Adult Dosing

Hyperkalemia

• 15 g PO qd-qid; may be administered through a nasogastric tube and mixed with an appropriate diet, if desired, for renal failure patients
• Each dose is given as a suspension in a small quantity of water or in syrup for greater palatability
• Fluid amount ranges, depending on the dose, from 20-100 mL, or may be determined by allowing 3-4 mL/g of resin
• Intensity and duration of therapy depend upon the severity and resistance of hyperkalemia

Note:

• Maintain the patient in an upright position while administering the resin
• Do not heat, as it may alter the exchange properties of the resin

Pediatric Dosing

Hyperkalemia [Non-FDA Approved]

• Infants/children
• 1 g/kg PO q6 hrs or use a rate of 1 mEq of potassium/1 g resin as a guide to calculate dose
• Each dose is given as a suspension in a small quantity of water or in syrup for greater palatability
• Fluid amount ranges, depending on the dose, from 20-100 mL, or may be determined by allowing 3-4 mL/g of resin
• Intensity and duration of therapy depends upon the severity and resistance of hyperkalemia

Note:

• Safety and effectiveness in pediatric patients have not been established
• Observe particular care in premature infants or low birth weight infants due to the risk of digestive hemorrhage or intestinal necrosis
• Maintain the patient in an upright position while administering the resin
• Do not heat, as it may alter the exchange properties of the resin

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of hyperkalemia

• Hypersensitivity to any of the ingredients of the product
• Hypokalemia
• Obstructive bowel disease
• Neonates with reduced gut motility (postoperatively or drug induced)
• Oral use in neonates
• Risk of developing constipation
• Chronic constipation
• Risk of fecal impaction
• Inflammatory bowel disease
• Ischemic colitis
• Vascular intestinal atherosclerosis
• Post-operative patients until normal bowel function resumes
• History of bowel resection
• History of bowel obstruction

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined, caution advised

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Intestinal necrosis, which may be fatal, and other serious gastrointestinal adverse events (bleeding, perforation, ischemic colitis) have been reported with this drug. However, majority of these cases were associated with concomitant sorbitol use. Risk factors for GI adverse events included prematurity, history of intestinal disease or surgery, hypovolemia, renal insufficiency and failure. It is advised not to use sorbitol concomitantly
• Use only in patients with normal bowel function; do not use in patients who have not had a bowel movement post-operatively
• Not recommended in patients who are at risk for developing constipation or impaction including those with history of impaction, chronic constipation, inflammatory bowel disease, ischemic colitis, vascular intestinal atherosclerosis, previous bowel resection, or bowel obstruction. Discontinue therapy in case of constipation
• Risk for developing serious potassium deficiency may be associated with this therapy; monitor serum potassium levels frequently within each 24-hour period. Intracellular potassium deficiency is not always reflected by serum potassium levels; hence, the level at which therapy should be discontinued must be determined individually for each patient. Patient’s clinical condition and ECG may be used as important aids in making this determination
• ECG changes of severe hypokalemia include a lengthened Q-T interval, widening, flattening, or inversion of the T wave, and prominent U waves. Cardiac arrhythmias such as premature atrial, nodal, and ventricular contractions, and supraventricular and ventricular tachycardias may also occur. Toxic effects of digitalis are likely to be exaggerated
• Significant hypokalemia may also be manifested by severe muscle weakness and even frank paralysis
• In case of severe hyperkalemia associated with states of rapid tissue breakdown (e.g., burns and renal failure) or hyperkalemia requiring emergency treatment, consider using an alternative therapy including dialysis, as sodium polystyrene sulfonate alone may be insufficient to rapidly correct severe hyperkalemia
• Patients receiving therapy should be monitored for all applicable electrolyte disturbances as this drug is not totally selective (for potassium) in its actions, and small amounts of other cations such as magnesium and calcium can also be lost during therapy
• Cases of systemic alkalosis have been reported after cation-exchange resins were administered orally in combination with nonabsorbable cation-donating antacids and laxatives such as magnesium hydroxide and aluminum carbonate. It is recommended not to administer magnesium hydroxide with this drug

Cautions: Use cautiously in

• Renal impairment
• Premature or low birth weight infants
• Pediatric patients
• Elderly patients
• History of GI disease or surgery
• End stage diabetic renal disease
• Severe CHF
• Severe hypertension
• Marked edema
• Hypernatremia
• Sodium restriction
• Severe hyperkalemia
• Hypovolemia

Pregnancy Category:C

Breastfeeding: Safety unknown. Manufacturer advises caution.

• CNS: Seizure
• GI: Gastric irritation, anorexia, nausea, vomiting, constipation, fecal impaction, diarrhea, intestinal obstruction, intestinal necrosis, GI bleed, ischemic colitis, GI perforation
• METABOLIC: Severe hypokalemia, hypocalcemia, hypomagnesemia, significant sodium retention, severe metabolic alkalosis

• Potassium-removing resin; binds excess potassium mainly in the large intestine to form indigestible potassium polystyrene sulfonate complex which is eliminated in feces, thus preventing the absorption of potassium into the blood stream and thereby decreasing serum potassium level
• Not absorbed following oral administration
• Eliminated in feces
• Half-life: Unknown

US Trade Name(s)

• Kalexate
• Kayexalate
• Kionex
• SPS

US Availability

sodium polystyrene sulfonate (generic)

• PWDR for SUSP: 454 g/bottle
• PWDR for SUSP: 453.6 g/bottle
• SUSP: 15 g/60mL

Kalexate

• PWDR for SUSP: 454 g/bottle

Kayexalate

• PWDR for SUSP: 453.6 g/bottle

Kionex

• SUSP: 15 g/60mL
• PWDR for SUSP: 454 g/bottle

SPS

• SUSP: 15 g/60mL

Canadian Trade Name(s)

• K-Exit Poudre
• Kayexalate
• Solystat

Canadian Availability

sodium polystyrene sulfonate (generic)

• PWDR: 94.3 mg/g

K-Exit Poudre, Kayexalate

• PWDR for SOLN: 100%

Solystat

• SUSP: 250 mg/mL

UK Trade Name(s)

• Resonium A

UK Availability

Resonium A

• PWDR for SUSP: 454 g

Australian Trade Name(s)

• Resonium A

Australian Availability

Resonium A

• PWDR for SUSP: 454 g

[Outline]

Miscellaneous

Minerals & Electrolytes

Pricing data from www.DrugStore.com in U.S.A.

• Kayexalate POWD [Jar] (SANOFI-AVENTIS U.S.)
  453.6 = $403.92
  1360.8 = $1182.59
• Sodium Polystyrene Sulfonate POWD [Jar] (CAROLINA MEDICAL PRODUCTS)
  454 = $142.97
  1362 = $416.89

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.