What is the recommended dosage and administration of Lokelma (sodium zirconium cyclosilicate) for treating hyperkalemia?

Lokelma (Sodium Zirconium Cyclosilicate) Dosing for Hyperkalemia

For treating hyperkalemia, Lokelma should be administered at 10 g three times daily for up to 48 hours for initial correction, followed by a maintenance dose of 5-10 g once daily, with dose adjustments based on serum potassium monitoring. 1, 2

Initial Treatment Phase

• Initial dose: 10 g three times daily for up to 48 hours 1, 2
• Administration: Mix entire contents of packet(s) in approximately 3 tablespoons of water, stir well and drink immediately 2
• Expected response:
  • Normalization in 84% of patients within 24 hours
  • 98% of patients within 48 hours
  • Onset of action begins within 1 hour 1
  • Mean reduction of serum potassium by approximately 1.1 mEq/L over 48 hours 1

Maintenance Phase

• Standard maintenance dose: 10 g once daily 2
• Dose range: 5 g every other day to 15 g daily 2
• Dose adjustment:
  • Monitor serum potassium and adjust at intervals of 1 week or longer
  • Increase in increments of 5 g based on serum potassium level
  • Decrease dose or discontinue if serum potassium falls below desired target range 2

Special Populations: Hemodialysis Patients

• Administration timing: Only on non-dialysis days 2
• Starting dose: 5 g once daily on non-dialysis days 2
• For severe hyperkalemia (>6.5 mEq/L): Consider 10 g once daily on non-dialysis days 1, 2
• Maintenance dose range: 5-15 g once daily on non-dialysis days 1, 2
• Monitoring: Assess serum potassium after one week of initiation or dose adjustment 2

Monitoring Recommendations

• Check serum potassium within 2-4 hours after initial treatment 1
• Check within 1 week of any dose adjustment 1
• Regular monitoring based on risk factors and comorbidities 1
• The 10 g maintenance dose maintains mean serum potassium at approximately 4.5 mEq/L, while the 5 g dose maintains levels at approximately 4.8 mEq/L 1

Important Precautions and Adverse Effects

• Hypokalemia risk: 10% of patients on 10 g daily and 11% on 15 g daily may experience hypokalemia 1
• Edema risk: Dose-dependent edema may occur, particularly with 15 g daily dosing 1, 2
• Sodium content: Each 5 g dose contains approximately 400 mg of sodium - consider in patients requiring sodium restriction 1, 2
• Contraindications: Avoid in patients with severe constipation, bowel obstruction or impaction 1, 2
• Drug interactions: Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma 2

Clinical Pearls

• Lokelma is not indicated for emergency treatment of life-threatening hyperkalemia due to its delayed onset of action 2
• Lokelma has a more rapid onset of action (within 1 hour) compared to patiromer (approximately 7 hours) 1
• Long-term studies show efficacy maintained for up to 12 months 1, 3
• May provide additional benefit for patients with metabolic acidosis due to sustained increases in serum bicarbonate 1