Lokelma Dosing and Duration for Potassium 6.0 mEq/L
For a potassium level of 6.0 mEq/L, initiate Lokelma 10 g three times daily for up to 48 hours, then transition to 10 g once daily for maintenance therapy, with ongoing monitoring to adjust dosing based on serum potassium response. 1
Initial Treatment Phase (First 48 Hours)
- Administer Lokelma 10 g orally three times daily for up to 48 hours as the standard initial treatment for hyperkalemia at this level 1
- Significant reductions in serum potassium occur within 1 hour of the first 10 g dose, with 84% of patients achieving normalization (3.5-5.0 mEq/L) within 24 hours and 98% by 48 hours 2, 3
- The mean serum potassium reduction is approximately 1.1 mEq/L over the 48-hour correction phase 4
- Mix each dose with approximately 3 tablespoons of water, stir well, and drink immediately 1
Important Caveat for Severe Hyperkalemia
- While a potassium of 6.0 mEq/L warrants urgent treatment, Lokelma should not be used as the sole emergency intervention if the patient has life-threatening symptoms or ECG changes 1
- Consider additional acute interventions alongside Lokelma, such as insulin plus glucose, for more rapid potassium lowering in symptomatic patients 2
- The delayed onset of action (though faster than older binders) means Lokelma is best suited for urgent but not immediately life-threatening hyperkalemia 1
Maintenance Phase (After 48 Hours)
- Transition to 10 g once daily after the initial 48-hour correction phase 1
- The maintenance dose range is 5 g every other day to 15 g daily, adjusted based on serum potassium levels 1
- Titrate the dose in 5 g increments at intervals of 1 week or longer based on potassium monitoring 1
- In clinical trials, both 5 g and 10 g once daily maintained normokalaemia over 28 days, with mean potassium levels of 4.8 mEq/L and 4.5 mEq/L respectively 3
Monitoring Schedule
- Check serum potassium within the first few hours of administration, then daily until stabilized during the initial 48-hour phase 2
- During maintenance therapy, monitor potassium at 3 days, 1 week, and monthly for the first 3 months 4
- Check serum potassium within 1 week after any dose adjustment 4
- Decrease the dose or discontinue if serum potassium falls below the desired target range 1
Duration of Therapy
- Lokelma is intended for long-term use to maintain normokalaemia, with clinical trial data supporting efficacy and safety for up to 12 months 5, 6
- Among patients with severe/end-stage CKD (eGFR <30 mL/min/1.73 m²), 82% maintained normokalaemia at Day 365 with continued once-daily dosing 6
- The duration should be determined by the underlying cause of hyperkalemia and whether RAAS inhibitor therapy needs to be continued 7, 4
Medication Timing Considerations
- Administer other oral medications at least 2 hours before or 2 hours after Lokelma to avoid potential binding interactions 1
- Each 5 g dose contains approximately 400 mg of sodium, so monitor for edema, particularly in patients requiring sodium restriction 1
- Edema risk is dose-dependent, occurring in 14% of patients on 15 g daily versus 2% on placebo 3
Special Populations
- For patients on chronic hemodialysis, start with 5 g once daily on non-dialysis days only (or 10 g if potassium >6.5 mEq/L) 1
- Avoid use in patients with severe constipation, bowel obstruction, or impaction, as Lokelma has not been studied in these conditions and may worsen gastrointestinal problems 1
RAAS Inhibitor Management
- The primary goal of using Lokelma is to enable continuation of cardioprotective RAAS inhibitors rather than discontinuing them 7, 2, 4
- Review and potentially adjust (but do not automatically discontinue) ACE inhibitors, ARBs, and aldosterone antagonists while initiating Lokelma 2
- The effectiveness of potassium binders to improve outcomes by facilitating RAAS inhibitor continuation remains uncertain in formal outcome trials, though the rationale is compelling 7