Patiromer

Source: UK SPC (eMC) for Veltassa (Patiromer) 16.8 g powder for oral suspension, §4.2 (https://www.medicines.org.uk/emc/product/10416/smpc). Indication is hyperkalaemia. ONSET: action occurs 4-7 hours after administration — it should NOT replace emergency treatment for life-threatening hyperkalaemia (§4.4). TITRATION: the daily dose may be adjusted at intervals of one week or longer, based on the serum potassium level and the desired target range; serum potassium should be monitored when clinically indicated; if serum potassium falls below the desired range, the dose should be reduced or discontinued. Duration of treatment should be individualised by the treating physician based on the need for serum potassium management. Multiple sachets may be used to achieve the desired dose. SEPARATION: administration of patiromer should be separated by 3 hours from other oral medicinal products (§4.5). MISSED DOSE: take as soon as possible on the same day; do not take with the next dose. PREPARATION VOLUMES (dose dependent): 1 g — 10 mL; 2 g — 20 mL; 3 g — 30 mL; 4 g — 40 mL; > 4 g — 80 mL. Pour the first half of the volume into a glass, add the complete dose, stir, then add the second half and stir thoroughly; the powder will not dissolve. More water may be added for the desired consistency, though larger volumes might accelerate sedimentation. If powder remains after drinking, add more water, stir and take immediately, repeating as needed. Instead of water, apple/cranberry/pineapple/orange/grape/pear juice, apricot or peach nectar, yoghurt, milk, thickener (e.g. cornstarch), apple sauce, or vanilla/chocolate pudding may be used — count their potassium content within the patient's dietary potassium allowance; limit cranberry juice to moderate amounts (for example less than 400 mL per day) due to its potential interaction with other medicinal products. May be taken with or without meals; must not be heated (e.g. microwaved) or added to heated foods or liquids, and must not be taken in its dry form. NG/PEG TUBE: for doses up to 8.4 g prepare as for oral use; for doses above 8.4 g and up to 16.8 g use a total volume of 160 mL, and for doses above 16.8 g and up to 25.2 g use 240 mL; compatibility shown with polyurethane, silicone and polyvinyl chloride tubes of recommended diameter 2.17 mm (6.5 Fr) or larger; flush the tube with water after administration. ELDERLY: no special dose and administration guidelines are recommended. DIALYSIS: limited data; no special dose and administration guidelines were applied in clinical trials; no paediatric patients receiving dialysis have been treated with patiromer. ESRD: studied only in a limited number of patients with eGFR < 15 mL/min/1.73 m2. PAEDIATRIC (age-based, NOT per-kg, so paedDose is null): adolescents aged 12 to 17 years — recommended starting dose 4 g patiromer once daily, adjusted on serum potassium and the desired target range up to a maximum dose of 25.2 g daily, with a recommendation to switch to 8.4 g sachets if doses above 7 g are needed; safety and efficacy in children aged under 12 years have not yet been established; data in adolescents 12-17 years are limited to 6 months exposure so treatment beyond 6 months should be done with caution. Verify any under-18 use against a children's formulary. The eMC bundle did not include the §4.5 text, so the interaction detail below is taken from the US label §7 (openFDA), which was truncated at the source-fetch limit — verify against the UK SPC §4.5.