Potassium Binder Pregnancy: As a precautionary measure it is preferable to avoid use during pregnancy (§4.6). There are no data from use in pregnant women; animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Breast-feeding: can be used during breast-feeding — the drug is not systemically absorbed and is not expected to be excreted in breast milk, and no effects on the breastfed newborn/infant are anticipated. Fertility: no human data; no effect on fertility in rats.

Sodium Zirconium Cyclosilicate

Brand names: Lokelma

Sodium zirconium cyclosilicate is a non-absorbed potassium-binding agent used to treat hyperkalaemia in adults.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Correction phase: 10 g three times a day. Maintenance phase (once normokalaemia is achieved): 5 g once daily starting dose, with possible titration up to 10 g once daily or down to 5 g once every other day as needed to maintain a normal potassium level

Route: Oral — empty the entire contents of the sachet(s) into a drinking glass containing approximately 45 mL of water, stir well and drink the tasteless liquid while still cloudy; the powder will not dissolve. If the powder settles, stir again and take; rinse the glass with more water if needed to ensure all the content is taken. May be taken with or without food

Frequency: Three times a day (correction phase); once daily (maintenance phase)

Max: No more than 10 g once daily should be used for maintenance therapy (in patients on dialysis the dose may be titrated up to 15 g once daily on non-dialysis days — see renalAdjustment)

Source: UK SPC (eMC) for Lokelma 10 g powder for oral suspension, §4.2 (https://www.medicines.org.uk/emc/product/10074/smpc). Indication is hyperkalaemia. CORRECTION PHASE: typically normokalaemia is achieved within 24 to 48 hours; if patients are still hyperkalaemic after 48 hours of treatment the same regimen can be continued for an additional 24 hours; if normokalaemia is not achieved after 72 hours of treatment, other treatment approaches should be considered. MAINTENANCE PHASE: once normokalaemia has been achieved, establish the minimal effective dose to prevent recurrence of hyperkalaemia. Serum potassium levels should be monitored regularly during treatment (§4.4). MISSED DOSE: take the next usual dose at the normal time. HEPATIC IMPAIRMENT: no changes from the normal doses are required. ELDERLY: no special dose and administration guidelines are recommended. PAEDIATRIC: safety and efficacy in children and adolescents (< 18 years) have not been established and no data are available — no per-kg dose is stated, hence paedDose is null; verify any under-18 use against a children's formulary. The eMC bundle did not include §4.5, so the interaction guidance below is taken from the US FDA label §7 (openFDA) — verify against the UK SPC §4.5 (note the US label advises 2-hour spacing of other oral medicines).

Dose adjustments

Renal

No changes from the normal doses are required for patients with renal impairment who are not on chronic haemodialysis. For patients on dialysis, dose only on non-dialysis days: recommended starting dose 5 g once daily; to establish normokalaemia (4.0-5.0 mmol/L) the dose may be titrated up or down weekly based on the pre-dialysis serum potassium value after the long inter-dialytic interval (LIDI), adjusted at intervals of one week in increments of 5 g up to 15 g once daily on non-dialysis days. Monitor serum potassium weekly while the dose is adjusted, then regularly (e.g. monthly, or more frequently on clinical judgement including changes in dietary potassium or in medicines affecting serum potassium) (§4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance

Side effects

Hypokalaemia (4.1%) — very common; resolved with dose adjustment or discontinuation
Oedema related events (5.7%) including fluid retention, generalised oedema, hypervolaemia, localised oedema, peripheral oedema and peripheral swelling — very common; observed in the maintenance phase only and more commonly with 15 g; up to 53% were managed by initiating a diuretic
Constipation (2.9%) — common; an estimated frequency of 8.9% was seen in non-dialysis patients in studies in countries with a predominantly Asian population, resolving with dose adjustment or discontinuation
Worsening of pre-existing heart failure — common; in a pooled analysis of three placebo-controlled studies in non-dialysis patients this occurred in 13.6% (30/220) on treatment versus 5.7% (12/209) on placebo, most cases resolving with appropriate clinical management without withdrawal
Nausea (1.6%), diarrhoea (0.9%), abdominal pain/distension (0.5%), vomiting (0.5%), rash (0.3%) and pruritus (0.1%) — reported as related in open-label exposure of up to 1 year; mild to moderate and none serious

Interactions

Oral medicines with pH-dependent solubility — sodium zirconium cyclosilicate can transiently increase gastric pH and so change their absorption, potentially altering their efficacy or safety when taken close to the time it is administered. In general, other oral medications should be administered at least 2 hours before or 2 hours after it (US label §7)
Drugs that do not exhibit pH-dependent solubility — systemic exposure is not expected to be affected, so spacing is not needed if it has been determined the concomitant medication does not exhibit pH-dependent solubility (US label §7)

Clinical monograph

How it works

It is an insoluble inorganic cation-exchanger that selectively traps potassium ions in exchange for hydrogen and sodium throughout the gastrointestinal tract, increasing faecal potassium excretion.

Prescribing in practice

Not for emergency treatment of life-threatening hyperkalaemia because its onset is too slow; use established acute measures first.
It can bind co-administered oral drugs, so separate the timing of other medicines that depend on gastric pH or could be affected.
It contributes a sodium load, which warrants caution in patients prone to fluid overload such as those with heart failure.

Monitoring

Monitor serum potassium during treatment and adjust therapy to maintain a normal level, watching also for oedema.

Counselling the patient

Take as a suspension in water as directed and report swelling, breathlessness or muscle weakness.
Space other oral medicines apart from this product as advised by your team.

Evidence & guidelines

MHRA and SPC guidance support its use for chronic hyperkalaemia management rather than acute correction.

Reference: HARMONIZE Trial (Kosiborod et al, JAMA 2014); NICE TA599; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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