What is the starting dose for Lokelma (sodium zirconium cyclosilicate) in treating hyperkalemia?

Starting Dose for Lokelma in Hyperkalemia Management

For initial treatment of hyperkalemia, the recommended starting dose of Lokelma (sodium zirconium cyclosilicate) is 10 g administered three times a day for up to 48 hours. 1

Initial Treatment Protocol

• Acute hyperkalemia correction (first 48 hours):

  • Dose: 10 g three times daily
  • Administration: Mix entire contents of packet(s) in approximately 3 tablespoons of water, stir well and drink immediately
  • Expected response: Normalization in 84% of patients within 24 hours and 98% within 48 hours 2
  • Onset of action: Begins within 1 hour (though not appropriate for emergency treatment of life-threatening hyperkalemia due to delayed onset) 2, 1

• After achieving normal potassium levels (maintenance phase):

  • Standard maintenance dose: 10 g once daily 1
  • Dose range: 5 g every other day to 15 g daily 1
  • Titration: Adjust dose based on serum potassium levels at intervals of 1 week or longer, in increments of 5 g 1

Special Population Considerations

Patients on Chronic Hemodialysis

• Administer only on non-dialysis days 1
• Starting dose: 5 g once daily on non-dialysis days 1
• For severe hyperkalemia (>6.5 mEq/L): Consider 10 g once daily on non-dialysis days 2, 1
• Maintenance dose range: 5-15 g once daily on non-dialysis days 2, 1

Monitoring Recommendations

• Check serum potassium within 2-4 hours after initial treatment 2
• Reassess within 1 week of any dose adjustment 2
• During maintenance therapy, monitor regularly based on individual risk factors and comorbidities 2
• Expected maintenance levels:
  • 10 g daily maintains mean serum potassium at approximately 4.5 mEq/L
  • 5 g daily maintains levels at approximately 4.8 mEq/L 2

Important Precautions

• Drug interactions: Administer other oral medications at least 2 hours before or 2 hours after Lokelma 1
• Adverse effects to monitor:
  • Hypokalemia: Occurs in 10% of patients with 10 g daily and 11% with 15 g daily 2
  • Edema: Dose-dependent, more common with 15 g daily dosing 2, 1
  • Sodium content: Each 5 g dose contains approximately 400 mg of sodium (important for patients with sodium restriction) 2, 1
• Contraindications: Avoid in patients with severe constipation, bowel obstruction or impaction 2, 1

Clinical Efficacy

• Mean reduction in serum potassium: Approximately 1.1 mEq/L over 48 hours with initial dosing 2
• Long-term efficacy: Demonstrated for up to 12 months in clinical trials 2, 3
• Comparative onset: More rapid action (within 1 hour) compared to patiromer (approximately 7 hours) 2

Lokelma has demonstrated consistent efficacy across various patient populations, including those with chronic kidney disease, diabetes, heart failure, and patients on RAAS inhibitor therapy 4. The medication's ability to rapidly normalize potassium levels while maintaining a favorable safety profile makes it an important option in hyperkalemia management.