Lokelma vs Kayexalate - summarizes the major differences between Lokelma and kayexalate. Lokelma is the brand name of Sodium zirconium cyclosilicate. It is a novel drug used to treat chronic hyperkalemia.
Another drug recently approved for the treatment of hyperkalemia is Patiromer (Veltassa). Until now, treatment of hyperkalemia focused on dietary restriction, avoiding drugs that cause hyperkalemia, drugs acting via the renal tubules such as diuretics, and increasing potassium elimination via the gastrointestinal tract with sodium polystyrene sulfonate or kayexalate.
The novel drugs Lokelma (Sodium Zirconium cyclosilicate) and Patiromer (Veltassa) have been approved by both the FDA and EMA for the chronic treatment of hyperkalemia. Their efficacy has been confirmed in various clinical trials.
What is Lokelma (Sodium Zirconium Cyclosilicate)?
It is an orally administered drug available as a powder formulation. It is tasteless and odorless. Before administering, it is mixed with water to form a soluble suspension. Lokelma acts within the whole gastrointestinal tract.
It acts by binding potassium within the gastrointestinal tract in exchange for Sodium and Hydrogen ions resulting in the excretion of potassium ions. Lokelma (Sodium Zirconium Cyclosilicate) is a highly selective inorganic molecule that acts immediately after ingestion. It does not bind calcium and magnesium ions and is not systemically absorbed.
What is Kayexalate (Sodium polystyrene sulfonate)?
Kayexalate (sodium polystyrene sulfonate) is a potassium-binding resin. It was approved in 1958 when clinical efficacy and safety were not measured in clinical trials prior to approval. It removes potassium ions in exchange for sodium ions in the intestine (in particular the large intestine).
It has an onset of action of 2 - 24 hours and is not absorbed into the systemic circulation. Because it is a sodium-containing resin, it may cause hypernatremia. Furthermore, it is a non-specific resin, therefore, it binds calcium, magnesium, and potassium.
Hence it may result in hypocalcemia and hypomagnesemia. It may also result in some serious side effects like intestinal ulceration, perforation, and ischemic colitis.
Lokelma vs Kayexalate - The main differences
Lokelm and Kayexalate are both resins that lower plasma potassium by inhibiting their absorption. Another potassium-lowering drug that is considered safer than kayexalate is Veltassa (Read: Veltassa vs Kayexalate).
Below is a table comparing Lokelma (Sodium Zirconium Cyclosilicate) and Kayexalate (Sodium Polystyrene sulfonate) [Ref]:
Lokelma vs Kayexalate
Lokelma (Sodium Zirconium cyclosilicate) |
Kayexalate (sodium polystyrene sulfonate) |
|
|
Date of FDA approval |
May 2018 |
June 1958 |
|
Date of EMA approval |
March 2018 |
NA |
|
Chemical properties |
|
|
|
Sodium content |
80 mg/gm |
100 mg/gm |
|
Mechanism of action |
Preferentially captures K+ in exchange for hydrogen and sodium |
Sodium-K+ exchange resin/polymer, nonspecifically binds K+, magnesium, and calcium |
|
Onset of action |
1 hour |
Hours to days |
|
Dose |
Initial:
Maintenance:
Usual maintenance dose:
|
15 g (4 level teaspoons) 1 - 4 times a day |
|
Preparation |
Combine powder with 45 mL ( 3 tablespoons ) of water, stir well, and drink immediately |
Combine with a small quantity of water or for greater palatability, the syrup may also give by a nasogastric tube or as an enema |
|
Administration |
Can be taken with or without food |
Oral suspension or enema |
|
Appearance and texture |
Free-flowing, odorless, insoluble white powder for oral suspension |
Cream to light brown finely ground powder |
|
storage |
15 - 30 C (59 - 86 F) |
25 C (77 F, excursions to 15 - 30 C permitted) |
|
Site of K+ binding |
GI tract |
GI tract or colon when administered by enema |
|
Adverse effects |
Edema (mild to moderate) hypokalemia |
|
|
Drug interactions |
Oral medications that exhibit pH-dependent solubility should be administered 2 h before or 2 h after their administration |
|
Sodium Zirconium cyclosilicate (Lokelma) and Patiromer have proven efficacy and safety in major trials, notably the Harmonize and Harmonize-GL trials.
