What is the recommended dose and frequency of Lokelma (sodium zirconium cyclosilicate) for treating hyperkalemia?

Lokelma (Sodium Zirconium Cyclosilicate) Dosing for Hyperkalemia

For the treatment of hyperkalemia, Lokelma (sodium zirconium cyclosilicate) should be dosed at 10 g three times daily for up to 48 hours for initial correction, followed by a maintenance dose of 10 g once daily, with adjustments based on serum potassium levels.1

Initial Treatment Phase (Correction)

• For acute correction of hyperkalemia, administer 10 g three times daily for up to 48 hours 1
• This dosing regimen has been shown to effectively reduce serum potassium levels within 48 hours, with a mean reduction of 1.1 mEq/L in patients with hyperkalemia 2
• In clinical trials, 84% of patients achieved normal potassium levels within 24 hours, and 98% within 48 hours using this regimen 3
• Onset of action begins within 1 hour of administration for patients with severe hyperkalemia (≥6.0 mEq/L) 2

Maintenance Treatment Phase

• After initial correction, the recommended maintenance dose is 10 g once daily 1
• Dose adjustments should be made based on serum potassium monitoring, with titration at intervals of 1 week or longer 1
• Dose may be adjusted in 5 g increments up to 15 g daily or down to 5 g every other day 1
• The maintenance dose range is 5 g every other day to 15 g daily 1
• Clinical trials showed that maintenance doses of 5 g, 10 g, and 15 g once daily effectively maintained normal potassium levels (3.5-5.0 mEq/L) for up to 28 days 2

Special Population: Hemodialysis Patients

• For patients on chronic hemodialysis, administer Lokelma only on non-dialysis days 1
• The recommended starting dose is 5 g once daily on non-dialysis days 1
• Consider a higher starting dose of 10 g once daily on non-dialysis days for patients with serum potassium >6.5 mEq/L 1
• Maintenance dose range for hemodialysis patients is 5-15 g once daily on non-dialysis days 1
• Monitor pre-dialysis serum potassium after the long interdialytic interval 1

Administration Instructions

• Empty the entire contents of the packet(s) into a glass containing approximately 3 tablespoons of water or more 1
• Stir well and drink immediately 1
• If powder remains in the glass, add more water, stir and drink immediately 1
• Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma to avoid potential drug interactions 1

Monitoring and Dose Adjustments

• Monitor serum potassium regularly to guide dose adjustments 1
• Decrease dose or discontinue if serum potassium falls below the desired target range 1
• During maintenance treatment, up-titrate based on serum potassium levels at intervals of 1 week or longer in increments of 5 g 1
• For hemodialysis patients, assess serum potassium one week after initiation or dose adjustment 1

Common Side Effects and Precautions

• The most common adverse effect is mild to moderate edema, particularly with higher doses (15 g daily) 2, 3
• Each 5 g dose contains approximately 400 mg of sodium, which may contribute to edema 1
• Monitor for signs of edema, especially in patients who should restrict sodium intake or are prone to fluid overload 1
• Hypokalemia may occur, particularly with higher doses (10-15 g) 3
• Avoid use in patients with severe constipation, bowel obstruction, or impaction 1

Lokelma has demonstrated consistent efficacy across various patient subgroups, including those with chronic kidney disease, diabetes, heart failure, and those receiving renin-angiotensin-aldosterone system inhibitor therapy 4, 5.