Potassium-Binding Agents to Treat Hyperkalemia Sodium zirconium cyclosilicate (Lokelma): • Mechanism: Preferentially captures K in exchange for hydrogen and sodium • Dosing: Initial: 10 g TID for up to 48 hours. Maintenance: 10 g QD (adjust dose at weekly intervals in 5-g increments to obtain the desired serum K range). Usual maintenance dose: 5 g QoD to 15 g QD • Side Effects: Edema (mild to moderate); hypokalemia Patiromer (Veltassa): • Mechanism: Exchanges calcium for K; also binds magnesium • Dosing: Initial: 8.4 g QD; increase dose as necessary at 1-wk intervals in increments of 8.4 g • Side Effects: Hypomagnesemia; hypokalemia; constipation, diarrhea, nausea, abdominal discomfort, flatulence Sodium polystyrene sulfonate (Kayexelate): • Mechanism: Sodium-K exchange resin/polymer; nonspecifically binds K, magnesium, and calcium • Dosing: 15 g (4 level teaspoons) 1-4 times daily • Side Effects: Intestinal necrosis; electrolyte disturbances (including hypokalemia); nausea, vomiting, constipation, diarrhea; fluid overload in patients sensitive to high sodium intake; risk of aspiration #Potassium #Binding #Hyperkalemia #medications #pharmacology #table #comparison #binders
