Drug Action
Sodium zirconium cyclosilicate is a non- absorbed cation-exchange compound that acts as a selective potassium binder in the gastro-intestinal tract.
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Drug reference
Sodium zirconium cyclosilicate is a non- absorbed cation-exchange compound that acts as a selective potassium binder in the gastro-intestinal tract.
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Hyperkalaemia ▶BY MOUTH ▶Adult: Initially 10 g 3 times a day, for up to 72 hours, followed by maintenance 5 g once daily, adjusted according to serum-potassium concentrations. The usual maintenance dose range is 5 g once every other day to 10 g once daily
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▶Onset of action about 1 hour.
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Abdominal X-ray (sodium zirconium cyclosilicate may be opaque to X-rays)
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NICE decisions ▶Sodium zirconium cyclosilicate for treating hyperkalaemia (September 2019) NICE TA599 Sodium zirconium cyclosilicate (Lokelma ®) is recommended as an option for treating hyperkalaemia in adults only if used in emergency care for acute life- threatening hyperkalaemia alongside standard care, or in outpatient care for patients with persistent hyperkalaemia and chronic kidney disease stage 3b to 5 or heart failure, if they: . have a confirmed serum potassium level of at least 6.0 mmol/litre . are not taking an optimised dosage of renin- angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia, and . are not on dialysis. Sodium zirconium cyclosilicate is recommended only if the manufacturer provides it according to the commercial arrangement. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta599 Scottish Medicines Consortium (SMC) decisions SMC No. SMC2233 The Scottish Medicines Consortium has advised (February 2020) that sodium zirconium cyclosilicate (Lokelma ®) is not recommended for use within NHS Scotland for the treatment of hyperkalaemia in adults as the economic case was not demonstrated.
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→Appendix 1: sodium zirconium cyclosilicate
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▶Common or very common Fluid imbalance. oedema. peripheral swelling ▶Frequency not known Constipation. nausea
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Manufacturer advises avoid—limited information; animal studies do not indicate toxicity.
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Manufacturer advises monitor serum potassium as clinically indicated.
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Manufacturer advises mix the contents of each 5- or 10-g sachet of powder with approx. 45 mL of water and stir well. The powder will not dissolve and the suspension should be taken while it is cloudy; if the powder settles it should be stirred again.
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There can be variation in the licensing of different medicines containing the same drug. Powder CAUTIONARY AND ADVISORY LABELS 13 A ▶Lokelma (AstraZeneca UK Ltd) Sodium zirconium cyclosilicate 5 gram Lokelma 5g oral powder sachets | 30 sachet P £213.60 Sodium zirconium cyclosilicate 10 gram Lokelma 10g oral powder sachets | 3 sachet P £42.72 | 30 sachet P £427.20 1.5b Hypokalaemia ELECTROLYTES AND MINERALS › POTASSIUM
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Initially 10 g 3 times a day, for up to 72 hours,
First-line fragment. Read the complete Indications and Dose section above.
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