Lokelma (Sodium Zirconium Cyclosilicate) Dosing for Hyperkalemia
For hyperkalemia treatment, Lokelma (sodium zirconium cyclosilicate) should be dosed at 10 g three times daily for 48 hours for initial correction, followed by 5-10 g once daily for maintenance therapy. 1
Initial Correction Phase Dosing
- Dose: 10 g three times daily
- Duration: 48 hours (first 2 days)
- Administration: Mix powder with water and take orally
- Expected response:
Maintenance Phase Dosing
After achieving normal potassium levels (3.5-5.0 mEq/L):
- Starting dose: 5 g once daily
- Dose adjustment: Can be titrated up to 15 g once daily based on serum potassium monitoring
- Minimum effective dose: 5 g once daily
- Maximum dose: 15 g once daily 1
The 10 g maintenance dose has been shown to maintain mean serum potassium at approximately 4.5 mEq/L, while the 5 g dose maintains levels at approximately 4.8 mEq/L over 28 days 1, 3.
Monitoring Recommendations
- Recheck serum potassium within 2-4 hours after initial treatment
- Monitor serum potassium within 1 week of any dose adjustment
- During maintenance therapy, monitor serum potassium regularly based on individual risk factors 2
Efficacy Considerations
- In the HARMONIZE trial, 90% of patients maintained normal potassium levels with 10 g daily dosing over 28 days 3
- Long-term studies show efficacy maintained for up to 12 months 4
- Effective across all patient subgroups including those with CKD, diabetes, heart failure, and patients on RAAS inhibitors 4
Safety and Adverse Effects
- Most common adverse events: gastrointestinal disorders (constipation, diarrhea, nausea, vomiting)
- Dose-dependent edema may occur, particularly with 15 g daily dosing (14% incidence) 3
- Risk of hypokalemia: 10% with 10 g daily and 11% with 15 g daily 3
- No serious adverse events have been associated with Lokelma in randomized trials 1
- Contains 400 mg of sodium per 5 g dose - consider in patients with sodium restriction 1
Clinical Pearls
- Unlike older potassium binders, Lokelma is highly selective for potassium
- No need to separate from other medications (unlike patiromer which requires 3-hour separation)
- May provide additional benefit for patients with metabolic acidosis due to increases in serum bicarbonate 2
- Efficacy is consistent regardless of CKD stage, with 82% of patients with severe CKD (eGFR <30 mL/min/1.73m²) maintaining normokalemia at 1 year 4
Lokelma's rapid onset of action makes it particularly valuable for more urgent correction of hyperkalemia, while its once-daily maintenance dosing supports long-term management of chronic hyperkalemia.