From the Guidelines
Sodium polystyrene sulfonate (Kayexalate) should be used with caution for treating hyperkalemia due to its potential for serious adverse events, including intestinal necrosis, and its variable efficacy. When considering Kayexalate for hyperkalemia treatment, it is essential to weigh the potential benefits against the risks, particularly in patients with severe hyperkalemia or those at high risk of complications 1. The typical dose of Kayexalate is 15-30 grams orally, mixed with 50-100 mL of water or sorbitol, administered 1-4 times daily as needed. For rectal administration, 30-50 grams mixed with 100 mL of sorbitol can be given as a retention enema.
Some key points to consider when using Kayexalate include:
- Monitoring potassium levels closely, as the medication may take 2-24 hours to effectively lower potassium 1
- Being aware of potential side effects, including constipation, diarrhea, and rarely intestinal necrosis 1
- Kayexalate works by exchanging sodium ions for potassium ions in the intestine, promoting potassium excretion through the stool 1
- For mild hyperkalemia (K+ 5.5 mEq/L), consider first addressing underlying causes and using less aggressive measures like dietary potassium restriction or adjustment of medications that may contribute to hyperkalemia before initiating Kayexalate 1
It is also important to note that newer K+-binding agents, such as patiromer and sodium zirconium cyclosilicate, may be considered as alternative treatments for hyperkalemia, particularly in patients with chronic kidney disease or those at high risk of complications 1. Ultimately, the decision to use Kayexalate should be made on a case-by-case basis, taking into account the individual patient's needs and risk factors.
From the FDA Drug Label
Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Limitation of Use: Sodium Polystyrene Sulfonate should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action [see Clinical Pharmacology ( 12.2)].
Kayexalate (sodium polystyrene sulfonate) is indicated for the treatment of hyperkalemia. However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2.
From the Research
Indications for Kayexalate (Sodium Polystyrene Sulfonate) in Hyperkalemia
- Kayexalate is indicated for the treatment of hyperkalemia, a serious medical condition that often manifests in patients with chronic kidney disease and heart failure 3.
- It is used to enhance potassium excretion, although its efficacy is ambiguous and it is associated with known toxicities 3.
- Kayexalate is a current treatment option for hyperkalemia, but it has largely been surpassed by newer agents such as patiromer and sodium zirconium cyclosilicate, which have improved efficacy and safety profiles 3, 4, 5, 6.
- However, some studies suggest that Kayexalate may not be efficacious for the treatment of hyperkalemia 7.
Mechanism of Action
- Kayexalate works by binding potassium in the gastrointestinal tract to facilitate fecal excretion 3.
- It is an unabsorbable compound that can also bind other medications in the GI tract, which may lead to high drug-drug interaction potential 3.