Can Lokelma (sodium zirconium cyclosilicate) be administered through a Nasogastric (NG) tube?

Can Lokelma Be Administered Through an NG Tube?

Yes, Lokelma (sodium zirconium cyclosilicate) can be administered through a nasogastric tube, as it is formulated as a powder for oral suspension in water, making it suitable for enteral tube delivery when proper administration techniques are followed.

Formulation Compatibility

• Lokelma is available as a powder that must be suspended in water before administration, which makes it physically compatible with NG tube delivery 1
• The medication should be prepared as a suspension immediately before administration to ensure proper drug delivery 1

Administration Protocol

Follow these specific steps when administering Lokelma through an NG tube:

• Flush the NG tube with 30 mL of water before administering the medication 2
• Mix the Lokelma powder with water according to package instructions to create a uniform suspension
• Administer the suspension through the tube using appropriate ENFit connectors (ISO 80369-3 standard) to prevent misconnection errors 2, 3
• Flush the tube with 30 mL of water after administration to ensure complete drug delivery and prevent tube occlusion 2
• Do not shake low-dose ENFit tip syringes to remove drug moat, as this can alter dosing accuracy 3

Critical Timing Considerations

• Administer Lokelma separately from other medications—do not mix with other drugs before administration due to risk of drug-drug interactions 2
• Hold enteral feeding and administer Lokelma apart from enteral formula, as the site of drug delivery (gastric versus duodenal) can affect drug availability 2
• Confirm tube position is in the stomach rather than post-pyloric, as gastric administration permits better tolerance of the suspension 2

Important Caveats

• Consult pharmacy to confirm compatibility with your specific tube material (polyurethane versus silicone) and enteral formula, as some medications can bind to tube materials 2
• Monitor for tube occlusion, particularly with fine-bore (5-8 French gauge) NG tubes, though most suspensions can be administered through these tubes 2
• Be aware that Lokelma is radiopaque on CT imaging, which may be mistaken for contrast material or other radiopaque substances 4

Monitoring Requirements

• Verify NG tube position using pH testing prior to each use 2
• Monitor serum potassium levels at least 4 hours after administration to assess efficacy 5
• Watch for electrolyte abnormalities, particularly in patients with severe CKD (eGFR <30 mL/min/1.73 m²) 6