Lokelma (Sodium Zirconium Cyclosilicate) Dosing for CKD Stage 3 Patient with Potassium of 6 mEq/L
For a patient with CKD stage 3 and a potassium level of 6 mEq/L, the recommended dose of Lokelma is 10 g three times daily for up to 48 hours for initial treatment, followed by 10 g once daily for maintenance therapy, with dose adjustments based on serum potassium monitoring. 1, 2
Initial Treatment Phase
- For severe hyperkalemia (K+ >6.0 mEq/L), Lokelma should be administered at 10 g three times daily for up to 48 hours to rapidly reduce serum potassium levels 1, 2
- This initial treatment protocol consistently demonstrates a mean reduction of 1.1 mEq/L in serum potassium within 48 hours 2
- Onset of action begins within 1 hour of administration, making it faster-acting than other potassium binders 2, 3
- Lokelma works by preferentially exchanging hydrogen and sodium for potassium ions in the gastrointestinal tract, increasing fecal potassium excretion 3
Maintenance Treatment Phase
- After the initial 48-hour treatment, transition to a maintenance dose of 10 g once daily 1, 2
- Monitor serum potassium regularly and adjust the dose based on the serum potassium level and desired target range 1
- The recommended maintenance dose range is from 5 g every other day to 15 g daily, depending on serum potassium levels 1
- Dose adjustments should be made at intervals of 1 week or longer and in increments of 5 g 1
Monitoring and Follow-up
- Check serum potassium within 1 week of initiating treatment or after any dose adjustment 4
- Continue monitoring potassium levels at regular intervals (recommended at 3 days, 1 week, and monthly for the first 3 months) 4
- Decrease the dose or discontinue Lokelma if serum potassium falls below the desired target range 1
Administration Instructions
- Administer Lokelma as a suspension in water 1
- 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; 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
Special Considerations for CKD Patients
- Lokelma has been shown to be effective and safe in patients with advanced CKD, with similar efficacy across all CKD stages 5
- In clinical trials, 82% of patients with eGFR <30 mL/min/1.73 m² achieved normokalaemia within 24 hours, and 100% within 72 hours 5
- Monitor for signs of edema, as each 5 g dose of Lokelma contains approximately 400 mg of sodium 1
- Unlike some other medications used in CKD, Lokelma does not require dose adjustment specifically for CKD stage 3 1, 5
Potential Adverse Effects
- The most common adverse effect is mild to moderate edema, particularly with higher doses (15 g daily) 2
- Avoid use in patients with severe constipation, bowel obstruction or impaction 1
- The incidence of hypokalemia with Lokelma is generally low when properly dosed and monitored 3
By following these dosing recommendations and monitoring protocols, Lokelma can effectively manage hyperkalemia in patients with CKD stage 3 while maintaining safety and efficacy.