sodium polystyrene sulfonate

REMS

Mild to moderate hyperkalemia (if severe, more immediate measures such as sodium bicarbonate IV, calcium, or glucose/insulin infusion should be instituted).

Contraind./Precautions ⬆ ⬇

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.

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

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).
Rect (Adults ): 30–50 g as a retention enema; repeat as needed every 6 hr.
PO Rect (Children ): 1 g/kg/dose every 6 hr.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Exchanges sodium ions for potassium ions in the intestine (each 1 g is exchanged for 1 mEq potassium).

Therapeutic effects:

Reduction of serum potassium concentrations.

Classifications ⬆ ⬇

Therapeutic Classification: hypokalemic, electrolyte modifiers

Pharmacologic Classification: cationic exchange resins

Pharmacokinetics ⬆ ⬇

Absorption: Distributed throughout the intestine but is nonabsorbable.

Distribution: Not distributed.

Metabolism/Excretion: Eliminated in the feces.

Half-Life: Unknown.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(decrease in serum potassium concentrations)

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

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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Indications ⬇