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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

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My daughter bled into the brain. She lived for another two years and ultimately died.

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Patiromer (Veltassa) Vs Kayexalate - Dose, Mechanism (MOA), Side effects

Patiromer (Veltassa) is an orally administered potassium-binding resin that has been approved by the FDA in 2015 for the treatment of hyperkalemia.

Patiromer (Veltassa) Uses:

It is indicated in patients with hyperkalemia due to kidney disease, diabetes, hypertension, heart failure, and patients receiving inhibitors of the renin-angiotensin-aldosterone system.

It is not indicated for the treatment of acute and life-threatening hyperkalemia that requires emergency treatment. Other drugs that are used in the chronic management of hyperkalemia include sodium zirconium cyclosilicate and Kayexalate.

Compared to Kayexalate, Patiromer is a better option in patients who are sensitive to sodium as in patients with cirrhosis and heart failure.

Veltassa vs kayexalate/ Patiromer vs kayexalate:

Drugs	Kayexalate	Patiromer (Veltassa)
FDA Approval	FDA approved	FDA Approved
Mechanism of action	Nonspecific sodium-cation exchange resin	Calcium-potassium cation exchange resin
Formulation	Available as Oral suspension, Powder, and Rectal enema	Available as Oral Suspension
Onset of action	1 – 2 hours	7 hours
Dosage	15 – 60 gms/day orally in 1 – 4 divided doses 30 – 50 gms/day rectally (up to 4 times per day)	8.4 – 25.2 gms once a day
Side effects	Constipation Diarrhea Nausea Vomiting Gastric irritation Hypokalemia Hypomagnesemia Hypocalcemia Systemic alkalosis	Constipation Diarrhea Nausea Vomiting Flatulence Hypokalemia Possible calcium load Hypomagnesemia
Serious side effects	Necrosis of the colon	None

A comparison of Lokelma (Sodium Zirconium Cyclosilicate) and Kayexalate is written in detail here: Lokelma vs Kayexalate for the treatment of Hyperkalemia.

Patiromer (Veltassa) Dose in Adults

(Patiromer) Veltassa dose in the treatment of Hyperkalemia:

8.4 g orally once a day.
The dose should be adjusted at weekly intervals in increments of 8.4 g to the maximum dose of 25.2 g/day.

Veltassa Use in Children:

Not studied in children.

Patiromer pregnancy risk category: B

It is not systemically absorbed, and it does not cause adverse fetal outcomes during pregnancy.

Patiromer use during breastfeeding

Because the drug is not systemically absorbed during breastfeeding, it does not pose any risk to the child.

Patiromer Dose in Kidney Disease:

Adjustment in the dose is not necessary for patients with kidney impairment.

Patiromer Dose in Patients with Liver Disease:

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

Side Effects of Patiromer (Veltassa):

Endocrine & Metabolic:
- Hypomagnesemia
- Hypokalemia
Gastrointestinal:
- Constipation
- Diarrhea
- Abdominal Distress
- Flatulence
- Nausea

Contraindications to Patiromer (Veltassa):

Allergy to Patiromer, or any component of this formulation

Warnings and precautions

GI effects
- Avoid its use in patients with severe constipation, acute abdomen, severe constipation, stool impurity, or bowel impaction.
- Postoperative ileus should be free of it.
- These conditions may make it ineffective or worsen the underlying gastrointestinal conditions.
Hypomagnesemia:
- It binds with magnesium in the colon and is excreted via feces.
- Hypomagnesemia may occur, which may need to be supplemented.
- It is important to monitor magnesium levels during Patiromer therapy.

Patiromer: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor D (Consider therapy modification)

Ciprofloxacin (Systemic)
Levothyroxine
Metformin

Patiromer lowers the plasma levels of these drugs.

Management: It is better to administer these drugs either 3 hours before or 3 hours after Veltassa.

Monitoring Parameters:

Serum potassium and magnesium.

How to administer Patiromer (Veltassa)?

It is an odorless and tasteless powder that may be mixed with water or food and administered orally.
It should not be administered in its dry form. After reconstituting it with water or food, it should be immediately administered.
To ensure the full dose is administered, remix any powder remaining in the glass and drink it immediately after stirring it.
The drug should not be heated as in a microwave or added to heated or boiling water or liquids.
Other medicines should be administered at least 3 hours after or before the administration of Patiromer.

Patiromer Mechanism of action (MOA):

It is most active in the distal colon, where potassium ions are highest. It reduces the intake of potassium from the diet and increases excretion via feces.

The onset of action is about 7 hours

The duration of action is about 24 hours.

It is not absorbed and excreted via the feces.

International Brands of Patiromer:

Veltassa

Patiromer Brand Names in Pakistan:

It is not available in Pakistan.