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

Lokelma (Sodium Zirconium Cyclosilicate) Dosing for Hyperkalemia

For hyperkalemia treatment, 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 titration based on serum potassium monitoring. 1, 2

Initial Treatment Phase

• Initial dose: 10 g three times daily for up to 48 hours 1, 2
• Administer as oral suspension in water
• Expected response:
  • Normalization in 84% of patients within 24 hours
  • Normalization in 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

• Starting maintenance dose: 10 g once daily 2
• Maintenance dose range: 5 g every other day to 15 g daily 2
• Dose adjustment:
  • Monitor serum potassium regularly
  • Up-titrate at intervals of 1 week or longer in increments of 5 g 2
  • Decrease dose or discontinue if serum potassium falls below desired target range 2
  • 10 g daily maintains mean serum potassium at approximately 4.5 mEq/L 1
  • 5 g daily maintains levels at approximately 4.8 mEq/L over 28 days 1

Special Population: Patients on Chronic Hemodialysis

• Important: Administer 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 2
• Maintenance dose range: 5-15 g once daily on non-dialysis days 1, 2
• Monitor pre-dialysis serum potassium after the long inter-dialytic interval 2

Administration Instructions

• Empty entire packet contents into a glass with approximately 3 tablespoons of water
• Stir well and drink immediately
• If powder remains, add more water, stir and drink until no powder remains 2
• Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma 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 patient risk factors and comorbidities 1

Important Precautions

• Not for emergency treatment of life-threatening hyperkalemia due to delayed onset of action 2
• Sodium content: Each 5 g dose contains approximately 400 mg of sodium 2
• Risk of hypokalemia: 10% with 10 g daily and 11% with 15 g daily 1
• Edema risk: Dose-dependent edema may occur, particularly with 15 g daily dosing 1, 2
• Contraindicated in patients with severe constipation, bowel obstruction or impaction 1, 2

Clinical Efficacy Context

• Lokelma has demonstrated efficacy for up to 12 months in patients with hyperkalemia 1
• More rapid onset of action (within 1 hour) compared to patiromer (approximately 7 hours) 1
• May provide additional benefit for patients with metabolic acidosis due to increases in serum bicarbonate 1