From the Guidelines
Lokelma (sodium zirconium cyclosilicate) is generally preferred over Veltassa (patiromer) for the treatment of hyperkalemia due to its faster onset of action and lower risk of serious adverse events, as supported by the most recent and highest quality study 1.
Key Differences
- Onset of action: Lokelma works faster, with a significant reduction in serum potassium levels within 1 hour, compared to Veltassa, which takes approximately 7 hours to onset 1.
- Dosing: Lokelma is typically dosed at 10g three times daily for acute treatment, then 5-10g once daily for maintenance, while Veltassa is dosed at 8.4g once daily, adjustable up to 25.2g daily 1.
- Side effects: Lokelma can cause edema due to its sodium content, making it potentially problematic for patients with heart failure or hypertension, while Veltassa more commonly causes constipation and may interact with other medications (requiring a 3-hour separation) 1.
Mechanism of Action
Both medications work by binding to potassium in the gastrointestinal tract, preventing its absorption and facilitating its elimination through stool. However, Lokelma is highly selective for potassium, while Veltassa is nonselective and may also bind magnesium and small amounts of sodium 1.
Clinical Considerations
The choice between Lokelma and Veltassa should be individualized based on the urgency of potassium reduction, comorbidities, medication regimen, and insurance coverage. Patients with heart failure or hypertension may be better suited for Veltassa, while those requiring rapid potassium reduction may benefit from Lokelma 1.
Safety Profile
Lokelma has not been associated with any serious adverse events in randomized trials, while Veltassa has been linked to rare cases of hypercalcemia and requires careful management to avoid interactions with other medications 1.
From the Research
Comparison of Veltassa (Patiromer) and Lokelma (Sodium Zirconium Cyclosilicate)
- Both Veltassa (patiromer) and Lokelma (sodium zirconium cyclosilicate) are used to treat hyperkalemia by increasing gastrointestinal potassium elimination 2, 3, 4.
- These medications have been shown to be effective in normalizing serum potassium levels and maintaining normalized serum potassium levels over several weeks 3, 4.
- Both agents have been studied in patients with chronic mild-to-severe hyperkalemia, chronic kidney disease (CKD), or heart failure, as well as those taking a renin-angiotensin system (RAS) inhibitor, an aldosterone antagonist, or both therapies 3, 4.
- The overall frequency of adverse effects in clinical trials was low, with gastrointestinal adverse events being the most commonly observed 3, 4.
Efficacy Comparison
- A retrospective observational analysis found that both sodium zirconium cyclosilicate and calcium polystyrene sulfonate effectively reduced plasma potassium concentrations in patients with hyperkalemia, with similar efficacy 5.
- Another study found that sodium zirconium cyclosilicate corrected hyperkalemia and maintained normokalaemia among outpatients regardless of the CKD stage 6.
- Patiromer and sodium zirconium cyclosilicate have been shown to effectively normalize elevated serum potassium and chronically maintain potassium homeostasis in hyperkalemic patients treated with RAAS blockers 4.
Safety and Cost-Effectiveness
- Both patiromer and sodium zirconium cyclosilicate exhibit good tolerability and were not associated with serious adverse effects 3, 4.
- A cost comparison analysis found that calcium polystyrene sulfonate has slightly better cost-effectiveness compared to sodium zirconium cyclosilicate, albeit at a cost of increased staff input 5.
- Adverse events during the maintenance phase were more common in patients with eGFR <30 mL/min/1.73 m2 subgroup 6.