Usual Adult Dose for Hyperkalemia

Initial dose: 10 g orally 3 times a day for up to 48 hours, then 10 g orally once a day

• Dose may be adjusted based on serum potassium level and desired target range; dose may be up-titrated at weekly or greater intervals in 5 g increments

• This drug should not be used for the emergency treatment of life-threatening hyperkalemia because of its delayed onset of action.
• Normal potassium levels are generally achieved within 24 to 48 hours; once normal potassium levels are achieved, the minimal effective maintenance dose should be established.
• Dose should be decreased or discontinued if serum potassium is below the desired target range.

Renal Dose Adjustments

No adjustment recommended; see dialysis section for dosing for patients on chronic hemodialysis

Liver Dose Adjustments

No adjustment recommended

Precautions

CONTRAINDICATIONS: None

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

For Patients on Chronic Hemodialysis:
Initial dose: 5 g orally once a day on non-dialysis days; if serum potassium is greater than 6.5 mEq/L, may consider a starting dose of 10 g orally once a day on non-dialysis days

• Monitor serum potassium and adjust dose based on pre-dialysis serum potassium after the long inter-dialytic interval
• Maintenance dose: 5 g to 15 g once daily on non-dialysis days

Other Comments

Administration advice:

• Take orally as a suspension in water
• Other oral medications should be administered at least 2 hours before or 2 hours after this drug (see general comments)

• Empty entire contents of packet(s) into approximately 3 tablespoons of water or more; stir well and drink immediately; if powder remains, add water, stir and drink, repeat until no powder remains

• This drug may transiently increase gastric pH; therefore, the absorption of drugs that exhibit pH-dependent solubility may be altered when taken at the same time as this drug. In general, other oral medications should be administered at least 2 hours before or 2 hours after taking this drug unless the concomitantly administered drug does not exhibit pH-dependent solubility.
• This drug should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

• Monitor serum potassium levels and adjust dose based on desired target range
• For patients on chronic hemodialysis, monitor serum potassium after the long inter-dialytic interval; during therapy initiation and after a dose adjustment, assess serum potassium after 1-week
• Monitor for signs of edema

• Patients should be instructed on proper reconstitution and administration of this drug.
• Patients on dialysis should be instructed to contact their healthcare provider if they experience an acute illness such as diarrhea or an illness that decreases their oral intake of food or fluids as their dose may need to be adjusted.
• Patients should be advised to separate dosing of other medications by 2 hours (before or after).
• Patients may need to adjust dietary sodium; if they have questions, they should speak to their healthcare provider.
• Patients should be instructed to notify their physician prior to an abdominal X-ray.

Frequently asked questions

• How does the drug Lokelma work?