Lokelma Inpatient Dosing for Hyperkalemia

For inpatient treatment of hyperkalemia, administer Lokelma 10 g three times daily (q8h) for up to 48 hours, not once daily (q24h). 1

Initial Treatment Phase (First 48 Hours)

The FDA-approved initial dosing is 10 g administered three times daily for up to 48 hours to rapidly reduce serum potassium levels 1
This regimen achieves normokalaemia (3.5-5.0 mEq/L) in 84% of patients within 24 hours and 98% within 48 hours 2
Mean serum potassium reduction is approximately 1.1-1.28 mEq/L from baseline (typically from 5.6 mEq/L to 4.5 mEq/L) after 48 hours 3, 2
Onset of action begins within 1 hour, with median time to normalization of 2.2 hours 3, 2

After the initial 48-hour correction phase, transition to 10 g once daily (q24h) for maintenance therapy 1
The maintenance dose range is 5 g every other day to 15 g daily, adjusted based on serum potassium monitoring 1
Monitor serum potassium and adjust the dose at intervals of 1 week or longer, in increments of 5 g 1

Do not use once-daily dosing during the acute correction phase - the three-times-daily regimen is essential for rapid potassium reduction in the inpatient setting 1, 2
Once-daily dosing (q24h) is reserved for maintenance therapy after normokalaemia is achieved 1
In clinical trials, 90% of patients maintained normokalaemia on 10 g daily maintenance dosing over 28 days 3

For patients on chronic hemodialysis, administer Lokelma only on non-dialysis days 1
Starting dose is 5 g once daily on non-dialysis days, or 10 g once daily if serum potassium exceeds 6.5 mEq/L 1
Maintenance dose range is 5-15 g once daily on non-dialysis days 1

Empty entire packet contents into approximately 3 tablespoons of water 1
Stir well and drink immediately; repeat if powder remains to ensure complete dose administration 1
Administer other oral medications at least 2 hours before or 2 hours after Lokelma to avoid binding interactions 1

Monitor serum potassium levels during treatment and adjust dose if levels fall below desired target range 1
Each 5 g dose contains approximately 400 mg of sodium; monitor for edema, particularly in patients requiring sodium restriction or prone to fluid overload 1
Edema occurs in approximately 6% of patients on 10 g daily and 14% on 15 g daily 3
Hypokalemia developed in 10-11% of patients receiving 10-15 g daily maintenance doses in clinical trials 2

Lokelma should not be used as emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 1
For acute, severe hyperkalemia with ECG changes, use rapid-acting treatments first (IV calcium, insulin/glucose, albuterol) before initiating Lokelma 3

Avoid use in patients with severe constipation, bowel obstruction, or impaction, as Lokelma has not been studied in these conditions 1
No absolute contraindications exist, but caution is warranted in patients with abnormal post-operative bowel motility disorders 1