National Institute for Health and Care Excellence (NICE) has recommended sodium zirconium cyclosilicate (Lokelma) as a treatment option for hyperkalaemia in adults.
Sodium zirconium cyclosilicate is recommended for the treatment of adults with hyperkalaemia psoriasis in case of the following:
- Emergency management of acute life-threatening hyperkalaemia in addition to standard care.
- Outpatient management of patients with persistent hyperkalaemia and chronic kidney disease stage IIIb-V or heart failure, if they:
- have a minimum serum potassium level of 6.0 mmol/L;
- are receiving an optimised dosage of a renin-angiotensin-aldosterone system (RAAS) inhibitor for hyperkalaemia; and
- are not on dialysis.
If RAAS inhibitors are no longer suitable for outpatient care, sodium zirconium cyclosilicate should be discontinued.
The recommended starting dose of sodium zirconium cyclosilicate is 10 g thrice daily as an oral suspension. The maintenance regimen should be followed once normal serum potassium levels are achieved. The drug should be discontinued if potassium levels have not been normalised after 72 hours of treatment.
In the maintenance phase, therapy should be initiated with 5 g once daily and possibly titrated up to maximum 10 g once daily or down to 5 g once every other day as required for maintaining the normal serum potassium level.
Evidence suggests that sodium zirconium cyclosilicate is effective in lowering serum potassium in patients with hyperkalaemia when used in emergency care and outpatient care. Although there is no evidence that sodium zirconium cyclosilicate directly extends life or improves quality of life, it may allow patients to remain on RAAS inhibitors for a longer duration.
The drug is to be used only when provided by the company in agreement with the commercial arrangement. The recommendations should not affect patients whose treatment with the drug was started before the publication of the guidance.