Potassium Reduction with Lokelma (Sodium Zirconium Cyclosilicate)
Each 10g dose of Lokelma (sodium zirconium cyclosilicate) reduces serum potassium by approximately 0.7 mEq/L within 48 hours of administration.
Mechanism and Onset of Action
Lokelma works by:
- Preferentially exchanging hydrogen and sodium for potassium ions in the gastrointestinal tract
- Increasing fecal potassium excretion
- Beginning to lower potassium within 1 hour of administration 1
- Achieving full effect within 48 hours 2
Potassium Reduction by Dosage
The potassium-lowering effect is dose-dependent:
| Lokelma Dose | Average K+ Reduction | Timeframe |
|---|---|---|
| 10g TID | 0.7 mEq/L | 48 hours |
| 5g TID | 0.5 mEq/L | 48 hours |
| 2.5g TID | 0.5 mEq/L | 48 hours |
For patients with higher baseline potassium levels (>5.5 mEq/L), the effect is more pronounced:
- 10g TID: 1.1 mEq/L reduction
- 5g TID: 0.9 mEq/L reduction 2
Timing of Effect
- Initial effect begins within 1 hour of administration 1
- Median time to normalization of potassium: 2.2 hours 3
- 84% of patients achieve normokalemia by 24 hours
- 98% of patients achieve normokalemia by 48 hours 3
Maintenance Dosing Effects
Once-daily maintenance dosing produces the following effects on serum potassium:
- 10g daily: maintains mean serum potassium at approximately 4.5 mEq/L
- 5g daily: maintains mean serum potassium at approximately 4.8 mEq/L 1, 2
Clinical Considerations
- Lokelma has a more rapid onset of action (within 1 hour) compared to patiromer (approximately 7 hours) 1
- The medication is particularly effective in patients with higher starting potassium levels 2
- Efficacy is consistent across patient subgroups including those with chronic kidney disease, heart failure, diabetes, and those on RAAS inhibitor therapy 2, 4
Potential Adverse Effects
- Dose-dependent edema may occur, particularly with higher doses (14% incidence with 15g daily) 3
- Risk of hypokalemia: 10% with 10g daily and 11% with 15g daily 1, 3
- Regular monitoring of serum potassium is recommended to avoid overcorrection 1
When managing hyperkalemia, the potassium-lowering effect of Lokelma is predictable and dose-dependent, making it a valuable tool for both acute correction and long-term management of elevated potassium levels.