TM Owner ANI Pharmaceuticals, Inc.
Kionex 15g/60ml Oral suspension
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Indications & Clinical Uses
- Kionex is a brand of sodium polystyrene sulfonate, a cation-exchange resin used to treat high blood potassium (hyperkalaemia) in adults.
- The resin passes through the gut and exchanges sodium for potassium, so potassium is carried out of the body in the stool, at roughly 1 mEq of potassium per gram of resin.
- The Kionex label currently on DailyMed is a raspberry-flavoured ORAL SUSPENSION containing 15 grams of resin per 60 mL, marketed by ANI Pharmaceuticals; the same molecule is also supplied by other companies as a plain powder for suspension in 15 g bottles and 453.6 g jars.
- The usual adult dose is 15 g, which is 60 mL of the suspension, one to four times daily by mouth, and a rectal enema is an alternative.
- Kionex acts slowly and must NOT be used as emergency treatment for life-threatening hyperkalaemia.
Side Effects
- The commonest effects are gut-related: constipation, diarrhoea, nausea, vomiting and loss of appetite.
- Sodium polystyrene sulfonate has NO boxed warning, but the Kionex label carries a prominent warning about serious gastrointestinal events, including faecal impaction, bowel concretions, ischaemic colitis and intestinal necrosis, which has sometimes been fatal.
- Most reported cases of intestinal necrosis involved sorbitol given at the same time, which is why sorbitol must not be used with it.
- The risk is higher in premature infants and in people with a history of bowel disease, low blood volume, reduced gut motility or kidney failure.
- Because the resin also removes magnesium and calcium and can drive potassium too low, cramps, marked muscle weakness, confusion or an irregular heartbeat should be reported.
- Seek urgent care for severe abdominal pain, a swollen abdomen, vomiting, bloody stools or no bowel movement.
Precautions & Warnings
- Do NOT give Kionex together with sorbitol in any form, because the combination has been linked to fatal intestinal necrosis.
- Separate Kionex from ALL other medicines taken by mouth: give other oral medicines at least 3 hours before or 3 hours after Kionex, and allow 6 hours if you have gastroparesis or another condition that slows stomach emptying, because the resin binds other drugs and stops them working.
- Serum potassium must be checked regularly, and magnesium and calcium should also be monitored; treatment stops once potassium reaches the target range.
- Avoid use in obstructive bowel disease, reduced bowel motility, after surgery and in newborns, and take care if you are prone to constipation.
- Each gram of resin delivers sodium, so caution is needed in heart failure, severe hypertension and marked oedema.
- Store at 20°C to 25°C and prepare or shake each dose as the label directs.
Avoid Interactions
- As a binding resin, sodium polystyrene sulfonate REDUCES the absorption and therefore the efficacy of many medicines taken by mouth at the same time, including levothyroxine and lithium, which is why every other oral medicine must be separated by at least 3 hours, or 6 hours if you have gastroparesis.
- Sorbitol, whether given with the resin or present in another preparation, increases the risk of intestinal necrosis and is not recommended.
- Antacids and laxatives containing magnesium or calcium, such as magnesium hydroxide or calcium carbonate, bind to the resin, reduce its potassium-lowering effect and can cause metabolic alkalosis, so they should be avoided.
- If potassium falls too far, digoxin toxicity and heart rhythm disturbances become more likely.
- Tell your healthcare provider about every medicine, antacid, laxative and supplement you take.
References
Frequently Asked Questions
Kionex (sodium polystyrene sulfonate) treats high blood potassium in adults. It is a resin that swaps sodium for potassium inside the bowel, removing about 1 mEq of potassium per gram in the stool. It works slowly, so it must never be used for emergency, life-threatening hyperkalaemia.
The usual adult dose of Kionex is 15 g by mouth, one to four times daily; on the DailyMed label that is 60 mL of raspberry-flavoured suspension. A rectal enema is an alternative when the oral route is not possible. Never give Kionex together with sorbitol.
Common side effects of Kionex (sodium polystyrene sulfonate) are constipation, diarrhoea, nausea, vomiting and loss of appetite. Serious bowel harm can occur, including faecal impaction, ischaemic colitis and fatal intestinal necrosis. Get urgent care for severe stomach pain, a swollen abdomen or bloody stools.
Avoid sorbitol completely with Kionex, because the combination has been linked to fatal intestinal necrosis. Avoid magnesium- and calcium-containing antacids and laxatives, which reduce its effect and can cause alkalosis. Separate every other oral medicine by at least 3 hours, or 6 hours with gastroparesis.
Yes. Potassium is checked regularly during Kionex treatment, because levels can fall too low, and treatment stops once potassium reaches the target range. Sodium polystyrene sulfonate also binds magnesium and calcium, so those are monitored. Report cramps, weakness or an irregular heartbeat.
The Kionex label on DailyMed is a ready-mixed oral suspension containing 15 g of sodium polystyrene sulfonate in 60 mL, from ANI Pharmaceuticals. Plain powder for suspension is sold by other companies under the generic name. Both are used the same way and both must be kept away from sorbitol.
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