OralHyperkalaemiaAdult: Precise dose must be determined based on regular clinical and serum electrolyte monitoring. As suspension or powder for suspension: 15 g 1-4 times daily. Administer dose while patient is in an upright position.
Child: Precise dose must be determined based on regular clinical and serum electrolyte monitoring. Employ lower doses using, as a guide, a rate of 1 mEq of K/g of resin as the basis for calculation. For acute cases: Initially, 1 g/kg daily in divided doses. Maintenance: 0.5 g/kg daily in divided doses.
RectalHyperkalaemiaAdult: Precise dose must be determined based on regular clinical and serum electrolyte monitoring. For patients with upper gastrointestinal tract problems or those who are vomiting: As enema: As suspension or powder for suspension: 30-50 g daily or given 6 hourly. Retain the enema for as long as possible or for at least 9 hours, then irrigate the colon using a non-sodium containing solution to remove the resin. If both oral and rectal routes are used initially, it may be unnecessary to continue rectal use once the oral resin has reached the rectum. Dosage recommendations may vary among countries and individual products (refer to detailed product guideline).
Child: Use a dose at least as great as that which would have been given via oral route and dilute in the same ratio as described for adults. Retain the enema for as long as possible or for at least 9 hours, then irrigate the colon using a non-sodium containing solution to remove the resin. If both oral and rectal routes are used initially, it may be unnecessary to continue rectal use once the oral resin has reached the rectum. Refer to detailed product guideline for further dosing information.
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Powder for suspension: Oral: Reconstitute in a small amount of water or syrup (in a ratio of 3-4 mL per g of resin); do not mix with fruit juices which contain K. Rectal: Reconstitute 1 g of resin with 5 mL of water or 10% dextrose solution; usually 30-50 g resin in 100 mL or 150 mL water or 10% dextrose solution (in adults).
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Hypokalaemia or serum K levels <5 mmol/L, obstructive bowel disease. Oral administration in neonates; neonates with reduced gut motility (postoperatively or drug-induced).
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Patient with severe CHF, severe hypertension, oedema, hypovolaemia. Consider other definitive measures (e.g. dialysis) or concomitant therapy (e.g. IV Na bicarbonate) in cases where rapid correction of severe hyperkalaemia is required. Avoid use in patients at risk of developing constipation or impaction (e.g. history of impaction, chronic constipation, ischaemic colitis, vascular intestinal atherosclerosis, previous bowel resection). Renal impairment. Neonates including premature or low birthweight infants (rectal); children. Pregnancy and lactation. Concomitant use with sorbitol is not recommended.
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Significant: Electrolyte disturbances (e.g. severe hypokalaemia, hypocalcaemia, hypomagnesaemia, Na retention); faecal impaction (after rectal administration, mainly in children); constipation, serious gastrointestinal adverse events (e.g. bleeding, ischaemic colitis, perforation). Rarely, acute bronchitis and bronchopneumonia (following inhalation of resin particles).
Gastrointestinal disorders: Nausea, vomiting, occasional diarrhoea, gastric irritation; bezoar formation (after oral administration).
Metabolism and nutrition disorders: Anorexia.
Potentially Fatal: Rarely, intestinal necrosis.
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Monitor serum electrolytes (e.g. K, Na, Ca, Mg); ECG (in selected patients); bowel function. Monitor for signs and symptoms of fluid overload in patients sensitive to Na intake (e.g. CHF, hypertension, oedema).
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Symptoms: Hypokalaemia (e.g. muscle weakness, irritability, delayed thought process, confusion, hyporeflexia and eventual paralysis and/or apnoea), cardiac arrythmia, hypocalcaemic tetany. Management: Correct serum electrolytes (Ca, K, Mg). Use laxatives or enemas to remove the resin from the alimentary tract.
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May decrease absorption and efficacy of other oral medications; administer 3 hours before or after other oral drugs (consider 6-hour interval in patients with gastroparesis). May cause systemic alkalosis when given with non-absorbable cation-donating antacids and laxatives (e.g. Mg hydroxide or Al carbonate); avoid concomitant use with Mg-containing laxatives. May increase the risk of intestinal obstruction with Al hydroxide. May enhance the adverse or toxic effects of digoxin. May decrease the serum concentration of lithium and levothyroxine.
Potentially Fatal: Increased risk of intestinal necrosis and other serious gastrointestinal adverse effects with sorbitol.
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Avoid mixing in orange juice or in any fruit juice containing K.
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Description: Sodium polystyrene sulfonate is a cation-exchange resin that reduces K levels by exchanging Na for K ions in the intestine, particularly the large intestine, before it passes from the body. The exchange capacity for each g of resin is approx 1 mEq of K in vivo, and approx 3.1 mEq of K in vitro.
Onset: Hours to days.
Pharmacokinetics:
Absorption: Not absorbed from the gastrointestinal tract.
Excretion: Via faeces (mainly as K polystyrene sulfonate).
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Store between 15-30°C. Freshly prepared suspensions should be used within 24 hours.
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V03AE01 - polystyrene sulfonate ; Belongs to the class of drugs used in the treatment of hyperkalemia and hyperphosphatemia.
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Anon. Sodium Polystyrene Sulfonate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 22/07/2021. Buckingham R (ed). Sodium Polystyrene Sulfonate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/07/2021. Joint Formulary Committee. Sodium Polystyrene Sulfonate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/07/2021. Resonium A (Aventis Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 22/07/2021. Sanofi-Aventis New Zealand Limited. Resonium A Powder 3.1 mEq/g data sheet 28 March 2018. Medsafe. http://www.medsafe.govt.nz. Accessed 20/08/2021. Sodium Polystyrene Sulfonate Powder for Suspension (Atlantic Biologicals Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 22/07/2021. Sodium Polystyrene Sulfonate Suspension (CMP Pharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 22/07/2021.
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