Sodium zirconium cyclosilicate (Lokelma) is a drug that binds potassium. Potassium binders are used to treat a condition called hyperkalemia, which is when you have too much potassium in your blood.

Hyperkalemia is more common in people with kidney disease, heart failure, high blood pressure and diabetes. It's also more common in people who eat a diet high in potassium-rich foods and take drugs that prevent the removal of potassium, including some drugs for your heart or blood pressure.

Potassium is found in certain foods and drinks and is an important nutrient that helps keep your body working well, including your heart, nerves, muscles, bones and digestive system.

Sodium zirconium cyclosilicate works quickly to reduce your potassium levels by binding to potassium in your digestive tract, so that it isn't absorbed into your blood stream.

Sodium zirconium cyclosilicate was approved by the US Food and Drug Administration (FDA) in 2018.

What is sodium zirconium cyclosilicate used for?

Sodium zirconium cyclosilicate is a prescription medication used to treat adults with hyperkalemia.

Sodium zirconium cyclosilicate should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

Sodium zirconium cyclosilicate can cause swelling (edema) caused by fluid retention in your body (such as hands, ankles, feet).

• Sodium zirconium cyclosilicate contains 400 mg of sodium in each 5 g dose. Watch for signs of swelling in your body especially if you limit sodium in your diet or are likely to have fluid retention in your body due to heart or kidney problems. Your doctor may tell you to reduce the sodium in your diet
• If you are not on dialysis, your doctor may also tell you to increase the dose of your diuretic

If you are a hemodialysis patient:

• Do not take sodium zirconium cyclosilicate on dialysis days
• Tell your doctor if you suddenly feel sick such as decreased oral intake of food or fluids or diarrhea, as you may be at risk of developing low levels of potassium in your blood while on sodium zirconium cyclosilicate. If you happens your dose of sodium zirconium cyclosilicate may need to be adjusted

Tell your doctor(s) you are taking sodium zirconium cyclosilicate before having an abdominal X-ray as it may appear on the X-ray.

• Take sodium zirconium cyclosilicate exactly as prescribed by your healthcare professional.
• During treatment with sodium zirconium cyclosilicate your doctor may monitor your potassium levels and adjust your dose.
• Initial treatment for people not on dialysis: Take one 10 g packet 3 times per day for up to 48 hours.
• Maintenance treatment of people not on dialysis: Take one 10 g packet once per day.
• If you are on dialysis: Take one 5 g packet once a day on non-dialysis days.
• Do not take sodium zirconium cyclosilicate on dialysis days.
• Sodium zirconium cyclosilicate can be taken with or without food.
• You may need to take your other medications 2 hours before or 2 hours after sodium zirconium cyclosilicate. Check with your doctor.

To make up a dose of sodium zirconium cyclosilicate:

• Fill a cup with at least 3 tablespoons of water.
• Empty the entire contents of your prescribed packet of sodium zirconium cyclosilicate into the cup.
• Stir the contents of the cup well and drink it straight away.
• If any powder is left in the cup, add more water, mix well and drink it.

• The recommended starting dose of sodium zirconium cyclosilicate is 10 g administered three times a day for up to 48 hours.
• For maintenance treatment, the recommended dose of sodium zirconium cyclosilicate is 10 g once daily. Adjust the dose at one-week intervals as needed (by 5 g daily) to obtain desired serum potassium target range.
• For patients on chronic hemodialysis the recommended starting dose of sodium zirconium cyclosilicate is 5 g once daily on non-dialysis days.
• See full Prescribing Information for additional dosing instructions, as well as reconstitution and administration instructions for the oral suspension.

Do not take sodium zirconium cyclosilicate if you are allergic to sodium zirconium cyclosilicate or any of the other ingredients in it. See below for a complete list of ingredients.

What should I tell my doctor before taking sodium zirconium cyclosilicate?

Before taking sodium zirconium cyclosilicate, tell your doctor about all your medical conditions, including

• problems having a bowel movement, including severe constipation, a blockage (obstruction) in your bowel, or dry hard stool that will not pass out of your rectum (impaction)
• problems with your bowels after surgery

The most common side effect of sodium zirconium cyclosilicate is swelling in your body caused by fluid retention. Tell your doctor if you have any side effects that bother you or do not go away

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Sodium zirconium cyclosilicate may affect how some oral medicines work. Ask your doctor or pharmacist if you need to take sodium zirconium cyclosilicate 2 hours before or after other oral medicines