Lokelma (Sodium Zirconium Cyclosilicate) Treatment Protocol for Hyperkalemia
For the treatment of hyperkalemia, Lokelma should be administered at 10g three times daily for 48 hours for initial correction, followed by maintenance dosing of 10g once daily, adjustable between 5-15g based on serum potassium levels. 1, 2
Initial Correction Phase
- Administer 10g of Lokelma three times daily for up to 48 hours 3, 2
- Onset of action begins within 1 hour of administration, particularly beneficial in severe hyperkalemia (≥6.0 mEq/L) 3, 1
- Mean reduction in serum potassium of approximately 1.1 mEq/L can be expected within 48 hours 3, 4
- In clinical trials, 84% of patients achieved normal potassium levels within 24 hours and 98% within 48 hours 4
- Median time to normalization (≤5.5 mEq/L) is approximately 2 hours 5
Maintenance Phase
- After initial correction, transition to 10g once daily for maintenance therapy 3, 2
- Adjust dose at one-week intervals as needed (by 5g daily) to maintain desired serum potassium target range 2
- Available maintenance doses: 5g, 10g, or 15g once daily 3, 1
- Efficacy of maintenance dosing:
- 5g daily: 80% of patients maintain normal potassium levels
- 10g daily: 90% of patients maintain normal potassium levels
- 15g daily: 94% of patients maintain normal potassium levels 4
Special Populations
- For patients on chronic hemodialysis:
Administration Instructions
- Administer as an oral suspension by mixing the powder with water 2
- Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma to avoid potential drug interactions 2
Monitoring
- Monitor serum potassium levels regularly during both correction and maintenance phases 3
- Pay particular attention to potassium levels when adjusting doses 2
- Watch for hypokalemia, which occurred in 10-11% of patients receiving 10-15g daily doses in clinical trials 4
Important Limitations and Precautions
- Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action (although effects begin within 1 hour, complete normalization takes longer) 2
- Most common adverse effect is mild to moderate edema, particularly with higher doses (14% incidence with 15g daily) 3, 4
- Lokelma has radio-opaque properties and may appear as an imaging agent during abdominal X-ray procedures 2
Advantages Over Other Potassium Binders
- Highly selective for potassium compared to older binders like sodium polystyrene sulfonate 3
- Faster onset of action (1 hour) compared to patiromer (7 hours) 3
- No serious adverse events reported in clinical trials, unlike sodium polystyrene sulfonate which has been associated with intestinal necrosis 3, 6
- Can be used for both acute correction and long-term maintenance of hyperkalemia 7