sodium polystyrene sulfonate

SOE-dee-um po-lee-STYE-reen SUL-fon-ate

Therapeutic Classification: hypokalemic, electrolyte modifiers

Pharmacologic Classification: cationic exchange resins

REMS

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

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.

Absorption: Distributed throughout the intestine but is nonabsorbable.

Distribution: Not distributed.

Metabolism/Excretion: Eliminated in the feces.

Half-Life: Unknown.

(↓ in serum potassium concentrations)

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.

CV: edema

F and E: hypocalcemia, hypokalemia, hypomagnesemia

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

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.
Sorbitol may ↑ risk of colonic necrosis; concurrent use not recommended.

4 level teaspoons = 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.

(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

Monitor for signs/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, cardiac arrhythmias). Assess for development of hypokalemia (weakness, fatigue, arrhythmias, flat or inverted T waves, prominent U waves).
Monitor intake, output, 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 signs/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 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.

Lab Test Considerations:

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

Consult health care provider regarding discontinuation of medications that may ↑ serum potassium (ACE inhibitors, angiotensin-receptor blockers, potassium-sparing diuretics, potassium supplements, salt substitutes).
Administer oral doses ≥3 hr before or 3 hr after other medications (patients with gastroparesis may require a 6-hr separation).
A laxative is often administered concurrently to prevent constipation.
PO: For oral or nasogastric tube administration, shake 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, ≥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 one port of the Y and allowed to drain by gravity through the other port.

Explain the purpose and side effects of sodium polystyrene sulfonate. Instruct on method of administration of medication to patient. Tell patient to separate dosing of other oral medications by ≥3 hr either before or after this drug. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
Advise patient to report GI symptoms, especially constipation.
Advise patient to avoid taking antacids or laxatives during therapy, unless approved by health care provider; may cause systemic alkalosis.
Instruct patient to report symptoms of hyperkalemia (fatigue, weakness, numbness, tingling, heart palpitations).
Inform patient of need for frequent lab tests to monitor effectiveness.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.

Normalization of serum potassium levels.

Kionex, SPS

Kayexalate

NDC Code

10135- Marlex Pharmaceuticals Inc
- 10135-146- Sodium Polystyrene Sulfonate
  - 10135-146-14- 15 g in 1 BOTTLE, PLASTIC (10135-146-14)

10135- Marlex Pharmaceuticals Inc
- 10135-146- Sodium Polystyrene Sulfonate
  - 10135-146-17- 454 g in 1 JAR (10135-146-17)

10702- KVK-Tech, Inc.
- 10702-036- Sodium Polystyrene Sulfonate
  - 10702-036-15- 15 g in 1 BOTTLE (10702-036-15)

10702- KVK-Tech, Inc.
- 10702-036- Sodium Polystyrene Sulfonate
  - 10702-036-45- 454 g in 1 JAR (10702-036-45)

11534- SUNRISE PHARMACEUTICAL, INC.
- 11534-166- SODIUM POLYSTYRENE SULFONATE
  - 11534-166-15- 15 g in 1 BOTTLE (11534-166-15)

11534- SUNRISE PHARMACEUTICAL, INC.
- 11534-166- SODIUM POLYSTYRENE SULFONATE
  - 11534-166-16- 15 g in 1 BOTTLE (11534-166-16)

11534- SUNRISE PHARMACEUTICAL, INC.
- 11534-166- SODIUM POLYSTYRENE SULFONATE
  - 11534-166-44- 454 g in 1 JAR (11534-166-44)

17856- ATLANTIC BIOLOGICALS CORP.
- 17856-0024- Sodium Polystyrene Sulfonate
  - 17856-0024-1- 50 CUP in 1 BOX, UNIT-DOSE (17856-0024-1) / 15 g in 1 CUP

17856- ATLANTIC BIOLOGICALS CORP.
- 17856-0024- Sodium Polystyrene Sulfonate
  - 17856-0024-2- 50 CUP in 1 BOX, UNIT-DOSE (17856-0024-2) / 30 g in 1 CUP

24658- PuraCap Laboratories, LLC
- 24658-760- Sodium Polystyrene Sulfonate
  - 24658-760-16- 453.6 g in 1 JAR (24658-760-16)

42806- Epic Pharma, LLC
- 42806-013- Sodium Polystyrene Sulfonate
  - 42806-013-94- 15 g in 1 BOTTLE (42806-013-94)

42806- Epic Pharma, LLC
- 42806-013- Sodium Polystyrene Sulfonate
  - 42806-013-96- 453.6 g in 1 JAR (42806-013-96)

46287- CMP Pharma, Inc.
- 46287-006- Sodium Polystyrene Sulfonate
  - 46287-006-01- 473 mL in 1 BOTTLE (46287-006-01)

46287- CMP Pharma, Inc.
- 46287-006- Sodium Polystyrene Sulfonate
  - 46287-006-04- 120 mL in 1 BOTTLE (46287-006-04)

46287- CMP Pharma, Inc.
- 46287-006- Sodium Polystyrene Sulfonate
  - 46287-006-60- 10 BOTTLE, UNIT-DOSE in 1 CARTON (46287-006-60) / 60 mL in 1 BOTTLE, UNIT-DOSE

46287- CMP Pharma, Inc.
- 46287-012- Sodium Polystyrene Sulfonate
  - 46287-012-16- 454 g in 1 JAR (46287-012-16)

53933- DSP
- 53933-7246-
  - 53933-7246-1- 100 kg in 1 CONTAINER (53933-7246-1)

55154- Cardinal Health 107, LLC
- 55154-7353- Sodium Polystyrene Sulfonate
  - 55154-7353-2- 2 BOTTLE, UNIT-DOSE in 1 BAG (55154-7353-2) / 60 mL in 1 BOTTLE, UNIT-DOSE

55363- ION EXCHANGE INDIA LIMITED
- 55363-254-
  - 55363-254-01- 25 kg in 1 DRUM (55363-254-01)

55363- ION EXCHANGE INDIA LIMITED
- 55363-254-
  - 55363-254-02- 10 kg in 1 DRUM (55363-254-02)

55363- ION EXCHANGE INDIA LIMITED
- 55363-254-
  55363-254-03- 5 kg in 1 DRUM (55363-254-03)

62135- Chartwell RX, LLC
- 62135-340- Sodium Polystyrene Sulfonate
  62135-340-11- 10 BOTTLE in 1 BOX (62135-340-11) / 15 g in 1 BOTTLE

62135- Chartwell RX, LLC
- 62135-340- Sodium Polystyrene Sulfonate
  - 62135-340-53- 453.6 g in 1 BOTTLE (62135-340-53)

62135- Chartwell RX, LLC
- 62135-340- Sodium Polystyrene Sulfonate
  - 62135-340-62- 15 g in 1 BOTTLE (62135-340-62)

62559- ANI Pharmaceuticals, Inc.
- 62559-356- Kionex
  - 62559-356-01- 10 BOTTLE in 1 CASE (62559-356-01) / 60 mL in 1 BOTTLE (62559-356-60)

63629- Bryant Ranch Prepack
- 63629-2031- Sodium Polystyrene Sulfonate
  - 63629-2031-1- 453.6 g in 1 JAR (63629-2031-1)

63629- Bryant Ranch Prepack
- 63629-2390- SODIUM POLYSTYRENE SULFONATE
  - 63629-2390-1- 454 g in 1 JAR (63629-2390-1)

63629- Bryant Ranch Prepack
- 63629-8849- SODIUM POLYSTYRENE SULFONATE
  - 63629-8849-1- 15 g in 1 BOTTLE (63629-8849-1)

63629- Bryant Ranch Prepack
- 63629-8850- SODIUM POLYSTYRENE SULFONATE
  - 63629-8850-1- 15 g in 1 BOTTLE (63629-8850-1)

68444- Purolite LLC
- 68444-0002-
  - 68444-0002-0- 90 kg in 1 DRUM (68444-0002-0)

68444- Purolite LLC
- 68444-0002-
  68444-0002-1- 50 kg in 1 DRUM (68444-0002-1)

68444- PUROLITE LLC
- 68444-0004-
  68444-0004-0- 90 kg in 1 DRUM (68444-0004-0)

68444- PUROLITE LLC
- 68444-0004-
  68444-0004-1- 50 kg in 1 DRUM (68444-0004-1)

68444- Purolite LLC
- 68444-0005-
  68444-0005-0- 90 kg in 1 DRUM (68444-0005-0)

68444- Purolite LLC
- 68444-0005-
  68444-0005-1- 50 kg in 1 DRUM (68444-0005-1)

72162- Bryant Ranch Prepack
- 72162-1230- SODIUM POLYSTYRENE SULFONATE
  72162-1230-2- 454 g in 1 JAR (72162-1230-2)

72162- Bryant Ranch Prepack
- 72162-1230- SODIUM POLYSTYRENE SULFONATE
  - 72162-1230-7- 15 g in 1 BOTTLE (72162-1230-7)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

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