sodium zirconium cyclosilicate


soe-dee-um zir-koe-nee-um sye-kloe-sil-i-kate

Trade Name(s)

  • Lokelma

Ther. Class.
electrolyte modifiers

Pharm. Class.
cationic exchange resins




Exchanges hydrogen and sodium ions for potassium ions in the intestine.

Therapeutic Effect(s):

Reduction of serum potassium concentrations.


Absorption: Not systemically absorbed.

Distribution: Not distributed.

Metabolism and Excretion: Does not undergo metabolism; eliminated in the feces.

Half-life: Unknown.

TIME/ACTION PROFILE (decrease in serum potassium concentrations)

PO1 hrunknown48 hr


Contraindicated in:

  • Severe constipation, bowel obstruction/impaction, post-operative motility disorders (ineffective and may worsen condition).

Use Cautiously in:

  • Heart failure or renal impairment (sodium content may cause edema);
  • Pedi:  Safety and effectiveness not established.

Adverse Reactions/Side Effects

CV: edema

F and E: hypokalemia

* CAPITALS indicate life-threatening.
Underline indicate most frequent.



May ↓ absorption of any medications that have pH-dependent absorption (↑ gastric pH); administer other oral medications ≥2 hr before or after sodium zirconium cyclosilicate.


PO (Adults): 10 g 3 times daily in water for up to 48 hr, then 10 g once daily (if treatment continued beyond 48 hr); may titrate chronic therapy in increments of 5 g at 1–wk intervals (recommended maintenance dose range = 5–15 g once daily).


Oral suspension: 5 g/pkt, 10 g/pkt


  • Assess bowel patterns prior to administration. Avoid use patients with severe constipation and bowel obstruction or impaction, including abnormal postoperative bowel motility disorders.
  • Monitor for signs of edema, particularly in patients with sodium restriction or prone to fluid overload (heart failure, renal disease). Each dose contains 400 mg of sodium. Advise patients to adjust dietary sodium, if appropriate. Increase dose of diuretics as needed.

Lab Test Considerations:

Monitor serum potassium frequently during therapy.

Potential Diagnoses


  • Sodium zirconium cyclosilicate is not used as emergency treatment for life-threatening hyperkalemia due to delayed action.
  • PO Empty entire contents of packet(s) into drinking glass with at least 3 tablespoons of water. Stir well and drink immediately. If powder remains in glass, add water, stir and drink immediately. Repeat until no powder remains to ensure entire dose is taken.
  • Administer other oral medications at least 2 hr or 2 hr after sodium zirconium cyclosilicate.

Patient/Family Teaching

  • Instruct patient to take medication as directed.
  • Advise patient to modify dietary sodium intake, if needed.
  • Inform patient of need to take other oral medications 2 hr before or 2 hr after sodium zirconium cyclosilicate
  • Advise patient to notify health care professional if edema or constipation occur.

Evaluation/Desired Outcomes

Normalization of serum potassium levels.

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