Are there any intravenous (IV) medications like Lokelma (sodium zirconium cyclosilicate)?

From the Guidelines

Lokelma (sodium zirconium cyclosilicate) has no direct IV equivalent, but for urgent hyperkalemia treatment, IV calcium gluconate, insulin with glucose, and sodium bicarbonate are used as alternatives. These medications are used to manage acute hyperkalemia, with calcium gluconate stabilizing cardiac membranes, insulin with glucose driving potassium into cells, and sodium bicarbonate helping to shift potassium intracellularly in patients with metabolic acidosis 1.

Key Considerations

• IV calcium gluconate is administered typically at a dose of 1 gram over 2-3 minutes to rapidly stabilize cardiac membranes.
• Insulin (10 units regular insulin) is given with glucose (25-50g) to temporarily drive potassium into cells, with the effect lasting about 30 to 60 minutes.
• Sodium bicarbonate (50 mEq IV) may be used in patients with metabolic acidosis to help shift potassium intracellularly, but its use is limited to these cases.
• Hemodialysis is the most effective method for removing potassium from the body in acute settings when oral binders like Lokelma cannot be used, especially in patients with severe hyperkalemia or those with end-stage renal disease 1.

Clinical Context

In clinical practice, the choice of IV medication for hyperkalemia depends on the severity of the condition, the presence of metabolic acidosis, and the patient's renal function. While Lokelma is an effective oral potassium binder, the IV alternatives provide rapid, though temporary, management of hyperkalemia, acting as bridge therapies until the underlying cause is addressed or oral medications can be initiated. The management strategy should always prioritize reducing morbidity, mortality, and improving the quality of life for patients with hyperkalemia.

From the Research

IV Medications for Hyperkalemia

• There are several IV medications that can be used to treat hyperkalemia, including:
  • Calcium gluconate to stabilize cardiomyocyte membranes 2, 3
  • Insulin injection to shift potassium into cells 2, 3, 4
  • Beta-agonists to shift potassium into cells 2, 3
  • Glucose and insulin to shift potassium into cells 5
  • Bicarbonate to shift potassium into cells 5
• However, there is no specific mention of an IV medication like Lokelma (sodium zirconium cyclosilicate) in the provided studies, but it is mentioned as an oral medication that can be used to treat hyperkalemia 5, 3, 4, 6

Oral Medications for Hyperkalemia

• Several oral medications can be used to treat hyperkalemia, including:
  • Sodium polystyrene sulfonate (SPS) 5, 3
  • Sodium zirconium cyclosilicate (SZC) 5, 3, 4, 6
  • Patiromer 5, 3, 4, 6
• These medications work primarily in the gastrointestinal (GI) tract to reduce serum potassium levels 5
• SZC and patiromer have been shown to be safe and effective in treating hyperkalemia, with SZC being the drug of choice for acute hyperkalemia and patiromer being the drug of choice for chronic hyperkalemia 6