II. Indications
- Chronic Hyperkalemia
- Often used to allow continuation of ACE Inhibitors or ARB Agents despite elevated Serum Potassium
- Considered in Systolic Dysfunction, recent MI and Chronic Kidney Disease
III. Dosing
- Zirconium Cyclosilicate 10 g orally three times daily for 48 hours, then 10 g orally daily (range 5-15 g/day)
IV. Efficacy
- Not effective or indicated in acute, life threatening Hyperkalemia
- Expected to lower Serum Potassium 0.67 mEq/L at 48 hours
V. Mechanism
- Exchanges Sodium to bind Potassium and hydrogen in the Gastrointestinal Tract
- Passes through the Gastrointestinal Tract without absorption
VI. Advantages
- Decreased gastrointestinal effects when compared with Kayexalate
VII. Disadvantages
- Very expensive ($25/day in 2019)
VIII. Adverse Effects
- Hypomagnesemia risk
- Edema risk
- Urinary Tract Infection (1.1%)
IX. Precautions
- Valtessa is preferred (less edema risk)
- Consider other measures to reduce Serum Potassium
- Avoid Dietary Potassium
- Avoid other medications that raise Potassium (e.g. Septra, NSAIDs)
- Consider adding Diuretic (e.g. Furosemide)
X. References
- (2019) Presc Lett 26(4): 23
- Kim (2023) Am Fam Physician 107(1): 59-70 [PubMed]
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