Lokelma Potassium Reduction: Expected Magnitude
Lokelma 10 g three times daily for 48 hours reduces serum potassium by approximately 1.1 mEq/L, with the average patient achieving a reduction from 5.6 mEq/L to 4.5 mEq/L. 1, 2
Acute Phase Reduction (First 48 Hours)
The magnitude of potassium reduction with Lokelma demonstrates clear dose-dependent effects during the initial treatment phase:
- 10 g three times daily: Mean reduction of 0.7-1.1 mEq/L at 48 hours 1, 2, 3
- 5 g three times daily: Mean reduction of 0.5 mEq/L at 48 hours 2, 3
- 2.5 g three times daily: Mean reduction of 0.5 mEq/L at 48 hours 2, 3
The response is greater in patients with higher baseline potassium levels. Patients starting with potassium >5.5 mEq/L experienced reductions of 1.1 mEq/L (from baseline to 48 hours) with the 10 g three times daily regimen. 2
Time Course of Action
Lokelma begins working within 1 hour of administration, which is significantly faster than alternative potassium binders like patiromer (7 hours). 1, 4
- Median time to normalization: 2.2 hours 5
- 84% of patients achieve normalization by 24 hours 5
- 98% achieve normalization by 48 hours 5
Maintenance Phase Reduction (Beyond 48 Hours)
Once daily maintenance dosing sustains potassium reduction over extended periods:
- 5 g once daily: Maintains mean potassium at 4.8 mEq/L (vs 5.1 mEq/L with placebo) 2, 5
- 10 g once daily: Maintains mean potassium at 4.5 mEq/L (vs 5.1 mEq/L with placebo) 2, 5
- 15 g once daily: Maintains mean potassium at 4.4 mEq/L (vs 5.1 mEq/L with placebo) 2, 5
90% of patients maintained normokalemia (3.5-5.0 mEq/L) on 10 g daily dosing over 28 days. 1, 5
Dose-Response Relationship
The exponential rate of change in serum potassium at 48 hours follows a clear dose-dependent pattern:
- 1.25 g three times daily: 0.11% reduction 1
- 2.5 g three times daily: 0.16% reduction 1
- 5 g three times daily: 0.21% reduction 1
- 10 g three times daily: 0.30% reduction (most effective studied dose) 1
Special Populations
In hemodialysis patients with persistent pre-dialysis hyperkalemia (mean baseline 5.8 mEq/L), Lokelma 5-15 g once daily on non-dialysis days achieved target pre-dialysis potassium of 4.0-5.0 mEq/L in 41% of patients versus 1% with placebo. 2
In patients with severe/end-stage CKD (eGFR <30 mL/min/1.73 m²), 82% achieved normalization within 24 hours during the acute phase, and 82% maintained normalization at Day 365 during maintenance therapy. 6
Clinical Considerations
Monitor for hypokalemia, particularly with higher doses. In clinical trials, hypokalemia developed in 10% of patients on 10 g daily and 11% on 15 g daily during maintenance therapy, versus none in the 5 g or placebo groups. 5
Edema risk increases with dose: 6% with 10 g daily versus 14% with 15 g daily, compared to 2% with placebo. 1, 5 Each 5 g dose contains approximately 400 mg of sodium. 1
The treatment effect is sustained long-term, with efficacy maintained for up to 12 months in open-label extension studies. 2, 7