How much does Lokelma (sodium zirconium cyclosilicate) lower potassium levels in hyperkalemia?

Efficacy of Lokelma (Sodium Zirconium Cyclosilicate) in Lowering Potassium Levels

Lokelma (sodium zirconium cyclosilicate) effectively lowers serum potassium by approximately 0.7 mEq/L within 2 hours for acute hyperkalemia and maintains normalization with daily dosing over extended periods. 1, 2

Acute Potassium Reduction

Lokelma demonstrates dose-dependent potassium reduction:

• Initial 48-hour treatment (acute phase):

  • 10g three times daily reduces serum potassium by approximately 0.7 mEq/L 1, 2
  • Significant reductions begin within 1 hour of administration 3
  • 84% of patients achieve normal potassium levels (3.5-5.0 mEq/L) within 24 hours 2, 4
  • 98% of patients achieve normal potassium levels within 48 hours 2, 4
  • More pronounced effect in patients with higher baseline potassium levels (>5.5 mEq/L), with reductions of approximately 1.1 mEq/L 2

• Emergency setting:

  • In emergency department patients with severe hyperkalemia (≥5.8 mEq/L), Lokelma added to insulin plus glucose provides reductions of approximately 0.72 mEq/L within 2 hours 1

Maintenance Therapy Efficacy

Once potassium is normalized, maintenance dosing effectively sustains normal levels:

• 5g once daily: Maintains mean serum potassium at approximately 4.8 mEq/L 2
• 10g once daily: Maintains mean serum potassium at approximately 4.5 mEq/L 2
• 15g once daily: Maintains mean serum potassium at approximately 4.4 mEq/L 4

Maintenance efficacy rates:

• 80% of patients maintain normal potassium with 5g daily 4
• 90% of patients maintain normal potassium with 10g daily 4
• 94% of patients maintain normal potassium with 15g daily 4

Special Populations

• Chronic kidney disease: Equally effective regardless of CKD stage, with 82% of patients with eGFR <30 mL/min/1.73m² and 90% of patients with eGFR ≥30 mL/min/1.73m² maintaining normalization at one year 5
• Hemodialysis patients: Effective for pre-dialysis hyperkalemia when administered on non-dialysis days 2

Advantages Over Other Potassium Binders

• Faster onset of action: Lokelma works within 1 hour compared to patiromer's 7-hour onset 1, 3
• Additional benefit: May provide added benefit for patients with metabolic acidosis due to sustained increases in serum bicarbonate 1

Safety Considerations

• Common adverse effects:

  • Hypokalemia (10% with 10g daily, 11% with 15g daily) 3
  • Dose-dependent edema, particularly with 15g daily dosing 1, 4

• Sodium content: Contains 400mg of sodium per 5g dose, which should be considered in patients with sodium restriction 3

Dosing Algorithm

1. For acute hyperkalemia (K+ >5.5 mEq/L):

   • Start with 10g three times daily for 48 hours
   • Monitor potassium within 2-4 hours after initial treatment

2. For maintenance therapy:

   • Start with 5g once daily after achieving normal potassium
   • Titrate based on serum potassium monitoring:
     • If K+ remains >5.0 mEq/L, increase to 10g daily
     • If K+ remains >5.0 mEq/L on 10g, increase to maximum 15g daily
     • If K+ <3.5 mEq/L, reduce dose or temporarily discontinue

3. For hemodialysis patients:

   • Administer on non-dialysis days only
   • Start with 5g and titrate up to 15g based on pre-dialysis potassium levels

Regular monitoring of serum potassium is essential during both acute treatment and maintenance therapy to ensure optimal dosing and prevent hypokalemia.