What is the typical dosage of Lokelma (sodium zirconium cyclosilicate) for treating hyperkalemia, is it 10 milligrams (mg) or 10 grams (gm)?

Lokelma Dosing: 10 Grams, Not Milligrams

Lokelma (sodium zirconium cyclosilicate) is dosed in grams, not milligrams—the typical initial dose is 10 grams (10 g), which equals 10,000 milligrams. 1

Standard Dosing Regimen

Initial Treatment Phase

• For acute hyperkalemia treatment: 10 g administered three times daily for up to 48 hours 1
• This dosing achieves a mean serum potassium reduction of approximately 1.1 mEq/L within 48 hours 2
• Onset of action begins within 1 hour, with 84% of patients achieving normokalemia by 24 hours and 98% by 48 hours 3

Maintenance Treatment Phase

• After initial correction: 10 g once daily is the recommended maintenance dose 1
• The maintenance dose range is 5 g every other day to 15 g daily, adjusted based on serum potassium monitoring 1
• In clinical trials, 90% of patients maintained normokalemia on 10 g daily dosing over 28 days 2

Critical Dosing Considerations

Available Formulations

• Lokelma comes as 5 g or 10 g powder packets for oral suspension 1
• Each 5 g dose contains approximately 400 mg of sodium 1
• The powder must be mixed with approximately 3 tablespoons of water before administration 1

Special Populations

For patients on chronic hemodialysis: 1

• Administer only on non-dialysis days
• Starting dose: 5 g once daily on non-dialysis days
• Consider 10 g once daily if serum potassium >6.5 mEq/L
• Dose range: 5-15 g once daily on non-dialysis days

Common Pitfalls to Avoid

Dosing Errors

• Never confuse grams with milligrams—10 mg would be a 1000-fold underdose and completely ineffective 1
• Do not use Lokelma as emergency treatment for life-threatening hyperkalemia due to delayed onset compared to insulin/glucose or calcium 1

Drug Interactions

• Administer other oral medications at least 2 hours before or 2 hours after Lokelma to avoid binding interactions 1

Monitoring Requirements

• Monitor serum potassium regularly during treatment to avoid hypokalemia 1
• In the HARMONIZE trial, hypokalemia developed in 10% of patients on 10 g and 11% on 15 g, versus none on placebo 3
• Watch for edema, particularly with higher doses (14% incidence with 15 g daily versus 6% with 10 g daily) 3

Dose-Response Relationship

The efficacy is clearly dose-dependent: 4

• 1.25 g: 0.11% exponential rate of potassium change
• 2.5 g: 0.16% rate of change
• 5 g: 0.21% rate of change
• 10 g: 0.30% rate of change (most effective studied dose)

Contraindications and Precautions

• Avoid in patients with severe constipation, bowel obstruction, or impaction 1
• Monitor for edema in patients who should restrict sodium intake or are prone to fluid overload 1
• Each 5 g dose contains ~400 mg sodium, though extent of absorption is unknown 1