Dosing of Lokelma (Sodium Zirconium Cyclosilicate) for Hyperkalemia of 6.0 mEq/L
For a potassium level of 6.0 mEq/L, administer 10g of Lokelma three times daily for up to 48 hours, followed by maintenance dosing of 10g once daily with dose adjustments based on serum potassium monitoring. 1
Initial Treatment Phase
The FDA-approved dosing regimen for Lokelma in hyperkalemia is clear:
- Initial treatment: 10g three times daily for up to 48 hours 1
- Administration method: Mix the entire contents of the packet in approximately 3 tablespoons of water, stir well and drink immediately 1
- Onset of action: Begins within 1 hour, which is faster than other potassium binders like patiromer (7 hours) 2
For a potassium level of 6.0 mEq/L, which is classified as severe hyperkalemia according to European guidelines 3, prompt initiation of the full recommended dose is essential to reduce the risk of cardiac arrhythmias and mortality.
Maintenance Phase
After the initial 48-hour treatment period:
- Maintenance dose: Start with 10g once daily 1
- Monitor serum potassium and adjust the dose at intervals of 1 week or longer 1
- Dose adjustments: Increase in 5g increments if potassium remains elevated; decrease or discontinue if potassium falls below desired range 1
- Maintenance dose range: 5g every other day to 15g daily 1
Efficacy Data
Clinical trials demonstrate the effectiveness of this dosing regimen:
- In the HARMONIZE trial, 84% of patients achieved normal potassium levels (3.5-5.0 mEq/L) within 24 hours and 98% within 48 hours using the 10g TID dosing 4
- Median time to normalization was 2.2 hours 4
- For patients with baseline potassium ≥5.5 mmol/L, median time to achieve potassium ≤5.5 mmol/L was 2.0 hours 5
Special Considerations
- Drug interactions: Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma 1
- Sodium content: Each 5g dose contains approximately 400mg of sodium, so monitor for edema, particularly in patients who should restrict sodium intake 1
- Hemodialysis patients: For patients on chronic hemodialysis, administer only on non-dialysis days, with a starting dose of 5g once daily (or 10g for severe hyperkalemia >6.5 mEq/L) 1
Monitoring
- Assess serum potassium regularly during initial treatment and after dose adjustments
- Monitor for signs of edema, particularly in patients prone to fluid overload 1
- Watch for potential adverse events, which are generally comparable to placebo in clinical trials, though edema was more common with higher doses (14% with 15g daily) 4
- Monitor for hypokalemia, which occurred in 10-11% of patients on 10-15g daily doses in clinical trials 4
Lokelma has demonstrated consistent efficacy across different patient populations, including those with chronic kidney disease, diabetes, and heart failure, with maintained effectiveness over long-term use (up to 12 months) 6, 7.