MSN 277L Adult Health I Clinical
Drug Reference Sheet
Drug Classification:
Potassium binders
Prototype drugs:
sodium zirconium cyclosilicate (Lokelma)
Indications:
Treatment of
hyperkalemia in adults
*Should not be used
as emergency tx for
life-threatening
hyperkalemia because
of delayed onset of
action
Mechanisms of Action:
Major Contraindications:
Increases fecal
potassium excretion
through binding of
potassium in the
lumen of the GI tract.
Binding of potassium
reduces concentration
of free potassium in GI
lumen, lowering
serum potassium
level.
None
Major Side Effects by
system:
GI: constipation, GI obstruction
F/I: edema, hypokalemia in pts on hemodialysis
Major Drug Interactions
with drugs or food:
- Lokelma can change the absorption of co-administered drugs that exhibit pHdependent solubility, potentially leading to altered efficacy or safety of these
drugs when taken close to time Lokelma is administered.
- LOKELMA, by elevating gastric pH, affects the systemic exposure of coadministered drugs whose solubility is pH-dependent
Usual Dosage:
For initial tx: 10g TID for up to 48h po as suspension in
water. For continued tx: 10g once daily. During
maintenance treatment, up-titrate based on the serum
potassium level at intervals of 1-week or longer and in
increments of 5 g.
Dosage adjustment for chronic HD: administer on nondialysis days. Recommended starting dose: 5g once
daily. During initiation and after a dose adjustment,
assess serum potassium after 1 week. The
recommended maintenance dose is 5-15 g once daily
Pharmacokinetics:
Absorption: not absorbed into blood stream systemically
following po admin
Distribution: not expected to cross placenta or into
breast milk
Metabolism
Excretion
Half Life
Duration of Action
Protein Binding
MSN 277L Adult Health I Clinical
Drug Reference Sheet
NURSING IMPLICATIONS
-Assess for edema in hands, ankles, feet. Can cause fluid retention due to
containing significant sodium in each dose. May need sodium restriction in diet
-Monitor serum potassium and adjust dose based on levels and desired target
range
-Decrease or discontinue dose if serum potassium is below desired range
Patient Teaching:
-Instruct pt how to reconstitute Lokelma for administration. Empty entire contents
into drinking glass containing approx. 3tbs water or more. Stir well and drink
immediately. If powder remains in glass, add water and repeat. It is necessary to
drink the full dose.
-If on dialysis, take on non-dialysis days
-Instruct dialysis pts who experience acute illness to contact provider
-Notify physician prior to an abdominal XR
-If taking other oral medications, separate dosing of Lokelma by at least 2h
-Adjust dietary sodium, if appropriate