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Lokelma (Sodium Zirconium Cyclosilicate) - Indications, Side effects, MOA

Lokelma is the brand name of sodium zirconium cyclosilicate. It binds to potassium in the gastrointestinal tract inhibiting its absorption.

Lokelma (Sodium Zirconium cyclosilicate) Uses:

It is used to treat adult patients with hyperkalemia.

Caution: It should not be used in emergency settings for life-threatening hyperkalemia because of its delayed onset of action.

Patiromer (Valtessa) is another novel drug used to treat hyperkalemia.

Lokelma (Sodium Zirconium Cyclosilicate) Dose in Adults

10 gms orally thrice daily for up to 48 hours.
The dose is then adjusted by 5 gms daily at an interval of one week if needed based on the serum potassium levels.
The maintenance dose is 10 gms once a day ranging from 5 gms on alternate days to 15 gms once a day to a maximum maintenance dose of 15 gms/day.

Lokelma (Sodium Zirconium Cyclosilicate) Use in Children:

Dosage in children is not established.

Lokelma pregnancy risk category: B

Since sodium zirconium cyclosilicate is not absorbed, therefore, adverse fetal outcomes are not expected to occur as exposure to the fetus would not occur.

Sodium zirconium cyclosilicate use during breastfeeding:

Sodium zirconium cyclosilicate is not systemically absorbed, therefore, distribution into breast milk would not be expected.

Sodium Zirconium Cyclosilicate Dose in Kidney Disease:

The manufacturer has not recommended any adjustment in the dose in patients with Kidney disease.

Sodium Zirconium Cyclosilicate Dose in Liver Disease:

The manufacturer has not recommended any adjustment in the dose in patients with liver disease.

Common Side Effects of Lokelma (Sodium zirconium cyclosilicate):

Cardiovascular:
- Edema

Less Common Side Effects of Sodium zirconium cyclosilicate:

Endocrine & metabolic:
- Hypokalemia

Contraindications to Lokelma (Sodium zirconium cyclosilicate):

The manufacturer has not listed any contraindications to the use of sodium zirconium cyclosilicate.

Warnings and Precautions

Edema:
- Mild to moderate leg swelling may develop especially in patients who are treated with higher doses of the drug.
- The patient should be monitored for leg swelling particularly those who are prone to fluid overload such as patients with heart failure and kidney disease.
GI motility disorders:
- Lokelma may be ineffective and worsen the following underlying gastrointestinal problems:
  - severe constipation
  - bowel obstruction or impaction, including post-operative abnormal bowel motility disorders.

Sodium zirconium cyclosilicate: Drug Interaction

Risk Factor D (Consider therapy modification)
Clopidogrel	Sodium Zirconium Cyclosilicate may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Separate the administration of sodium zirconium cyclosilicate and clopidogrel by at least 2 hours.
Dabigatran Etexilate	Sodium Zirconium Cyclosilicate may decrease the serum concentration of Dabigatran Etexilate. Management: Separate the administration of sodium zirconium cyclosilicate and dabigatran by at least 2 hours.
Warfarin	Sodium Zirconium Cyclosilicate may increase the serum concentration of Warfarin. Management: Separate the administration of sodium zirconium cyclosilicate and warfarin by at least 2 hours. If simultaneous administration is required, monitor for signs and symptoms of warfarin toxicity (eg, elevated INR, bleeding).

Monitor:

Serum potassium
leg swelling

How to administer Lokelma (Sodium zirconium cyclosilicate)?

It is administered orally. The contents of the packet are emptied into a glass of water (minimum 45 ml or ≥3 tablespoons of water.
Stir the contents well and drink immediately. If any powder remains in the glass, add more water, stir, and drink immediately.
Repeat until no powder remains. Other oral medications should be administered at least 2 hours before or 2 hours after the dose.
It can also be administered via an NG tube. Mix the contents of the packet in a glass of water and administer via a nasogastric tube.

Mechanism of action (MOA) of Lokelma (Sodium zirconium cyclosilicate):

Sodium zirconium cyclosilicate is a potassium binder.
It preferentially exchanges potassium for sodium and hydrogen ions.
The binding of Sodium zirconium cyclosilicate to potassium reduces its concentration in the gastrointestinal lumen thus lowering the serum potassium levels.

The onset of action: 1 hour

Absorption: It is not systemically absorbed

Metabolism: None

Excretion: Feces

International Brands of Sodium zirconium cyclosilicate:

Lokelma

Sodium Zirconium Cyclosilicate Brands in Pakistan:

Sodium Zirconium cyclosilicate is not available in Pakistan.