Potassium Binder Pregnancy: Limited data; likely safe (not systemically absorbed) — use under specialist guidance

Sodium Zirconium Cyclosilicate

Brand names: Lokelma

Adult dose

Dose: Acute hyperkalaemia: 10 g TDS for up to 48 hours. Maintenance: 5 mg OD (range 5–15 g OD).

Route: Oral (mix in water)

Frequency: TDS (acute) or OD (maintenance)

Max: 10 g TDS (acute phase); 15 g OD (maintenance)

Non-absorbed potassium binder — exchanges sodium for potassium throughout GI tract. Onset within 1–2 hours (faster than patiromer). Stagger by 2h from other oral medications.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

No established paediatric dosing

Dose adjustments

Renal

No dose adjustment required; designed for use in CKD

Hepatic

No dose adjustment required

Clinical pearls

Superior to calcium resonium — better tolerated, no faecal impaction/necrosis risk, faster onset
HARMONIZE trial: rapid K+ reduction within 1h of first dose
HARMONIZE-Global: maintained normokalaemia and allowed continuation of RAASi therapy
Each 5 g sachet provides 500 mg of sodium — caution in fluid-restricted patients (heart failure, CKD stage 5)

Contraindications

Hypokalaemia
Inability to take oral medication

Side effects

Oedema (sodium exchange — significant if daily dose ≥10 g due to sodium load)
Hypokalaemia (overcorrection)
Gastrointestinal disturbance (less than older resins like calcium resonium)

Interactions

All oral medications — reduce absorption (separate administration by 2 hours)
Particularly: thyroid hormones, digoxin, fluoroquinolones (important to space adequately)

Monitoring

Serum potassium (every 2h during acute phase; then daily; then at intervals)
Sodium (sodium loading risk)
Weight and oedema
All oral medication absorption

Reference: BNFc; BNF; HARMONIZE Trial (Kosiborod et al, JAMA 2014); NICE TA599. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways