What is the recommended dosing for Lokelma (sodium zirconium cyclosilicate) in patients with impaired renal function (renal failure)?

Lokelma (Sodium Zirconium Cyclosilicate) Dosing in Renal Failure

For patients with renal failure, Lokelma does not require dose adjustment as it is not systemically absorbed, with specific dosing recommendations for patients on hemodialysis. 1

Standard Dosing

• Initial treatment: 10 g three times daily for up to 48 hours 1
• Maintenance treatment: 10 g once daily, with adjustment based on serum potassium levels 1
• Maintenance dose range: 5 g every other day to 15 g daily 1

Dosing in Chronic Hemodialysis Patients

• Administer Lokelma ONLY on non-dialysis days 1
• Starting dose: 5 g once daily on non-dialysis days 1
• For patients with serum potassium >6.5 mEq/L, consider starting at 10 g once daily on non-dialysis days 1
• Maintenance dose range: 5-15 g once daily on non-dialysis days 1
• Monitor serum potassium and adjust dose based on pre-dialysis serum potassium value after the long inter-dialytic interval 1

Monitoring and Dose Adjustment

• After initiating therapy or adjusting dose, assess serum potassium after one week 1
• Decrease dose or discontinue if:
  • Serum potassium falls below desired target range based on pre-dialysis value after long interdialytic interval 1
  • Patient develops clinically significant hypokalemia 1

Administration Instructions

• Empty packet contents into a glass with approximately 3 tablespoons of water 1
• Stir well and drink immediately 1
• 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 1

Special Considerations

• Each 5 g dose contains approximately 400 mg of sodium; monitor for edema, particularly in patients who should restrict sodium intake or are prone to fluid overload 1
• Avoid use in patients with severe constipation, bowel obstruction or impaction, as Lokelma may worsen gastrointestinal conditions 1
• Lokelma is not recommended for emergency treatment of life-threatening hyperkalemia due to its delayed onset of action 1

Efficacy and Safety

• Lokelma effectively lowers serum potassium levels to normal range (3.5-5.0 mmol/L) during the first 48 hours of treatment 2
• Beneficial effects are consistent across patient subgroups, including those with chronic kidney disease 2
• Generally well-tolerated with a safety profile similar to placebo over treatment periods up to 28 days 2
• Long-term studies (up to 12 months) show consistent safety profile 2

Unlike many medications that require dose adjustments in renal impairment due to altered pharmacokinetics 3, Lokelma works locally in the gastrointestinal tract and is not systemically absorbed, making it safe to use in patients with renal failure without dose adjustment except in the specific case of hemodialysis patients 1, 2.