sodium polystyrene sulfonate

ROUTE	ONSET	PEAK	DURATION
PO	2–12 hr	unknown	6–24 hr
Rectal	2–12 hr	unknown	4–6 hr

Contraindicated in:

Life-threatening hyperkalemia (other, more immediate measures should be instituted);
Hypersensitivity to saccharin or parabens (some products);
Ileus;
Abnormal bowel function (↑ risk for intestinal necrosis);
Postoperative patients with no bowel movement (↑ risk for intestinal necrosis);
History of impaction, chronic constipation, inflammatory bowel disease, ischemic colitis, vascular intestinal atherosclerosis, previous bowel resection, or bowel obstruction (↑ risk for intestinal necrosis);
Known alcohol intolerance (suspension only).

Use Cautiously in:

HF;
Hypertension;
Edema;
Sodium restriction;
Constipation.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema

F and E: hypocalcemia, hypokalemia, hypomagnesemia

GI: constipation, fecal impaction, anorexia, gastric irritation, INTESTINAL NECROSIS, ischemic colitis, nausea, vomiting

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of any other orally administered medication; administer sodium polystyrene sulfonate ≥3 hr before or after other oral medications (≥6 hr for patients with gastroparesis).
Administration with calcium or magnesium-containing antacids may ↓ resin-exchanging ability and ↑ risk of systemic alkalosis.
Hypokalemia may enhance digoxin toxicity.
Use with sorbitol may ↑ risk of colonic necrosis; concurrent use not recommended.

Route/Dosage ⬆ ⬇

4 level tsp = 15 g (4.1 mEq sodium/g)
PO (Adults ): 15 g 1–4 times daily in water (up to 40 g 4 times daily).
(Adults ): 30–50 g as a retention enema; repeat as needed every 6 hr.
PO
(Children ): 1 g/kg/dose every 6 hr.

Availability ⬆ ⬇

(Generic available)

Oral suspension: 15 g sodium polystyrene sulfonate with 20 g sorbitol/60 mL; 15 g sodium polystyrene sulfonate with 14.1 g sorbitol/60 mL
Powder for suspension: 15 g/bottle; 454 g/bottle

Assessment ⬆ ⬇

Monitor response of symptoms of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, peaked T waves, depressed ST segments, prolonged QT segments, widened QRS complexes, loss of P waves, and cardiac arrhythmias). Assess for development of hypokalemia (weakness, fatigue, arrhythmias, flat or inverted T waves, prominent U waves).
Monitor intake and output ratios and daily weight. Assess for symptoms of fluid overload (dyspnea, rales/crackles, jugular venous distention, peripheral edema). Concurrent low-sodium diet may be ordered for patients with HF (see Food Sources for Specific Nutrients).
In patients receiving concurrent digoxin, assess for symptoms of digoxin toxicity (anorexia, nausea, vomiting, visual disturbances, arrhythmias).
Assess abdomen and note character and frequency of stools. Discontinue sodium polystyrene sulfonate if patient becomes constipated. Concurrent sorbitol or laxatives may be ordered to prevent constipation or impaction. Some products contain sorbitol to prevent constipation. Patient should ideally have 1–2 watery stools each day during therapy. Monitor for intestinal necrosis if sorbitol is added.

Lab Test Considerations:

Monitor serum potassium daily during therapy. Notify health care professional when potassium ↓ to 4–5 mEq/L.
- Monitor renal function and electrolytes (especially sodium, calcium, bicarbonate, and magnesium) prior to and periodically throughout therapy.

Implementation ⬆ ⬇

Consult health care professional regarding discontinuation of medications that may increase serum potassium (angiotensin-converting enzyme inhibitors, potassium-sparing diuretics, potassium supplements, salt substitutes).
Administer PO doses at least 3 hr before or 3 hr after other medications (patients with gastroparesis may require a 6-hr separation).
An osmotic laxative (sorbitol) is usually administered concurrently to prevent constipation.
PO: For oral or nasogastric tube administration, shake commercially available suspension well before use. Solution is stable for 24 hr when refrigerated. When using powder, add prescribed amount to 3–4 mL water/g of powder. Shake well. Do not mix in orange juice or in any fruit juice known to contain potassium. Do not heat solution to enhance dissolution of powder; heating impairs exchange resin properties. Chilling and adding syrup may improve palatability. May also be added to food. Resin cookie or candy recipes are available; discuss with pharmacist or dietitian.
Retention Enema: Precede retention enema with cleansing enema. Administer solution via rectal tube or 28-French Foley catheter with 30-mL balloon. Insert tube at least 20 cm and tape in place.
- For retention enema, add powder to 100 mL of prescribed solution (usually sorbitol or 20% dextrose in water). Shake well to dissolve powder thoroughly; should be of liquid consistency. Position patient on left side and elevate hips on pillow if solution begins to leak. Follow administration of medication with additional 50–100 mL of diluent to ensure administration of complete dose. Encourage patient to retain enema as long as possible, at least 30–60 min.
- After retention period, irrigate colon with 1–2 L of non-sodium-containing solution. Y-connector with tubing may be attached to Foley or rectal tube; cleansing solution is administered through 1 port of the Y and allowed to drain by gravity through the other port.

Patient/Family Teaching ⬆ ⬇

Explain purpose and method of administration of medication to patient.
Advise patient to avoid taking antacids or laxatives during therapy, unless approved by health care professional; may cause systemic alkalosis.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Inform patient of need for frequent lab tests to monitor effectiveness.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇