Nephrology Book


Sodium Zirconium Cyclosilicate

Aka: Sodium Zirconium Cyclosilicate, Zirconium Cyclosilicate, Lokelma
  1. See Also
    1. Hyperkalemia
    2. Patiromer (Veltassa)
    3. Kayexalate (Sodium Polystyrene Sulfonate)
  2. 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
  3. Efficacy
    1. Not effective or indicated in acute, life threatening Hyperkalemia
  4. Mechanism
    1. Exchanges Sodium to bind Potassium and hydrogen in the Gastrointestinal Tract
    2. Passes through the Gastrointestinal Tract without absorption
  5. Advantages
    1. Decreased gastrointestinal effects when compared with Kayexalate
  6. Disadvantages
    1. Very expensive ($25/day in 2019)
    2. Hypomagnesemia risk
    3. Edema risk
  7. 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)
  8. References
    1. (2019) Presc Lett 26(4): 23

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