What is the name of the new potassium-lowering medication prescription for hyperkalemia?

New Potassium-Lowering Medications for Hyperkalemia

The two newer FDA-approved potassium-lowering medications for hyperkalemia are patiromer and sodium zirconium cyclosilicate (SZC, brand name Lokelma). 1

Mechanism of Action

Both medications work by binding potassium in the gastrointestinal tract, but through different mechanisms:

• Patiromer (RLY5016):

  • Contains a calcium-sorbitol counterion that exchanges calcium for potassium in the colon
  • Non-selective for potassium and may also bind magnesium
  • Onset of action: approximately 7 hours 1

• Sodium Zirconium Cyclosilicate (SZC, Lokelma):

  • Inorganic crystal that selectively binds potassium and ammonium in exchange for sodium and hydrogen throughout the GI tract
  • More rapid onset of action: significant reductions within 1 hour, with full effect within 48 hours 1, 2

Clinical Evidence

Both medications have been shown to effectively lower potassium levels:

• Patiromer:

  • In the PEARL-HF trial, patiromer led to lower potassium levels, less hyperkalemia, and allowed more patients to increase spironolactone dose to 50 mg daily compared with placebo 1
  • Effective for long-term management of hyperkalemia for up to 12 months 1

• Sodium Zirconium Cyclosilicate (SZC):

  • In emergency department patients with severe hyperkalemia (≥5.8 mEq/L), SZC reduced mean serum potassium by 0.72 mEq/L within 2 hours 1
  • In Study 1, SZC 10g three times daily reduced serum potassium by 0.7 mEq/L at 48 hours 2
  • Maintenance doses of 5-15g once daily effectively maintained normokalemia for up to 12 months 2
  • Also effective in patients on chronic hemodialysis 2

Dosing

• Patiromer:

  • Typical starting dose: 8.4g once daily 1

• Sodium Zirconium Cyclosilicate (SZC):

  • Acute phase: 10g three times daily for up to 48 hours
  • Maintenance: 10g once daily, adjustable at one-week intervals by 5g daily as needed
  • For patients on chronic hemodialysis: 5g once daily on non-dialysis days 2

Adverse Effects

• Patiromer:

  • Gastrointestinal events (constipation, diarrhea, nausea/vomiting)
  • Hypomagnesemia (requires monitoring)
  • Potential hypercalcemia (rare) 1, 3

• Sodium Zirconium Cyclosilicate (SZC):

  • Dose-dependent edema (due to sodium content)
  • Urinary tract infections
  • No serious adverse events in clinical trials 1, 2, 3

Clinical Considerations

• Time to Effect:

  • For acute hyperkalemia requiring rapid correction, SZC may be preferred due to its faster onset of action (1-2 hours vs. 7 hours for patiromer) 3, 4
  • For chronic hyperkalemia management, patiromer may be preferred in patients at risk for fluid overload due to lower sodium content 4

• Drug Interactions:

  • Patiromer: Separate administration from other oral medications by at least 3 hours 1
  • SZC: Separate administration from other oral medications by at least 2 hours before or after 2

• Patient Selection:

  • Both agents are particularly valuable in patients with heart failure, chronic kidney disease, or diabetes who require RAAS inhibitor therapy but develop hyperkalemia 1
  • SZC should be used with caution in patients at risk for fluid overload due to its sodium content 1, 4

Important Caveats

• Neither medication should be used as emergency treatment for life-threatening hyperkalemia due to their delayed onset of action compared to traditional emergency treatments (calcium, insulin/glucose, albuterol) 2

• These medications enable continued use of beneficial RAAS inhibitors in patients who might otherwise have to discontinue them due to hyperkalemia 1, 5

• Recent head-to-head comparison showed no significant difference in effectiveness between patiromer and SZC for acute hyperkalemia management 6