What is the best way to administer Lokelma (sodium zirconium cyclosilicate) to a patient who is Nothing Per Oral (NPO)?

Administration of Lokelma in NPO Patients

Lokelma cannot be administered to patients who are NPO, as it is only available as an oral powder for suspension in water and must be given by mouth or via enteral feeding tube. 1

Key Administration Requirements

• Lokelma is formulated exclusively as a powder for oral suspension that must be mixed with water before administration 1
• The medication works by exchanging potassium for hydrogen and sodium ions in the gastrointestinal tract, requiring passage through the GI system to be effective 1, 2
• No alternative routes of administration (intravenous, rectal, or intramuscular) exist for this medication 1

Management Options for NPO Patients

If the patient has a feeding tube in place:

• Lokelma can be administered via nasogastric (NG) or nasoenteral tube after mixing the powder with water to create a suspension 3
• This approach is supported by general principles for medication administration in NPO patients where alternate routes such as enteral tubes are appropriate when oral intake is contraindicated 3
• Ensure the tube is properly positioned and functioning before administration 3

If the patient cannot receive enteral medications:

• Hold Lokelma until the patient can safely swallow or has enteral access established 3
• Use alternative acute hyperkalemia management strategies in the interim, such as:
  • Insulin with dextrose for acute potassium lowering
  • Calcium gluconate for cardiac membrane stabilization if indicated
  • Hemodialysis for severe, refractory hyperkalemia 2

Important Clinical Considerations

• Complete a swallowing assessment using a validated screening tool before administering any oral medications to NPO patients who may be able to resume oral intake 3
• Patients should remain NPO until swallowing screen is completed and found normal 3
• The radiopaque nature of Lokelma may create artifacts on CT imaging, appearing as radiopaque fluid in the GI tract, which should not be confused with contrast material 4
• Once NPO status is lifted and swallowing is deemed safe, Lokelma can be resumed at the prescribed dose (typically 5-10g once daily for maintenance) 1, 5