Lokelma
Lokelma
Generic Name
Lokelma
Mechanism
- Potassium‑specific ion exchange: Each polymer cage contains zirconium and silicon that preferentially bind potassium ions over sodium or chloride in the gastrointestinal tract.
- Selective clearance: The bound K⁺ is excreted fecally, reducing intestinal re‑absorption and shifting plasma potassium toward the extracellular space.
- Rapid onset: Peak urinary potassium excretion occurs within 30 minutes after dosing, with a maintained effect for up to 24 h.
Pharmacokinetics
| Parameter | Typical Value | Notes |
| Absorption | Minimal systemic absorption; primarily remains in gut lumen | 95 % of drug remains non‑absorbed |
| Distribution | No significant tissue distribution; confined to GI tract | |
| Metabolism | None (non‑metabolizable polysaccharide) | |
| Elimination | Fecal excretion of un‑absorbed polymer | Renal function does not alter clearance |
| Half‑life | Not applicable (due to negligible systemic exposure) | Patient safety depends on renal function for drug dosing |
| CYP interaction | None | No dose adjustments for CYP inhibitors or inducers |
Indications
- Acute or chronic hyperkalemia in adults with or without renal impairment, including CKD stages 1–5.
- Hyperkalemia associated with:
- Renal failure (including post‑transplant and autosomal dominant polycystic kidney disease).
- Heart failure or cardiovascular disease with impaired renal clearance.
- Adjunct therapy to allow use of RAAS inhibitors or other potassium‑elevating agents.
Contraindications
- Absolute contraindication: None.
- Precautions:
- Severe hypokalemia – avoid use as it may worsen low potassium.
- Hypotension or severe cardiovascular compromise: monitor BP due to potential volume shifts.
- Patients on systemic potassium replacements requiring urgent reversal may need combined therapies.
- Warnings:
- Monitor serum potassium; overdosing can cause permanent hypokalemia.
- Possible fluid retention in patients with heart failure – evaluate weight and edema.
Dosing
| Condition | Dose | Frequency | Route | Notes |
| Acute hyperkalemia | 15 g orally, divided into 5 g doses every 4–6 h | Up to 3 doses in 24 h | Oral | Rapid potassium reduction; reassess each dose |
| Maintenance (CKD or heart failure) | 7.5 g every 12 h (15 g/day) | Twice daily | Oral | Tailor dose frequency to potassium trend |
| Titration | Adjust by ±7.5 g increments every 24 h | Based on serum potassium goal | ||
| Renal impairment | Same starting dose; monitor closely; do not dose > 30 g/day | No formal dose adjustment needed |
• Administration: Take with food or between meals; can be taken with or without water, ensuring full swallow of tablets.
• Discontinuation: Stop when sodium levels fall below target or if adverse events arise.
Adverse Effects
- Common
- Constipation
- Headache
- Nausea
- Fatigue
- Diarrhea (rare)
- Serious
- Hypokalemia → muscle weakness, arrhythmias
- Hypotension (rare)
- Fluid overload in heart‑failure patients
- Rare allergic reactions (rash, anaphylaxis)
Monitoring
- Serum potassium: baseline, 4–6 h after first dose, then 12 h; adjust dosing accordingly.
- Electrolytes: sodium, chloride, calcium, magnesium (pre‑ and post‑therapy).
- Renal function: eGFR or serum creatinine (baseline, follow‑up).
- Blood pressure & weight: especially in heart‑failure or CKD‑5 patients.
- Cardiac rhythm: ECG for patients with arrhythmia risk.
Clinical Pearls
- Rapid reversal tool: When patients on RAAS inhibitors present with impending hyperkalemia (> 6 mEq/L), Lokelma can be used to lower potassium quickly, allowing continuation of lifesaving blockers.
- Avoid synergy with other potassium binders: Combining with patiromer or sodium polystyrene sulfonate may increase the risk of hypokalemia or gastrointestinal side effects; use only if additive effect is clinically justified.
- Dose timing matters: If a patient takes a high‑potassium meal, give *Lokelma* as soon as possible (within 1 h) to mop up late‑absorbed ions.
- Fluid balance: Because the polymer can bind water, monitor fluid status in fluid‑restricted patients to avoid hidden volume shifts.
- Not for dialysis: In patients on hemodialysis, rely on dialysis for potassium removal; Lokelma offers no advantage and may add unnecessary cost.
- Patient education: Emphasize that Lokelma does not replace dietary potassium restrictions; ongoing dietary advice remains essential.
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• *This drug card is intended for educational purposes and should not replace professional clinical judgement or prescribing guidelines. Always consult product labeling and local protocols before prescribing.*