Hyperkalaemia correction phase Patient w/ serum K level >5 mmol/L Recommended starting dose: 10 g tds. Patient still w/ serum K level >5 mmol/L at the end of 48 hr Give an additional day (24 hr) of 10 g tds prior to initiation of maintenance dose. Hyperkalaemia maintenance phase Recommended dose:5 g once daily w/ possible titration up to 10 g once daily or down to 5 g once every other day as needed. Max: 10 g once daily. Patient on dialysis Recommended starting dose: 5 g once daily (non-dialysis days). May be titrated up or down wkly based on pre-dialysis serum K value after the long inter-dialytic interval in increments of 5-15 g once daily (non-dialysis days).
View Lokelma overdosage for action to be taken in the event of an overdose.
Administration
May be taken with or without food.
Special Precautions
Regularly monitor serum K levels during treatment. Risk of hypokalaemia. Discontinue therapy & re-evaluate patients w/ severe hypokalaemia; serum K levels <3 mmol/L. Monitor serum K when clinically indicated eg, if changes are made to medications that affect serum K levels (eg, use of renin-angiotensin-aldosterone system inhibitors or diuretics). Monitor for signs of oedema particularly in patients w/ Na-intake restrictions or prone to fluid overload (eg, heart failure or renal disease); adjust dietary Na if appropriate may increase dose of diuretics as needed. Possible lengthening of QT interval. Na zirconium cyclosilicate may be opaque to X-rays. Monitor for signs & symptoms related to intestinal perforation. Patients w/ severe hyperkalaemia (serum K conc >6.5 mmol/L). Long-term (>1 yr) exposure. Pregnancy & lactation. Childn.
May transiently increase gastric pH; administer at least 2 hr before or after oral medications w/ clinically meaningful gastric pH dependent bioavailability eg, azole antifungals (ketoconazole, itraconazole, posaconazole), anti-HIV drugs (atazanavir, nelfinavir, indinavir, ritonavir, saquinavir, raltegravir, ledipasvir, rilpivirine), tyrosine kinase inhibitors (erlotinib, dasatinib, nilotinib). Decreased AUC & Cmax of tacrolimus; administer at least 2 hr before or after Lokelma.
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