II. Indications
- Chronic Hyperkalemia
III. Contraindications
IV. Mechanism
- Potassium binding agent
- Exchanges Calcium for free Potassium in the Gastrointestinal Tract
- Passes through the Gastrointestinal Tract (bound to Potassium) without absorption
- Results in greater Potassium excretion in the stool, and hence lower Serum Potassium levels
V. Efficacy
- Not effective or indicated in acute, life threatening Hyperkalemia
- Expected to lower Serum Potassium 0.7 mEq/L at 4 weeks
VI. Precautions
- Delayed onset of action
- Use other rapid acting measures to lower Potassium in life-threatening Hyperkalemia
-
Electrolyte loss
- Monitor Potassium and Magnesium levels
- Magnesium Supplementation as needed
-
Drug Interaction with oral medications (decreases absorption of other medications)
- Avoid other oral medications for at least 3 hours before and 3 hours after Patiromer
VII. Dosing
- Start: 8.4 g once daily
- Next: Increase to16.8 g once daily after at least one week if needed
- Next: Increase to 25.2 g once daily (max dose) after at least one week at 16.8 g dose if needed
VIII. Adverse Effects
-
Electrolytes
- Hypomagnesemia (5-9%)
- Hypokalemia (5%)
- Gastrointestinal (increased Incidence in elderly patients)
- Transient Constipation (7%)
- Diarrhea (5%)
- Nausea (2%)
- Abdominal Pain (2%)
- Flatulence (2%)
-
Hypersensitivity
- Lip edema (<1%)
IX. References
- Lovecchio (2017) Crit Dec Emerg Med 31(2): 24
- Chaitman (2016) P T 41(1): 43-50+PMID:26765867 [PubMed]
- Kim (2023) Am Fam Physician 107(1): 59-70 [PubMed]
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