Sodium zirconium cyclosilicate


Generic Medicine Info
Indications and Dosage
Oral
Hyperkalaemia
Adult: Correction phase: Initially, 10 g tid for up to 48-72 hours. If normokalaemia is not achieved after 72 hours, consider other treatment approaches. Maintenance phase: Initially, 5 g once daily, may be titrated up to 10 g once daily or decreased to 5 g once every other day as needed to maintain normal serum K level. Adjust dose in increments of 5 g daily at intervals of at least 1 week according to serum K concentrations. Usual maintenance dose range: 5 g once every other day to 15 g daily. Max maintenance dose: 10 g once daily, or 15 g daily. Re-evaluate patient and discontinue treatment if severe hypokalaemia occurs. Dosage recommendations may vary among individual products or between countries (refer to detailed product guideline).
Renal Impairment
Patients on chronic haemodialysis: Initially, 5 g once daily on non-dialysis days. Alternatively, may consider an initial dose of 10 g once daily on non-dialysis days in patients with >6.5 mEq/L serum K levels. Doses may be adjusted at intervals of 1 week based on the pre-dialysis serum K value after the long inter-dialytic interval (LIDI). Maintenance dose range: 5-15 g once daily on non-dialysis days.
Administration
Susp: May be taken with or without food. Empty entire contents of sachet into a glass w/ 45 mL of water. The powd will not dissolve. Stir well & consume immediately, rinse remaining powd in the glass w/ water until no powd remains.
Special Precautions
Patient on Na-restricted diet or prone to fluid overload (e.g. heart failure). Avoid use in patients with gastrointestinal motility disorders (e.g. severe constipation, bowel obstruction or impaction, abnormal postoperative bowel motility disorder). Not indicated for use in the emergency treatment of life-threatening hyperkalaemia due to its delayed onset of action. Patients on chronic haemodialysis. Renal impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Hypokalaemia, QT prolongation, mild to moderate oedema or oedema related events (e.g. fluid overload and retention, generalised or localised oedema, hypervolaemia, peripheral oedema); may worsen gastrointestinal conditions (in patients with gastrointestinal motility disorders).
Gastrointestinal disorders: Nausea, constipation.
Potentially Fatal: Severe hypokalaemia.
Monitoring Parameters
Monitor serum K levels regularly. In patients on chronic haemodialysis, check serum K at treatment initiation and weekly during dose adjustments. Assess for signs and symptoms of oedema (particularly in those on a Na-restricted diet or at risk of fluid overload) and intestinal perforation.
Overdosage
Symptoms: Hypokalaemia manifestations. Management: Monitor serum K levels and administer K supplements as needed.
Drug Interactions
May transiently increase the gastric pH which may affect the absorption of agents with pH-dependent bioavailability, such as azole antifungals (e.g. itraconazole, ketoconazole, posaconazole), anti-HIV drugs (e.g. atazanavir, nelfinavir, ritonavir), and tyrosine kinase inhibitors (e.g. dasatinib, erlotinib, nilotinib); therefore, these oral agents must be administered ≥2 hours before or 2 hours after sodium zirconium cyclosilicate. May decrease the serum concentrations of dabigatran.
Lab Interference
May be opaque to X-rays (e.g. abdominal X-ray).
Action
Description: Sodium zirconium cyclosilicate, a non-absorbed cation-exchange compound, acts as a selective K binder by preferentially exchanging K for hydrogen and Na cations. This activity binds K throughout the entire gastrointestinal tract and decreases the levels of free K in the gastrointestinal lumen, thus reducing serum K concentrations and increasing faecal K excretion.
Onset: Reduction of serum K levels: 1 hour.
Pharmacokinetics:
Absorption: Not systematically absorbed.
Metabolism: Not subject to enzymatic metabolism.
Excretion: Via faeces.
Chemical Structure

Chemical Structure Image
Sodium zirconium cyclosilicate

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 92042806, Lokelma (TN). https://pubchem.ncbi.nlm.nih.gov/compound/Lokelma-_TN. Accessed Mar. 26, 2021.

Storage
Store between 15-30°C.
ATC Classification
V03AE10 - sodium zirconium cyclosilicate ; Belongs to the class of drugs used in the treatment of hyperkalemia and hyperphosphatemia.
References
Anon. Sodium Zirconium Cyclosilicate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 08/02/2021.

Buckingham R (ed). Sodium Zirconium Cyclosilicate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/02/2021.

Joint Formulary Committee. Sodium Zirconium Cyclosilicate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/02/2021.

Lokelma 5 g and 10 g Powder for Oral Suspension (AstraZeneca Hong Kong Limited). MIMS Hong Kong. http://www.mims.com/hongkong. Accessed 10/03/2021.

Lokelma 5 g, 10 g Powder for Oral Suspension (AstraZeneca AB). European Medicines Agency [online]. Accessed 08/02/2021.

Lokelma Powder, for Suspension (AstraZeneca Pharmaceuticals LP). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 08/02/2021.

Disclaimer: This information is independently developed by MIMS based on Sodium zirconium cyclosilicate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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