Sodium Zirconium Cyclosilicate

Indications

Sodium Zirconium Cyclosilicate is used for: Hyperkalemia

Adult Dose

Hyperkalemia Indicated for hyperkalemia Initial: 10 g PO TID for up to 48 hr Maintenance 10 g PO qDay May titrate based on serum potassium level and desired target range at intervals of 1 week or longer and in increments of 5 g Dosing may range from 5 g every other day to 15 g qDay); not to exceed 15 g/day

Child Dose

Renal Dose

Administration

Empty the entire contents of the packet(s) into a drinking glass containing ~3 tablespoons of water or more if desired Stir well and drink immediately If powder still remains in the drinking glass, add water, stir, and drink immediately; repeat until no powder remains to ensure the entire dose is taken

Contra Indications

Precautions

Avoid with severe constipation or bowel obstruction or impaction, including abnormal postoperative bowel motility disorders; safety and efficacy not studied in these patients and may be ineffective and may worsen GI conditions Each 5-g dose of sodium zirconium cyclosilicate contains ~400 mg of sodium; in clinical trials, mild-to-moderate edema was more commonly seen in patients treated with 15 g qDay; monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure, renal disease); increase diuretic dose as needed

Pregnancy-Lactation

Pregnancy Not absorbed systemically following oral administration and maternal use is not expected to result in fetal exposure to the drug Lactation Not absorbed systemically following oral administration, and breastfeeding is not expected to result in exposure to the child

Interactions

Transient changes of gastric pH Sodium zirconium cyclosilicate transiently increases gastric pH, which can change the absorption of coadministered drugs that exhibit pH-dependent solubility, potentially leading to altered efficacy or safety of these drugs when coadministered In general, other oral medications whose solubility is pH-dependent should be administered at least 2 hr before or after sodium zirconium cyclosilicate

Adverse Effects

Side effects of Sodium Zirconium Cyclosilicate : >10% Edema (4.4-16.1%) 1-10% Hypokalemia (4.1%)

Mechanism of Action

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