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. Efficacy

  1. Not effective or indicated in acute, life threatening Hyperkalemia

IV. Mechanism

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

V. Advantages

  1. Decreased gastrointestinal effects when compared with Kayexalate

VI. Disadvantages

  1. Very expensive ($25/day in 2019)
  2. Hypomagnesemia risk
  3. Edema risk

VII. 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)

VIII. References

  1. (2019) Presc Lett 26(4): 23

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