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Lokelma 5g Oral Powder
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Indications & Clinical Uses
- Lokelma 5 g powder for oral suspension contains sodium zirconium cyclosilicate, a non-absorbed potassium binder.
- Lokelma is used to treat hyperkalaemia, meaning a high blood potassium level, in adults; the European authorisation was granted on 22 March 2018 to AstraZeneca AB and the US label is held by AstraZeneca Pharmaceuticals LP.
- It traps potassium in the gut in exchange for sodium and hydrogen ions, so the potassium leaves the body in the stool rather than entering the blood.
- Lokelma must not be used as an emergency treatment for life-threatening hyperkalaemia, because its effect takes hours; urgent cases need intravenous treatment or dialysis.
- The powder is stirred into water and swallowed as a cloudy suspension.
- Adults on haemodialysis usually take it once daily on non-dialysis days only.
Side Effects
- Lokelma has no boxed warning.
- The most frequent side effect is mild to moderate oedema, swelling of the ankles, feet or legs, reported in roughly 4 to 16 percent of people depending on the dose compared with about 2 percent on placebo, because each 5 g dose contains about 400 mg of sodium.
- Low blood potassium (hypokalaemia) occurred in about 4 percent and can cause muscle weakness, cramps or an irregular heartbeat.
- Constipation was reported in about 5 to 9 percent in some study populations.
- Tell your healthcare provider if you notice increasing swelling, sudden weight gain, breathlessness, severe constipation, marked muscle weakness or palpitations.
- Lokelma is radio-opaque and can show up on abdominal X-rays, which the radiology team should be told about.
Precautions & Warnings
- Blood potassium must be monitored regularly while you take Lokelma, especially in the first days, after any dose change, and in people on haemodialysis, who are more likely to drop too low.
- Because each 5 g dose provides roughly 400 mg of sodium, watch for fluid retention; people with heart failure, kidney disease or on a salt-restricted diet may need a lower dose or an adjustment to their diuretic.
- Lokelma has not been studied in severe constipation, bowel obstruction or impaction, or after major gastrointestinal surgery, and is used with care in gut motility disorders.
- It is not absorbed into the bloodstream, so systemic effects are limited.
- Mix the whole sachet in water, stir, drink it promptly, then rinse the glass with more water and drink that too so the full dose is taken.
Avoid Interactions
- Lokelma temporarily raises stomach pH and can bind other medicines taken at the same time, so all other oral medicines should be taken at least 2 hours before or 2 hours after Lokelma.
- This matters most for drugs whose absorption depends on stomach acid, such as the azole antifungals ketoconazole and itraconazole, atazanavir, nelfinavir, erlotinib and dasatinib.
- Studies showed higher exposure to furosemide and atorvastatin and lower exposure to dabigatran and tacrolimus when these were given together with Lokelma.
- Lokelma may also alter the effect of other treatments that raise or lower potassium, including potassium supplements, ACE inhibitors, angiotensin receptor blockers and potassium-sparing diuretics, so potassium needs checking.
- Tell your healthcare provider about every medicine and supplement you take.
References
Frequently Asked Questions
Lokelma (sodium zirconium cyclosilicate) treats hyperkalaemia, or high blood potassium, in adults. It is a powder that binds potassium in the gut so it leaves the body in the stool. Lokelma is not for emergency treatment of life-threatening high potassium, because it takes hours to act.
Empty the whole Lokelma (sodium zirconium cyclosilicate) sachet into water, stir well and drink the cloudy suspension straight away, with or without food. The usual dose is 10 g three times daily for up to 48 hours, then 5 g to 15 g once daily. Rinse the glass and drink that too.
The most common Lokelma (sodium zirconium cyclosilicate) side effect is swelling of the ankles, feet or legs, reported in up to about 16 percent of users, because each 5 g dose contains roughly 400 mg of sodium. Low potassium affected about 4 percent, and constipation can also occur.
Do not take other oral medicines within 2 hours before or 2 hours after Lokelma (sodium zirconium cyclosilicate), because it can bind them and change how well they work. This matters for azole antifungals, atazanavir, tacrolimus and dabigatran. Never rely on it alone for emergency high potassium.
Blood potassium is checked regularly on Lokelma (sodium zirconium cyclosilicate), particularly in the first days, after each dose change, and in people on haemodialysis, who can drop too low. Your healthcare provider will also watch weight, swelling and fluid status because of the sodium load.
Yes. Lokelma (sodium zirconium cyclosilicate) can cause oedema because each 5 g dose delivers about 400 mg of sodium. Report new ankle swelling, rapid weight gain or breathlessness; a lower dose or a change in your diuretic may be needed, especially if you have heart failure.
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