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polystyrene sulfonate (Kayexalate, Kalimate, Kionex)

Tradename: Kayexalate. (sodium polystyrene sulfonate) Indications: - non-life-threatening hyperkalemia * use is controversial [6] Contraindications: - recent bowel surgery [6] Dosage: 1) 1 g/kg up to 15-60 g PO or 30-50 g - do not give with other oral medications [7] 2) retention enema (in 33% sorbitol) a) 30-60 g rectally b) hold for 30 minutes if possible c) repeat every hour as needed d) follow with sterile water enema to remove resin from bowel Suspension: oral or rectal: - 1.25 g/5 mL with sorbitol 33% & alcohol 0.3% (500 mL) Pharmacokinetics: 1) not absorbed from GI tract 2) binds K+ as it passes through the intestine 3) onset of action: a) 2-10 hours when given orally b) 3-12 hours when given rectally 4) rectal administration is less effective 5) 50 grams reduces serum K+ apporoximately 0.5-1 meq/L Adverse effects: 1) common (> 10%) - constipation, loss of appetite, nausea/vomiting 2) less common (1-10%) - fecal impactation, hypokalemia, hypocalcemia, hypomagnesemia, sodium retention 3) risk of severe GI adverse effects [9] - diarrhea - intestinal necrosis - colonic necrosis (rare) - risk is highest with 70% sorbitol [5,8] - risk may be highest in elderly [8] - no increased risk [9] - intestinal ischemia - intestinal thrombosis - intestinal ulceration - intestinal perforation Mechanism of action: 1) cation exchange resin that exchanges K+ for Na+ 2) each gram of resin binds up to 1 meq of K+ in exchange for 1-2 meq of Na+ 3) sorbitol is present to induce diarrhea, reducing the risk of fecal impactation

General

metabolic agent (metabolic modifier)

Properties

MISC-INFO: elimination route FECES pregnancy-category ? safety in lactation ?

Database Correlations

PUBCHEM cid=169893

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Department of Veterans Affairs, VA National Formulary
  5. Prescriber's Letter 17(11): 2010 Sodium Polystyrene Sulfonate for Hyperkalemia Detail-Document#: 261106 (subscription needed) http://www.prescribersletter.com
  6. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
  7. Lowes R Don't Give Kayexalate With Other Oral Drugs, FDA Warns. Medscape - Sep 06, 2017. http://www.medscape.com/viewarticle/885282 - FDA Safety Alert. Sept 6, 2017 Kayexalate (sodium polystyrene sulfonate): Drug Safety Communication - FDA Recommends Separating Dosing. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm574763.htm
  8. Noel JA, Bota SE, Petrcich W et al Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age. JAMA Intern Med. Published online June 10, 2019 PMID: 31180477 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735447 - Parks M, Grady D Sodium Polystyrene Sulfonate for Hyperkalemia. JAMA Intern Med. Published online June 10, 2019 PMID: 31180445 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735442
  9. Holleck JL, Roberts AE, Marhoffer EA et al. Risk of intestinal necrosis with sodium polystyrene sulfonate: A systematic review and meta-analysis. J Hosp Med 2021 Aug; 16:489 PMID: 34328838 https://www.journalofhospitalmedicine.com/jhospmed/article/243000/hospital-medicine/risk-intestinal-necrosis-sodium-polystyrene-sulfonate