension is 15 g to 60 g, administered as a 15-g dose (four level teaspoons), one to four times daily. The average adult dose is 30 g to 50 g every six hours [2].
The dose of Kayexalate (sodium polystyrene sulfonate) is:
- Oral: 15 g to 60 g per day, given as 15-g doses (4 level teaspoons) 1 to 4 times daily
- Rectal: 30 g to 50 g every 6 hours 2
From the Research
Dose of Kayexalate (Sodium Polystyrene Sulfonate)
- The dose of Kayexalate (sodium polystyrene sulfonate) is not consistently reported across studies, but it is mentioned in a few studies:
- In the study 3, the dose of Kayexalate was 1 gm/Kg body weight given rectally every four hours.
- In the study 4, doses of 15 g of SPS were considered "low dose" while 30 g of SPS were considered "high dose".
- In the study 5, the dose of SPS is not explicitly stated, but it is mentioned that SPS was used in combination with IV insulin for the treatment of acute hyperkalemia.
- It is worth noting that the efficacy and safety of Kayexalate (sodium polystyrene sulfonate) for the treatment of hyperkalemia have been questioned in some studies, with some suggesting that it is not efficacious 6 or that it has a slower onset of action compared to other treatments 4.
Comparison with Other Treatments
- Kayexalate (sodium polystyrene sulfonate) has been compared to other treatments for hyperkalemia, including patiromer 4 and sodium zirconium cyclosilicate 5.
- The study 4 found that SPS was more effective than patiromer in reducing potassium levels, but noted that SPS has well-documented adverse reactions and a slower onset of action.
- The study 5 found that SPS and sodium zirconium cyclosilicate had similar rates of normokalemia achievement when used in combination with IV insulin for the treatment of acute hyperkalemia.