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Sodium Zirconium Cyclosilicate

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Sodium Zirconium Cyclosilicate, Zirconium Cyclosilicate, Lokelma

  • See Also
  1. Hyperkalemia
  2. Hyperkalemia Management
  3. Patiromer (Veltassa)
  4. Kayexalate (Sodium Polystyrene Sulfonate)
  • 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
  • Dosing
  1. Zirconium Cyclosilicate 10 g orally three times daily for 48 hours, then 10 g orally daily (range 5-15 g/day)
  • Efficacy
  1. Not effective or indicated in acute, life threatening Hyperkalemia
  2. Expected to lower Serum Potassium 0.67 mEq/L at 48 hours
  • Mechanism
  1. Exchanges Sodium to bind Potassium and hydrogen in the Gastrointestinal Tract
  2. Passes through the Gastrointestinal Tract without absorption
  • Advantages
  1. Decreased gastrointestinal effects when compared with Kayexalate
  • Disadvantages
  1. Very expensive ($25/day in 2019)
  • Adverse Effects
  1. Hypomagnesemia risk
  2. Edema risk
  3. Urinary Tract Infection (1.1%)
  • 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
  2. Kim (2023) Am Fam Physician 107(1): 59-70 [PubMed]