What is the treatment regimen for hyperkalemia using Lokelma (sodium zirconium cyclosilicate)?

Lokelma Treatment Regimen for Hyperkalemia

For hyperkalemia treatment, start Lokelma 10 g three times daily for up to 48 hours, then transition to 10 g once daily for maintenance, adjusting by 5 g increments weekly to maintain potassium between 3.5-5.0 mEq/L. 1

Initial Treatment Phase (Correction Phase)

Dosing Protocol:

• Administer 10 g orally three times daily for up to 48 hours 2, 1
• Onset of action begins within 1 hour of the first dose 2, 3
• Median time to potassium normalization is 2.2 hours 4
• 84% of patients achieve normokalemia (3.5-5.0 mEq/L) within 24 hours 4
• 98% achieve normokalemia within 48 hours 4

Expected Potassium Reduction:

• Mean serum potassium reduction of 1.1 mEq/L with the standard 10 g three times daily protocol 2, 3
• In clinical trials, potassium decreased from 5.6 mEq/L at baseline to 4.5 mEq/L at 48 hours 2, 4
• Dose-dependent response with exponential rate of change: 0.30% reduction with 10 g dosing 2

Maintenance Treatment Phase

Standard Maintenance Dosing:

• Recommended starting dose: 10 g once daily 2, 1
• Adjust dose at one-week intervals by 5 g increments (5 g, 10 g, or 15 g daily) based on serum potassium levels 1
• Target serum potassium range: 3.5-5.0 mEq/L 2, 3

Efficacy Data:

• 90% of patients maintained normokalemia on 10 g daily dosing over 28 days 2
• All three maintenance doses (5 g, 10 g, 15 g) effectively maintained normal potassium levels for up to 28 days 2, 3
• Mean potassium levels during days 8-29: 4.8 mEq/L (5 g), 4.5 mEq/L (10 g), and 4.4 mEq/L (15 g) 4

Special Population: Chronic Hemodialysis Patients

• Recommended starting dose: 5 g once daily on non-dialysis days 1
• Monitor closely for hypokalemia 1

Administration Instructions

Timing Considerations:

• Administer other oral medications at least 2 hours before or 2 hours after Lokelma to avoid drug interactions 1
• Lokelma works in both the small and large intestines, contributing to its faster onset compared to other potassium binders 2

Monitoring Protocol

Potassium Monitoring:

• Regular monitoring of serum potassium is essential to avoid hypokalemia and guide dose adjustments 2, 3
• Greater reductions typically occur in patients with higher baseline potassium levels 2
• Check potassium levels before transitioning from correction to maintenance phase 4

Adverse Effects and Safety

Common Side Effects:

• Mild to moderate edema is the most common adverse effect 2, 3
• Edema incidence: 6% with 10 g daily, 14% with 15 g daily 2, 4
• Hypokalemia occurred in 10% of patients on 10 g and 11% on 15 g during long-term treatment 4

Gastrointestinal Considerations:

• Avoid use in patients with severe gastrointestinal motility disorders 1
• More favorable side effect profile than sodium polystyrene sulfonate (SPS), which has been associated with serious gastrointestinal adverse events 2

Important Clinical Context

Advantages Over Other Potassium Binders:

• Faster onset of action (1 hour) compared to patiromer (7 hours) 2, 3
• More selective for potassium than SPS and patiromer 2
• Works throughout the entire gastrointestinal tract 2, 5

Critical Limitation:

• Do not use Lokelma as emergency treatment for life-threatening hyperkalemia due to delayed onset of action 1
• For severe hyperkalemia with ECG changes, use standard emergency treatments (calcium, insulin/glucose, beta-agonists) first 1

RAAS Inhibitor Management:

• Do not discontinue cardioprotective RAAS inhibitors; manage hyperkalemia with Lokelma while maintaining therapy 2
• Lokelma enables optimization of RAAS inhibitor therapy in patients who would otherwise require dose reduction or discontinuation 2, 6

Radiology Consideration

• Lokelma has radio-opaque properties and may appear as an imaging agent during abdominal X-ray procedures 1