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

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.