Lokelma Dosing Frequency
Lokelma can be administered three times daily for up to 48 hours during initial treatment, then once daily for maintenance therapy. 1
Initial Treatment Phase (Acute Hyperkalemia)
For initial treatment of hyperkalemia, administer 10 g three times daily for up to 48 hours. 1 This regimen:
- Reduces serum potassium within 1 hour of the first dose 2
- Achieves a mean reduction of 1.1 mEq/L by 48 hours 3
- Normalizes potassium levels (3.5-5.0 mEq/L) in 84% of patients by 24 hours and 98% by 48 hours 4
The three-times-daily dosing during this initial 48-hour period is the maximum frequency recommended. 1
Maintenance Treatment Phase (Chronic Management)
After the initial 48 hours, transition to 10 g once daily for continued treatment. 1 The maintenance dosing:
- Is administered once daily only, not multiple times per day 1
- Can be adjusted between 5 g every other day to 15 g daily based on serum potassium levels 1
- Should be titrated at intervals of 1 week or longer in increments of 5 g 1
- Maintains normokalemia in 90% of patients over 28 days at the 10 g daily dose 3
Special Population: Hemodialysis Patients
For patients on chronic hemodialysis, administer Lokelma only on non-dialysis days, starting at 5 g once daily. 1 Key considerations:
- Never administer on dialysis days 1
- Consider starting at 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 only 1
Long-Term Use
Lokelma can be used continuously for extended periods—efficacy and safety have been demonstrated for up to 11-12 months. 2, 5 In the long-term extension studies:
- 64% of patients completed 11 months of treatment 5
- 88% maintained mean serum potassium ≤5.1 mEq/L throughout the study period 5
- The median daily maintenance dose was 10 g 5
- No new safety concerns emerged with prolonged use 2, 5
Critical Monitoring Requirements
Check serum potassium within 1 week after initiating or adjusting the dose, then continue monitoring based on clinical context. 3, 1
- Decrease the dose or discontinue if potassium falls below the desired target range 1
- For hemodialysis patients, assess serum potassium after one week following dose adjustments 1
- Monitor for edema, particularly with the 15 g daily dose, as each 5 g contains approximately 400 mg of sodium 1
Common Pitfall to Avoid
Do not continue three-times-daily dosing beyond 48 hours—this exceeds the approved regimen and increases the risk of hypokalemia and edema. 1, 4 The FDA label explicitly limits the three-times-daily regimen to a maximum of 48 hours, after which once-daily dosing should be used for maintenance. 1