Lokelma (Sodium Zirconium Cyclosilicate) Treatment Regimen for Hyperkalemia
The recommended treatment regimen for hyperkalemia using Lokelma is 10g three times daily for up to 48 hours for initial correction, followed by a maintenance dose of 10g once daily, with dose adjustments of 5g increments as needed to maintain normal potassium levels. 1
Initial Treatment Phase (Acute Correction)
- Start with 10g administered three times daily for up to 48 hours to rapidly correct hyperkalemia 1, 2
- Onset of action begins within 1 hour of administration, making it suitable for relatively rapid potassium reduction 2, 3
- In clinical trials, this regimen consistently demonstrated a mean reduction of 1.1 mEq/L in serum potassium within 48 hours 2, 4
- Median time to normalization is approximately 2.2 hours, with 84% of patients achieving normokalemia by 24 hours and 98% by 48 hours 4
Maintenance Treatment Phase
- After achieving normokalemia, transition to 10g once daily for maintenance therapy 1, 2
- Adjust dose at one-week intervals as needed (by 5g daily) to obtain desired serum potassium target range 1
- Maintenance doses of 5g, 10g, and 15g once daily have been shown to effectively maintain normal potassium levels (3.5-5.0 mEq/L) for up to 28 days 2, 4
- In long-term studies, Lokelma has demonstrated efficacy in maintaining normokalemia for up to 12 months 5
Special Populations: Patients on Chronic Hemodialysis
- For patients on chronic hemodialysis, the recommended starting dose is 5g once daily on non-dialysis days 1
- Monitor these patients closely for hypokalemia, as they are at higher risk 1
Administration Instructions
- Lokelma should be mixed with approximately 3 tablespoons of water and stirred well 1
- The powder will not dissolve and the mixture will look cloudy 1
- Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma to avoid potential drug interactions 1
Monitoring and Dose Adjustments
- Regular monitoring of serum potassium is essential to guide dose adjustments and avoid hypokalemia 3
- Dose-dependent response has been demonstrated with increasing effectiveness at higher doses 2, 3
- Greater potassium reductions are typically seen in patients with higher initial potassium levels 2
Important Precautions
- Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action (although faster than other binders, it's still not immediate) 1
- Monitor for edema, particularly with higher doses (15g daily), as it is the most common adverse effect 2, 4
- Be aware that Lokelma has radio-opaque properties and may give the appearance typical of an imaging agent during abdominal X-ray procedures 1, 6
- Monitor for hypokalemia, especially in patients on higher doses (10g and 15g) 4
Advantages Over Other Potassium Binders
- Lokelma is more selective for potassium than other binders like sodium polystyrene sulfonate (SPS) 2, 7
- It has a faster onset of action (1 hour) compared to patiromer (7 hours) 2, 3
- Works in both small and large intestines, contributing to its faster onset of action 2, 7
- Has a more favorable side effect profile than SPS, which has been associated with serious gastrointestinal adverse events 2, 7