What is Patiromer (Veltassa)?

From the Guidelines

Patiromer is recommended as a first-line treatment for hyperkalemia in patients with chronic kidney disease or those taking medications that can increase potassium levels, with a typical starting dose of 8.4 grams once daily, adjusted based on serum potassium levels, and a maximum recommended dose of 25.2 grams daily 1.

Key Points

• Patiromer works by binding to potassium in the gastrointestinal tract, preventing its absorption and facilitating its elimination through the feces.
• This medication should be taken with food and separated from other oral medications by at least 3 hours to prevent potential interactions.
• Common side effects include constipation, diarrhea, abdominal discomfort, and flatulence.
• Patiromer should not replace emergency treatment for life-threatening hyperkalemia but serves as a maintenance therapy to help manage chronic potassium elevation.
• Regular monitoring of serum potassium levels is essential during treatment to ensure effectiveness and appropriate dosing adjustments.
• Patients should maintain adequate hydration while taking this medication and inform their healthcare provider about all other medications they are taking.

Clinical Considerations

• The use of patiromer has been shown to be effective in reducing serum potassium levels in patients with hyperkalemia, particularly in those with chronic kidney disease or those taking renin-angiotensin-aldosterone system inhibitors 1.
• Patiromer has been compared to other potassium-binding agents, such as sodium zirconium cyclosilicate, and has been shown to be effective in reducing serum potassium levels and preventing hyperkalemia-related complications 1.
• The medication should be used with caution in patients with gastrointestinal disorders, such as constipation or diarrhea, and in patients with electrolyte imbalances, such as hypokalemia or hypercalcemia.

Monitoring and Follow-up

• Regular monitoring of serum potassium levels is essential during treatment with patiromer to ensure effectiveness and appropriate dosing adjustments.
• Patients should be instructed to maintain adequate hydration while taking this medication and to inform their healthcare provider about all other medications they are taking.
• Follow-up appointments should be scheduled regularly to monitor serum potassium levels and adjust the dose of patiromer as needed.

From the FDA Drug Label

Veltassa is a powder for suspension in water for oral administration. The active ingredient is patiromer sorbitex calcium which consists of the active moiety, patiromer, a non-absorbed potassium-binding polymer, and a calcium-sorbitol counterion Veltassa increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, resulting in a reduction of serum potassium levels.

Pratiromer is a non-absorbed potassium-binding polymer that works by increasing fecal potassium excretion, thereby reducing serum potassium levels.

• The mechanism of action involves binding of potassium in the gastrointestinal tract, reducing the concentration of free potassium and resulting in a decrease in serum potassium levels.
• Key points about pratiromer include:
  • It is not absorbed systemically following oral administration.
  • It is used to lower serum potassium levels in patients with hyperkalemia.
  • The safety and effectiveness of pratiromer have been established in pediatric patients ages 12 years and older 2

From the Research

Pratiromer Overview

• Pratiromer is a potassium binder that uses calcium as the exchange ion and may also reduce serum phosphorus (sP) 3.
• It is used to treat patients with chronic kidney disease (CKD), hyperkalemia, and hyperphosphatemia.

Mechanism of Action

• Pratiromer works by binding to potassium in the gut and exchanging it for calcium, which helps to reduce serum potassium levels 3.
• It also has the potential to reduce serum phosphorus levels, although the exact mechanism is not fully understood 3.

Efficacy and Safety

• Studies have shown that pratiromer is effective in reducing serum potassium and phosphorus levels in patients with CKD and hyperkalemia 3.
• Pratiromer was generally well tolerated in clinical trials, with no serious adverse events considered related to the treatment 3.
• However, the long-term safety and efficacy of pratiromer need to be established in future controlled trials 3.

Comparison to Other Treatments

• Other treatments for hyperphosphatemia, such as calcium-based phosphate binders, sevelamer, and lanthanum carbonate, have their own safety and efficacy profiles 4, 5, 6.
• Pratiromer may offer a unique benefit in reducing both serum potassium and phosphorus levels, but more research is needed to compare its effectiveness to other treatments 3.

Clinical Management

• The clinical management of hyperphosphatemia in CKD involves a combination of dietary restriction, phosphate binders, and dialysis intensification 7.
• Pratiromer may be a useful addition to the treatment arsenal for hyperphosphatemia in CKD, but its place in the treatment algorithm needs to be further defined 3.