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Sodium Zirconium Cyclosilicate

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Sodium Zirconium Cyclosilicate, Lokelma

  • Indications
  1. Chronic Hyperkalemia
    1. Often to allow continuation of ACE Inhibitors or ARB Agents despite elevated Serum Potassium
    2. Considered in Systolic Dysfunction, recent MI and Chronic Kidney Disease
  • Mechanism
  1. Exchanges Sodium to bind Potassium and hydrogen
  • Advantages
  1. Decreased gastrointestinal effects when compared with Kayexalate
  • Disadvantages
  1. Very expensive ($25/day in 2019)
  2. Hypomagnesemia risk
  3. Edema risk
  • 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)
  • References
  1. (2019) Presc Lett 26(4): 23