Lokelma (Sodium Zirconium Cyclosilicate) Dosing Regimen for Hyperkalemia
For hyperkalemia treatment, Lokelma should be administered at 10g three times daily for up to 48 hours initially, followed by a maintenance dose of 5-15g once daily, with dosing adjusted based on serum potassium monitoring. 1, 2
Initial Treatment Phase
- Acute hyperkalemia: 10g three times daily for up to 48 hours 1, 2
- Administer orally as a suspension in water
- Expect normalization of potassium in:
- 84% of patients within 24 hours
- 98% of patients within 48 hours 1
- Onset of action begins within 1 hour (faster than patiromer which takes ~7 hours) 1
Maintenance Phase
Special Considerations for Hemodialysis Patients
- Administer only on non-dialysis days 2
- Starting dose: 5g once daily on non-dialysis days
- Consider 10g once daily for patients with serum potassium >6.5 mEq/L
- Maintenance range: 5-15g once daily on non-dialysis days 2
- Adjust based on pre-dialysis serum potassium after long inter-dialytic interval
Administration Instructions
- Empty 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
- Other oral medications should be taken at least 2 hours before or after Lokelma 2
Monitoring Recommendations
- Check serum potassium within 2-4 hours after initial treatment
- Recheck within 1 week of any dose adjustment
- Regular monitoring based on patient risk factors and comorbidities 1
- For dialysis patients, assess serum potassium after one week of initiation or dose adjustment 2
Important Precautions and Adverse Effects
- Edema risk: Each 5g dose contains ~400mg sodium; monitor for edema, especially in patients who should restrict sodium intake 2
- Hypokalemia risk: 10% of patients on 10g daily and 11% on 15g daily may experience hypokalemia 1
- Contraindications: Avoid in patients with severe constipation, bowel obstruction or impaction 1, 2
- Temporarily withhold during prolonged fasting, surgery, or critical medical illness 1
Long-term Efficacy
- Efficacy maintained for up to 12 months in patients with chronic hyperkalemia 1, 3
- For patients with kidney failure, Lokelma should be continued indefinitely as maintenance therapy with regular monitoring 1
By following this structured approach to Lokelma dosing, hyperkalemia can be effectively managed while minimizing risks of adverse effects such as hypokalemia and edema.