Which medications in the drug class Potassium Binders are used in the treatment of Hyperkalemia?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Potassium Binders

Potassium binders are cationic exchange resins that enhance fecal excretion of potassium.

Sodium polystyrene sulfonate (Kayexalate, Klonex, Kalexate, SPS)

SPS exchanges sodium for potassium and binds it in the gut, primarily in the large intestine, decreasing the total body potassium level by approximately 0.5-1 mEq/L. Multiple doses are usually necessary.

Onset of action ranges from 2 to 24 hours after oral administration and is even longer after rectal administration. The duration of action is 4-6 hours. Do not use SPS as a first-line therapy for severe life-threatening hyperkalemia; use it in the second stage of therapy.

The US Food and Drug Administration (FDA) notes that SPS has been associated with intestinal necrosis and other serious gastrointestinal (GI) complications and advises against its use in patients who do not have normal bowel function. Concomitant use of sorbitol with sodium polystyrene sulfonate has been implicated in cases of colonic necrosis. [62]

Patiromer (Veltassa)

Patiromer sorbitex calcium is a nonabsorbed, cation exchange polymer that contains a calcium-sorbitol counterion. It increases fecal potassium excretion by binding potassium in the lumen of the GI tract. It is indicated for hyperkalemia. It should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

Sodium zirconium cyclosilicate (Lokelma)

Potassium binder; nonabsorbed zirconium silicate that preferentially captures potassium in exchange for hydrogen and sodium. It increases fecal potassium excretion through binding of potassium in the lumen of the GI tract; binding of potassium reduces the free potassium concentration in the GI lumen, thereby lowering serum potassium level. It is indicated for treatment of nonemergent hyperkalemia in adults.

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