What is the recommended dosing for Lokelma (sodium zirconium cyclosilicate) in a patient with hyperkalemia?

Lokelma Dosing for Hyperkalemia with Potassium of 6

For a patient with a potassium level of 6 mEq/L, the recommended dose of Lokelma (sodium zirconium cyclosilicate) is 10 g administered three times daily for up to 48 hours, followed by 10 g once daily for maintenance therapy. 1

Initial Correction Phase

• Initial dosing: 10 g three times daily for up to 48 hours 1
• Administration: Mix the entire contents of the packet in approximately 3 tablespoons of water, stir well, and drink immediately 1
• Expected response:
  • 84% of patients achieve normokalemia within 24 hours
  • 98% of patients achieve normokalemia within 48 hours 2
  • Median time to normalization is approximately 2.2 hours 3
  • Mean reduction in serum potassium is approximately 1.1 mEq/L over 48 hours 2

Maintenance Phase

• Starting maintenance dose: 10 g once daily after achieving normokalemia 1
• Dose adjustment:
  • Monitor serum potassium regularly
  • Adjust dose based on serum potassium level at intervals of 1 week or longer
  • Increase in increments of 5 g if potassium remains elevated
  • Decrease dose if potassium falls below desired range 1
• Maintenance dose range: 5 g every other day to 15 g daily 1
  • 10 g daily maintains mean serum potassium at approximately 4.5 mEq/L
  • 5 g daily maintains mean serum potassium at approximately 4.8 mEq/L 2, 3

Special Considerations

For Hemodialysis Patients

• Administer only on non-dialysis days
• Starting dose: 5 g once daily on non-dialysis days
• For potassium >6.5 mEq/L: Consider 10 g once daily on non-dialysis days
• Maintenance dose range: 5-15 g once daily on non-dialysis days 1

Monitoring

• Check serum potassium within 2-4 hours after initial treatment
• Monitor within 1 week of any dose adjustment
• Regular monitoring based on risk factors and comorbidities 2

Administration Precautions

• Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma 1
• Each 5 g dose contains approximately 400 mg of sodium, which should be considered in patients with sodium restriction 2

Safety Considerations

• Common adverse events:
  • Dose-dependent edema (particularly with 15 g daily dosing)
  • Risk of hypokalemia: 10% with 10 g daily and 11% with 15 g daily 2, 3
• Contraindications:
  • Avoid use in patients with severe constipation, bowel obstruction or impaction 1
• Advantages over older agents:
  • Rapid onset of action (within 1 hour)
  • No serious adverse events in randomized trials, unlike sodium polystyrene sulfonate which has been linked to intestinal necrosis 2, 4

Lokelma has demonstrated long-term efficacy and safety for up to 12 months in patients with hyperkalemia 5, 6, making it a valuable option for both acute correction and chronic management of hyperkalemia.