Lokelma (Sodium Zirconium Cyclosilicate) for Hyperkalemia Management
Lokelma (sodium zirconium cyclosilicate) is a non-absorbed potassium binder specifically designed to treat hyperkalemia by selectively capturing potassium ions in the gastrointestinal tract, thereby increasing fecal potassium excretion and lowering serum potassium levels. 1
Mechanism of Action
- Acts as a selective potassium binder in the gastrointestinal tract
- Preferentially exchanges hydrogen and sodium for potassium ions 1
- Increases fecal potassium excretion, reducing free potassium concentration in the GI tract
- Not systemically absorbed - works locally in the intestines 1
Clinical Indications
Lokelma is indicated for:
- Treatment of acute hyperkalemia (serum K+ >5.0 or >5.5 mEq/L) 2
- Maintenance of normal potassium levels in patients with chronic hyperkalemia 2
- Management of hyperkalemia in patients with:
- Chronic kidney disease (CKD)
- Heart failure (HF)
- Diabetes
- Patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi) 2
Dosing and Administration
- Acute hyperkalemia: 10g three times daily for up to 48 hours 2
- Maintenance therapy: 5-10g once daily 2
- Administered as a powder for oral suspension in water 2
- Onset of action: 1 hour (much faster than other potassium binders) 3
Clinical Efficacy
- Reduces serum K+ levels within 1 hour of administration 2
- In emergency settings, provides significant K+ reduction within 2 hours when combined with insulin and glucose 4
- Achieves normalization of potassium levels (3.5-5.0 mmol/L) within 48 hours in most patients 2
- Maintains normal potassium levels during long-term therapy (up to 12 months) 5
- Effective across all patient subgroups, including those with severe CKD 6
Advantages Over Other Potassium Binders
- Faster onset of action (1 hour) compared to patiromer (7 hours) 3
- More predictable potassium lowering compared to sodium polystyrene sulfonate (SPS) 7
- Better gastrointestinal tolerability profile than SPS 7
- Can be used for both acute and chronic hyperkalemia management 2
Safety Considerations
- Generally well-tolerated with a safety profile similar to placebo in short-term studies 2
- Most common adverse effects:
- Hypokalemia (dose-dependent)
- Edema (dose-dependent) 2
- Contains sodium (400mg per 5g dose) - consider in patients with heart failure or fluid restrictions 3
- Causes small dose-dependent increases in serum bicarbonate (1.1-2.6 mmol/L) 1
- No serious adverse events reported in randomized trials 2
Drug Interactions
- May affect absorption of co-administered medications
- Separate administration from other oral medications by at least 2 hours 1
- Potential for increased systemic exposure to weak acids (e.g., furosemide, atorvastatin)
- Potential for decreased systemic exposure to weak bases (e.g., dabigatran) 1
Clinical Pearls
- Monitoring serum potassium should be individualized based on risk factors
- More frequent monitoring recommended for patients with CKD, diabetes, heart failure, history of hyperkalemia, and those on RAASi therapy 3
- May allow optimization of RAASi therapy in patients who would otherwise require dose reduction or discontinuation 2
- Consider Lokelma as an alternative to SPS for acute hyperkalemia management in hospitalized patients 7
Lokelma represents an important advancement in hyperkalemia management, offering rapid onset of action with good tolerability, making it suitable for both acute and chronic hyperkalemia treatment across various patient populations.