Can I administer another 5g dose of Lokelma (sodium zirconium cyclosilicate) at midnight for hyperkalemia if I already gave 5g at 2200?

Lokelma Dosing for Hyperkalemia

Yes, you can administer another 5g dose of Lokelma at midnight after giving 5g at 2200 for hyperkalemia, as this aligns with the recommended initial treatment protocol of 10g three times daily for up to 48 hours. 1

Initial Treatment Protocol

• The FDA-approved dosing for initial treatment of hyperkalemia with Lokelma (sodium zirconium cyclosilicate) is 10g administered three times daily for up to 48 hours 1
• Administering 5g at 2200 and another 5g at midnight would constitute a partial dose of the recommended initial treatment protocol 1
• Sodium zirconium cyclosilicate begins working within 1 hour of administration by preferentially exchanging hydrogen and sodium for potassium ions in both the small and large intestines 2, 3

Expected Potassium Reduction

• The standard initial treatment protocol of 10g three times daily consistently demonstrates a mean serum potassium reduction of 1.1 mEq/L within 48 hours 2, 4
• In clinical trials, 84% of patients achieved normal potassium levels by 24 hours and 98% by 48 hours with the recommended dosing 4
• The median time to normalization of potassium levels was 2.2 hours in clinical studies 4

Monitoring Recommendations

• Monitor serum potassium levels to adjust subsequent dosing based on the patient's response 1
• After the initial treatment phase, transition to a maintenance dose of 10g once daily, which can be adjusted based on serum potassium levels 1
• The recommended maintenance dose range is from 5g every other day to 15g daily 1

Important Considerations

• Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action (though still relatively rapid compared to other potassium binders) 1
• Each 5g dose contains approximately 400mg of sodium, so monitor for signs of edema, particularly in patients who should restrict sodium intake or are prone to fluid overload 1
• Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma to avoid potential interactions 1

Administration Instructions

• Empty the entire contents of the packet into a drinking glass containing approximately 3 tablespoons of water or more if desired 1
• Stir well and drink immediately 1
• If powder remains in the glass, add more water, stir and drink immediately; repeat until no powder remains to ensure the entire dose is taken 1

Long-term Safety and Efficacy

• Long-term studies have shown that Lokelma maintains normokalaemia for up to 11 months during ongoing treatment 5
• The medication is effective regardless of chronic kidney disease stage, with similar efficacy observed in patients with mild/moderate versus severe/end-stage CKD 6