Zirconium Cyclosilicate

Brand names: Lokelma
Drug class: Antineoplastic Agents

Usage of Zirconium Cyclosilicate

Hyperkalemia

Treatment of hyperkalemia.

Has been shown to reduce elevated serum potassium concentrations and maintain normal serum potassium concentrations in patients with hyperkalemia.

Degree of reduction in serum potassium concentrations appears to be greater in patients with higher serum potassium concentrations at baseline.

Efficacy maintained during continued treatment for up to 1 year in clinical studies.

Not used as an emergency treatment for life-threatening hyperkalemia because of delayed onset of action.

Relate drugs

How to use Zirconium Cyclosilicate

Administration

Oral Administration

Administer orally as a suspension.

Administer ≥2 hours before or ≥2 hours after other oral drugs. (See Drugs that Exhibit pH-dependent Solubility under Interactions.)

Preparation of Oral Suspension

Empty entire contents of packet(s) containing sodium zirconium cyclosilicate into a glass containing approximately 45 mL of water, or more if desired. Stir thoroughly and administer immediately.

If any powder remains in glass after initial administration, add more water, stir, and administer immediately; repeat, as needed, until the entire dose is administered.

Dosage

Adults

Hyperkalemia Oral

Initial treatment: 10 g 3 times daily for up to 48 hours.

Maintenance therapy: 10 g once daily. Monitor serum potassium concentration; dosage may be increased (in 5-g increments at intervals of ≥1 week, up to 15 g daily) or decreased, or therapy may be discontinued based on serum potassium concentration and desired target range. Usual maintenance dosage is 5 g every other day to 15 g once daily.

Prescribing Limits

Adults

Hyperkalemia Oral

Maximum 15 g once daily for maintenance therapy.

Special Populations

Hepatic Impairment

No special dosage recommendations.

Renal Impairment

No special dosage recommendations.

Geriatric Patients

No special dosage recommendations.

Warnings

Contraindications

  • Manufacturer states none known.

    • Warnings/Precautions

    Worsening of GI Motility Disorders

    Not evaluated in patients with severe constipation, bowel obstruction, or fecal impaction, including abnormal postoperative bowel motility disorders. Avoid use in such patients because the drug may not be effective and may worsen GI conditions.

    Edema

    Each 5-g dose of sodium zirconium cyclosilicate contains approximately 400 mg of sodium; possible risk of edema if sodium is absorbed from preparation. In clinical trials, edema was generally mild to moderate in severity and was more common in patients receiving higher dosages (i.e., 15 g once daily).

    Monitor for signs of edema, especially in patients who should restrict their sodium intake or have conditions predisposing them to fluid overload (e.g., heart failure, renal disease). Advise patients to reduce dietary sodium intake, if appropriate. Increase dosage of concomitant diuretics as needed.

    Specific Populations

    Pregnancy

    Not expected to result in fetal exposure if used during pregnancy because sodium zirconium cyclosilicate is not absorbed systemically following oral administration.

    Lactation

    Breast-feeding not expected to result in infant exposure because sodium zirconium cyclosilicate is not absorbed systemically following oral administration.

    Pediatric Use

    Safety and efficacy not established in pediatric patients.

    Geriatric Use

    No overall differences in efficacy observed between geriatric patients and younger adults.

    Renal Impairment

    Patients with renal disease may be at greater risk for edema. (See Edema under Cautions.)

    Common Adverse Effects

    Edema, hypokalemia.

    What other drugs will affect Zirconium Cyclosilicate

    Drugs that Exhibit pH-dependent Solubility

    Sodium zirconium cyclosilicate causes transient increases in gastric pH and can affect solubility (and consequent bioavailability) of certain pH-dependent drugs. Administer sodium zirconium cyclosilicate ≥2 hours before or ≥2 hours after other oral drugs unless it is determined that the other drug does not exhibit pH-dependent solubility.

    Drugs that Inhibit the Renin-angiotensin-aldosterone System

    Concomitant use does not appear to alter pharmacokinetics of renin-angiotensin-aldosterone system inhibitors.

    Specific Drugs

    Drug

    Interaction

    Comments

    Allopurinol

    No interaction observed in vitro

    Amlodipine

    No substantial change in peak plasma concentrations and AUC of amlodipine

    Apixaban

    No interaction observed in vitro

    Aspirin

    No interaction observed in vitro

    Atorvastatin

    Increased peak plasma concentrations of atorvastatin by 69%

    Separate administration times by ≥2 hours

    Captopril

    No interaction observed in vitro

    Clopidogrel

    No substantial change in peak plasma concentrations, but increased AUC of clopidogrel

    Separate administration times by ≥2 hours

    Cyclosporine

    No interaction observed in vitro

    Dabigatran

    Decreased peak plasma concentrations and AUC of dabigatran

    Separate administration times by ≥2 hours

    Digoxin

    No interaction observed in vitro

    Ethinyl estradiol

    No interaction observed in vitro

    Furosemide

    Increased peak plasma concentrations of furosemide by 66%

    Separate administration times by ≥2 hours

    Glipizide

    Although an interaction was observed in vitro, no effect on glipizide exposure in vivo

    Levothyroxine

    Although an interaction was observed in vitro, no effect on levothyroxine exposure in vivo

    Lisinopril

    No interaction observed in vitro

    Lithium

    Concomitant use decreased the potassium exchange capacity of sodium zirconium cyclosilicate by 12%

    Losartan

    Although an interaction was observed in vitro, no effect on losartan exposure in vivo

    Magnesium

    No interaction observed in vitro

    Metformin

    No interaction observed in vitro

    Phenytoin

    No interaction observed in vitro

    Prednisone

    No interaction observed in vitro

    Propranolol

    No interaction observed in vitro

    Quinapril

    No interaction observed in vitro

    Spironolactone

    No interaction observed in vitro

    Ticagrelor

    No interaction observed in vitro

    Warfarin

    Increased peak plasma concentrations of R- and S-warfarin by about 38%

    Separate administration times by ≥2 hours

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