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Drug: Sodium Polystyrene Sulfonate
Brand: Kayexalate 15g
Manufacturer /
TM Owner
Sanofi
Origin: France

Kayexalate 15g Powder

Kayexalate is a nephrology medicine containing Sodium Polystyrene Sulfonate. It acts on the underlying disease process to relieve symptoms and improve clinical outcomes. It is used in the treatment of kidney disease. It is supplied as a powder (15g). It supports better disease control and quality of life when used as directed.
Strength: 15g
Pack Size: 1s
Storage: 20°C to 25°C
Form: Powder

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Indications & Clinical Uses

  • Kayexalate, the original brand of sodium polystyrene sulfonate powder, is DISCONTINUED in the United States: Drugs@FDA records application NDA 011287 (sponsor Concordia) with a marketing status of 'Discontinued', and no Kayexalate-branded label appears on DailyMed, so the information below comes from current US prescribing information for generic sodium polystyrene sulfonate powder for oral or rectal suspension.
  • This is a manufacturer discontinuation, not a safety withdrawal or a revoked approval.
  • Sodium polystyrene sulfonate is a cation-exchange resin that swaps sodium for potassium in the bowel, removing potassium in the stool at a rate of roughly 1 mEq of potassium per gram of resin.
  • It is indicated for the treatment of high blood potassium (hyperkalaemia) in adults.
  • It must NOT be used as emergency treatment for life-threatening hyperkalaemia, because it acts too slowly.
  • The usual oral dose is 15 g, one to four times daily.

Side Effects

  • The commonest effects are gut-related: loss of appetite, constipation, diarrhoea, nausea and vomiting.
  • More serious reported reactions include faecal impaction, gastrointestinal concretions (bezoars), ischaemic colitis and intestinal necrosis, which has sometimes been fatal.
  • Current US labels for sodium polystyrene sulfonate carry NO boxed warning, but they do carry a prominent warning about intestinal necrosis and state that concomitant administration of SORBITOL IS NOT RECOMMENDED, because the combination has been linked to these severe bowel injuries.
  • Severe hypokalaemia (potassium falling too low) can occur, and the resin also binds magnesium and calcium, so low magnesium and low calcium are possible.
  • Seek urgent medical help for severe abdominal pain, a swollen abdomen, vomiting, bloody stools, no bowel movement, or marked muscle weakness, cramps or an irregular heartbeat.

Precautions & Warnings

  • Do not give sodium polystyrene sulfonate with sorbitol.
  • Separate it from ALL other medicines taken by mouth: take other oral medicines at least 3 hours before or 3 hours after the resin, and allow 6 hours if you have gastroparesis or another condition that slows stomach emptying, because the resin binds other drugs and can stop them working.
  • Serum potassium must be monitored during treatment, and magnesium and calcium should also be checked; treatment stops when potassium falls to the target range.
  • The resin is avoided in people with obstructive bowel disease, reduced gut motility, after surgery, and in newborns, and is used with caution in those at risk of constipation or impaction.
  • Each gram delivers sodium, so caution is needed in heart failure, severe hypertension or marked oedema.
  • Store the powder at 20°C to 25°C, and prepare each dose fresh.

Avoid Interactions

  • Because it is a binding resin, sodium polystyrene sulfonate reduces the absorption and therefore the efficacy of many oral medicines taken at the same time - this includes levothyroxine and lithium among others - which is why every other oral medicine must be separated by at least 3 hours, or 6 hours in gastroparesis.
  • Antacids and laxatives containing magnesium or calcium, such as magnesium hydroxide or calcium carbonate, can bind to the resin, reduce its potassium-lowering effect and cause metabolic alkalosis, so they should be avoided.
  • Sorbitol, whether given with the resin or in a sorbitol-containing preparation, increases the risk of intestinal necrosis and is not recommended.
  • Digoxin toxicity may be worsened if potassium falls too far.
  • Tell your healthcare provider about every medicine, antacid, laxative and supplement you take.

References

Frequently Asked Questions

Kayexalate (sodium polystyrene sulfonate) treats high blood potassium in adults by exchanging sodium for potassium in the bowel, removing about 1 mEq of potassium per gram of resin. It works slowly and must never be used as emergency treatment for life-threatening hyperkalaemia.

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