What is the recommended interval between doses of Lokelma (sodium zirconium cyclosilicate) for hyperkalemia?

Lokelma (Sodium Zirconium Cyclosilicate) Dosing Interval

For Lokelma (sodium zirconium cyclosilicate), doses should be administered three times daily during initial treatment for hyperkalemia, and then once daily for maintenance therapy, with other oral medications taken at least 2 hours before or 2 hours after Lokelma. 1

Initial Treatment Phase

• Acute hyperkalemia dosing: 10g three times daily for up to 48 hours 2, 1
• Administer as a suspension in water
• Timing: Space doses evenly throughout the day (approximately every 8 hours)
• Other oral medications should be taken at least 2 hours before or 2 hours after Lokelma 1

Maintenance Phase

• After achieving normal potassium levels: Switch to once daily dosing 2, 1
• Starting maintenance dose: 5g once daily 2
• Dose adjustment range: 5g every other day to 15g once daily 1
• Titration: Adjust dose based on serum potassium levels at intervals of 1 week or longer, in increments of 5g 1

Special Considerations

For Patients on Hemodialysis

• Administer only on non-dialysis days 1
• Starting dose: 5g once daily on non-dialysis days 1
• For patients with serum potassium >6.5 mEq/L: Consider 10g once daily on non-dialysis days 1

Administration Instructions

1. Empty entire contents of packet(s) into a drinking glass with approximately 3 tablespoons of water or more
2. Stir well and drink immediately
3. If powder remains, add more water, stir and drink until no powder remains 1

Monitoring and Dose Adjustments

• Check serum potassium within 2-4 hours after initial treatment 2
• Recheck within 1 week of any dose adjustment 2
• Regular monitoring based on risk factors and comorbidities 2
• Target: Maintain mean serum potassium at approximately 4.5 mEq/L with 10g daily 2

Clinical Efficacy Timeline

• Onset of action: Within 1 hour 2, 3
• Normalization of potassium: 84% of patients within 24 hours, 98% within 48 hours 2, 4
• Maintenance efficacy: Sustained for up to 12 months 2, 5

Common Pitfalls and Caveats

• Drug interactions: Space other oral medications at least 2 hours before or after Lokelma 1
• Edema risk: Each 5g dose contains approximately 400mg of sodium; monitor for signs of edema, particularly in patients who should restrict sodium intake 1
• Contraindications: Avoid use in patients with severe constipation, bowel obstruction or impaction 2, 1
• Hypokalemia risk: 10% of patients on 10g daily and 11% on 15g daily may experience hypokalemia 2
• Not for emergency use: Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 1

By following these dosing intervals and monitoring recommendations, Lokelma can effectively manage hyperkalemia while minimizing adverse effects and optimizing patient outcomes.