Administration of Lokelma via Nasogastric Tube (NGT)
Lokelma (sodium zirconium cyclosilicate) can be administered via nasogastric tube (NGT) when properly prepared as a suspension in water, ensuring complete dissolution before administration.
Preparation and Administration Procedure
Pre-Administration Steps
- Verify proper NGT placement before medication administration by checking pH or x-ray confirmation according to institutional protocols 1
- Flush the NGT with at least 30 mL of water to clear any residual formula 1
- If the patient is receiving enteral feeding, pause the feeding 1-2 hours before Lokelma administration to prevent potential interactions between the medication and formula components 1
Preparation of Lokelma
- Lokelma is available as a powder for oral suspension 2
- Mix the prescribed dose thoroughly in water until completely dissolved
- Ensure complete dissolution to prevent tube occlusion 1
- Use appropriate ENFit syringes that comply with ISO 80369-3 standards 1
Administration Technique
- Administer the Lokelma suspension directly through the NGT using the appropriate syringe 1
- Do not mix Lokelma with other medications during administration 1
- Administer medications individually to prevent drug interactions 1
Post-Administration Steps
- Flush the NGT with at least 30 mL of water after administration to:
- Ensure complete medication delivery
- Prevent tube occlusion 1
- Resume enteral feeding 30-40 minutes after administration if applicable 1
Clinical Considerations
Efficacy and Monitoring
- Lokelma works by exchanging hydrogen and sodium for potassium in the gastrointestinal tract, thereby increasing fecal potassium excretion and lowering serum potassium levels 2
- Monitor serum potassium levels regularly to assess efficacy and adjust dosing as needed
- Be aware that Lokelma can normalize serum potassium levels within 48 hours when administered at appropriate doses 2
Potential Complications
- Watch for signs of hypokalemia, although the incidence is generally low 2
- Monitor for potential sodium retention, especially in patients with heart failure 3
- Ensure the NGT remains patent, as medication administration is a common cause of tube occlusion 1
Special Precautions
- For patients with significant GI tract resections, drug absorption may be compromised 1
- Consider consulting with a pharmacist before administering Lokelma through an NGT to ensure proper drug delivery 1
- Never add Lokelma directly to enteral formula, as this may affect drug stability and efficacy 1
By following these guidelines, Lokelma can be safely and effectively administered via NGT when oral administration is not possible or practical.