Nephrology Book



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

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