II. Indications

  1. Chronic Hyperkalemia
    1. Often used to allow continuation of ACE Inhibitors or ARB Agents despite elevated Serum Potassium
    2. Considered in Systolic Dysfunction, recent MI and Chronic Kidney Disease

III. Dosing

  1. Zirconium Cyclosilicate 10 g orally three times daily for 48 hours, then 10 g orally daily (range 5-15 g/day)

IV. Efficacy

  1. Not effective or indicated in acute, life threatening Hyperkalemia
  2. Expected to lower Serum Potassium 0.67 mEq/L at 48 hours

V. Mechanism

  1. Exchanges Sodium to bind Potassium and hydrogen in the Gastrointestinal Tract
  2. Passes through the Gastrointestinal Tract without absorption

VI. Advantages

  1. Decreased gastrointestinal effects when compared with Kayexalate

VII. Disadvantages

  1. Very expensive ($25/day in 2019)

VIII. Adverse Effects

IX. Precautions

  1. Valtessa is preferred (less edema risk)
  2. Consider other measures to reduce Serum Potassium
    1. Avoid Dietary Potassium
    2. Avoid other medications that raise Potassium (e.g. Septra, NSAIDs)
    3. Consider adding Diuretic (e.g. Furosemide)

X. References

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