What is the typical dosing frequency of Lokelma (sodium zirconium cyclosilicate) for treating hyperkalemia?

Lokelma (Sodium Zirconium Cyclosilicate) Dosing Frequency for Hyperkalemia

For hyperkalemia treatment, Lokelma (sodium zirconium cyclosilicate) is dosed at 10g three times daily for initial correction (up to 48 hours), followed by maintenance dosing of 5g every other day to 15g once daily based on serum potassium levels. 1

Initial Treatment Phase

• For acute hyperkalemia correction, administer 10g three times daily for up to 48 hours 1
• Onset of action begins within 1 hour, making it faster than other potassium binders like patiromer (7 hours) 2, 3
• In clinical trials, this initial dosing regimen consistently demonstrated a mean reduction of 1.1 mEq/L in serum potassium 3, 4
• 84% of patients achieve normokalemia (3.5-5.0 mEq/L) within 24 hours and 98% within 48 hours of starting treatment 4

Maintenance Treatment Phase

• After initial correction, transition to a maintenance dose of 10g once daily 1
• Monitor serum potassium regularly and adjust the dose based on levels and desired target range 1
• The FDA-approved maintenance dose range is 5g every other day to 15g once daily 1
• Dose adjustments should be made at intervals of 1 week or longer, in increments of 5g 1
• Clinical trials showed that maintenance doses of 5g, 10g, and 15g once daily effectively maintained normal potassium levels for up to 28 days 3, 4

Special Population: Hemodialysis Patients

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

Administration Instructions

• Empty the entire contents of the packet(s) into a drinking glass containing approximately 3 tablespoons of water 1
• Stir well and drink immediately; if powder remains, add more water, stir and drink until no powder remains 1
• Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma to avoid potential interactions 1

Monitoring and Dose Adjustments

• Decrease the dose or discontinue if serum potassium falls below the desired target range 1
• Monitor for signs of edema, particularly in patients who should restrict sodium intake (each 5g dose contains approximately 400mg of sodium) 1
• The incidence of hypokalemia is low but increases with higher doses (10% with 10g daily and 11% with 15g daily) 4

Advantages Over Other Potassium Binders

• Lokelma is highly selective for potassium compared to other binders like sodium polystyrene sulfonate (SPS) 2, 3
• It works in both small and large intestines, contributing to its faster onset of action (1 hour) 3, 5
• Has a more favorable side effect profile than SPS, which has been associated with serious gastrointestinal adverse events 2

Lokelma's dosing frequency should be guided by the phase of treatment (initial correction vs. maintenance) and regular monitoring of serum potassium levels to ensure effective and safe management of hyperkalemia.