Initial Lokelma Dosing for Severe Hyperkalemia (K+ 6.9)
For a potassium level of 6.9 mEq/L, the recommended initial dose of Lokelma (sodium zirconium cyclosilicate) is 10 g administered three times daily for up to 48 hours. 1
Acute Management of Severe Hyperkalemia
- Lokelma 10 g three times daily is the FDA-approved initial dosing regimen for hyperkalemia, including severe cases like 6.9 mEq/L 1
- This dosing regimen can effectively reduce serum potassium levels to the normal range (3.5-5.0 mEq/L) within 48 hours 2
- In clinical trials, the median time to normalization of potassium was 2.2 hours, with 84% of patients achieving normokalemia by 24 hours and 98% by 48 hours 2
- For severe hyperkalemia (≥6.0 mEq/L), significant reductions in serum potassium levels were observed within 1 hour of a single 10 g dose 3
Administration Instructions
- Empty the entire contents of the packet(s) 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 1
- Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma 1
Important Considerations and Monitoring
- Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action compared to other emergency interventions 1
- For patients with severe hyperkalemia (K+ 6.9), consider additional acute interventions alongside Lokelma, such as insulin plus glucose, which may provide more rapid potassium lowering 3
- Monitor serum potassium levels closely during the initial treatment phase, ideally within the first few hours of administration and then daily until stabilized 3
- After the initial correction phase, transition to maintenance dosing based on serum potassium levels 1
Maintenance Dosing
- After the initial 48-hour treatment period, the recommended maintenance dose is 10 g once daily 1
- Adjust the dose based on serum potassium levels and desired target range 1
- The maintenance dose can range from 5 g every other day to 15 g daily 1
- Dose adjustments should be made at intervals of 1 week or longer and in increments of 5 g 1
Potential Side Effects and Precautions
- Monitor for edema, particularly in patients who should restrict sodium intake or are prone to fluid overload, as each 5 g dose contains approximately 400 mg of sodium 1
- The most common adverse events are hypokalemia and dose-dependent edema, with edema being more common at higher doses (14% of patients at 15 g daily) 2
- Avoid use in patients with severe constipation, bowel obstruction or impaction 1
- For patients on chronic hemodialysis, administer only on non-dialysis days 1
Efficacy and Safety Profile
- In clinical trials, Lokelma demonstrated consistent efficacy across all patient subgroups, including those with chronic kidney disease, diabetes, heart failure, and those on RAAS inhibitor therapy 4
- Long-term studies have shown that Lokelma can maintain normal potassium levels for up to 12 months 5
- The safety profile remains consistent over long-term use (up to 12 months) 4