Sodium Polystyrene Sulfonate

Class: Potassium-removing Agents
VA Class: AD400
CAS Number: 9003-59-2
Brands: Kayexalate, Kionex, SPS

Introduction

A sulfonated cation-exchange resin used for the removal of excess potassium.a b c

Uses for Sodium Polystyrene Sulfonate

Hyperkalemia

Treatment of hyperkalemia.a b c Used as an adjunct to other measures (e.g., restriction of electrolyte intake, control of acidosis, high-calorie diet).b

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Prior to initiating therapy, determine cause of hyperkalemia and eliminate if possible.b

Not recommended for treatment of hyperkalemia evidenced by conduction defects (widening of the QRS complex) or arrhythmiasb because action of the resin is slow.a b

Most useful when hyperkalemia is not life-threatening or when other measures have reduced the dangers of hyperkalemia.b

Sodium Polystyrene Sulfonate Dosage and Administration

General

  • Dosage and duration of therapy must be individualized and depend on daily assessment of total body potassium.a b c

Administration

Administer orally or rectally.a b c

Oral Administration

Administer orally as a suspension (either as the commercially available suspensionb c or prepared extemporaneously from the powdered resin).a b

Suspension also may be introduced into the stomach via a tube.a b c

Prior to administration, shake suspension well.c

Reconstitution

Reconstitute each 1 g of the powdered resin in 3–4 mL of water or a syrup;a usually 20–100 mL of fluid is used.a b

Powdered resin may be mixed with a diet appropriate for a patient in renal failure.a c Do not mix with foods or liquids that contain a large amount of potassium (e.g., bananas, orange juice).b

Rectal Administration

Administer rectally as a retention enema by gravity feed (either as the commercially available suspensionb c or prepared extemporaneously from the powdered resin).a b

Prior to administration, administer an initial cleansing enema, and then insert a soft, large (French 28) rubber tube about 20 cm into the rectum, with the tip well into the sigmoid colon, and tape in place.a b c

Prior to administration, warm suspension to body temperaturea b and shake well.c

During administration, extemporaneously prepared suspension should be kept in suspension by stirring.a b The tube may be flushed with 50–100 mL of fluid, clamped, and left in place.a b c If back-leakage occurs, the hips should be elevated on pillows or a knee-chest position assumed.a b c

Retain suspension in the colon for at least 30–60 minutesb or for several hours if possible,a b c then irrigate the colon with a non-sodium containing solution at body temperature to remove the resin.a b Returns should be drained constantly through a Y tube connection.a c Approximately 2 L of irrigating solution may be needed to adequately flush out the resin;a b c proper removal of resin is particulary important when sorbitol is used.a

Alternatively, some clinicians recommend placing the resin in a sealed dialysis bag and inserting the bag into the rectum.b

Reconstitution

Suspend appropriate dose of powdered resin in 100–200 mL of an aqueous vehicle (e.g., 25% sorbitol, 1% methylcellulose, 10% dextrose, water) at body temperature.b

A thicker suspension may be used; however, care should be taken that a paste, which would greatly reduce the exchange surface and be particularly ineffective if deposited in the rectal ampulla, is not formed.a b

Dosage

Pediatric Patients

Hyperkalemia
Oral

Infants and small children: Reduced dosage recommended. Calculate dosage based on the fact that 1 g of the resin binds approximately 1 mEq of potassium.a b c

Oral administration not recommended in neonates.a (See Contraindications under Cautions.)

Rectal

Reduced dosage recommended.a Calculate dosage based on the fact that 1 g of the resin binds approximately 1 mEq of potassium.a b c

Use with caution.a (See Pediatric Use under Cautions.)

Adults

Hyperkalemia
Oral

15 g (approximately 4 level teaspoonfuls of the powder or 60 mL of the commercially available suspension) 1–4 times daily (average 15–60 g daily).a b c

Rectal

30–50 g (120–200 mL of the commercially available suspension)a b c every 6 hours or as necessary.a b c

Prescribing Limits

Adults

Hyperkalemia
Oral

15 g 4 times daily (60 g daily).a b c

Rectal

50 g every 6 hours.a b c

Cautions for Sodium Polystyrene Sulfonate

Contraindications

  • Hypokalemia.a

  • Obstructive bowel disease.a

  • Neonates with decreased gut mobility (postoperative or drug induced).a

  • Oral administration in neonates.a

  • Known hypersensitivity to sodium polystyrene sulfonate resins or any ingredient in the formulation.a c

Warnings/Precautions

Warnings

Severe Hyperkalemia

Because of its slow action, sodium polystyrene sulfonate alone may be insufficient (effective lowering of serum potassium may occur within hours to days) to rapidly correct severe hyperkalemia, including that associated with states of rapid tissue breakdown (e.g., burns, renal failure).a b c If severe hyperkalemia occurs, consider other definitive measures, including dialysis.a b c

Hypokalemia

Possible severe hypokalemia (manifested by irritable confusion, delayed thought processes, muscle cramps, muscle weakness, and, occasionally, frank paralysis),a b c electrocardiogram (ECG) abnormalities (e.g., lengthened QT intervals; widened, flat, or inverted T waves; prominent U waves), and cardiac abnormalities (e.g., premature atrial, nodal, or ventricular contractions; supraventricular and ventricular tachycardias) may occur.a b c

Intracellular potassium deficiency is not always reflected by serum potassium levels; individualize decision to discontinue sodium polystyrene sulfonate therapy, taking into account patient's clinical condition and ECG.a c

Other Electrolyte Effects

Cation-exchange action is not totally selective for potassium; possible increased excretion of other cations (e.g., magnesium, calcium).a b c

Systemic Alkalosis

Systemic alkalosis reported after oral administration of cation-exchange resins in combination with nonabsorbable cation-donating antacids and laxatives (e.g., magnesium hydroxide, aluminum carbonate). (See Specific Drugs under Interactions).a b c

General Precautions

Patient Monitoring

Determine serum potassium concentrations at least daily during therapy.a

Monitor for other electrolyte (e.g., calcium, magnesium) abnormalities.b

Closely monitor ECGs and clinical condition of the patient during therapy.b

Sodium Content

Each 1 g of the powdered resin contains approximately 4.1 mEq of sodium;a b each 60 mL of the commercially available suspension contains 65 mEq of sodium.c

Clinically important sodium retention may occur.a Use with caution in patients who cannot tolerate even a small increase in sodium loads (e.g., severe CHF, severe hypertension, marked edema); restriction of sodium intake from other sources may be required.a b c

GI Effects

Possible constipation.a If clinically important constipation occurs, discontinue therapy until normal bowel movements resume; administration of magnesium-containing laxatives and sorbitol not recommended.a (See Specific Drugs under Interactions.)

Specific Populations

Pregnancy

Category C.a c

Lactation

Not known whether sodium polystyrene sulfonate is distributed into milk.a Caution if used in nursing women.a c

Pediatric Use

Efficacy not established.a

Oral administration not recommended in neonates.a Contraindicated in neonates with reduced gut motility (postoperatively or drug induced).a

Administer rectally with caution; excessive dosages or inadequate dilution may result in fecal impaction.a

Possible risk of digestive hemmorhage or colonic necrosis in premature infants or low birth weight infants; use with caution.a

Geriatric Use

Large doses in geriatric individuals may cause fecal impaction.a

Renal Impairment

Severe systemic alkalosis and a tonic-clonic seizure reported in one patient with chronic hypocalcemia secondary to renal failure who received magnesium hydroxide and sodium polystyrene sulfonate concomitantly.a b c (See Systemic Alkalosis under Cautions and Specific Drugs under Interactions.)

Intestinal necrosis reported rarely following rectal administration of sodium polystyrene sulfonate in sorbitol in azotemic patients.a b c

Common Adverse Effects

Gastric irritation.a b c Anorexia, nausea, vomiting, and constipation may occur with high doses.a c

Interactions for Sodium Polystyrene Sulfonate

Specific Drugs

Drug

Interaction

Comments

Antacids, cation-donating (e.g., aluminum carbonate, aluminum hydroxide, magnesium hydroxide, calcium carbonate)

Possible reduced potassium exchange capabilitya b c

Concomitant oral administration of sodium polysytrene sulfonate may result in systemic alkalosisa b

Possible intestinal obstruction with large doses of aluminum hydroxidea b c

Concomitant use of orally administered sodium polystyrene sulfonate with magnesium hydroxide not recommendeda c

Rectal use of sodium polystyrene sulfonate may avoid systemic alkalosisb c

Cardiac glycosides

Sodium polystyrene sulfonate-induced hypokalemia may increase toxic effects of cardiac glycosides on the heart (e.g., ventricular arrhythmias, AV nodal dissociation)a (See Hypokalemia under Cautions)

Laxatives, cation-donating

Possible reduced potassium exchange capabilitya b

Concomitant oral administration of sodium polysytrene sulfonate may result in systemic alkalosisa b

Concomitant use of orally administered sodium polystyrene sulfonate with magnesium hydroxide not recommendeda

Rectal use of sodium polystyrene sulfonate may avoid systemic alkalosis)b

Lithium

Possible decreased absorption of lithium a

Sorbitol

Possible intestinal necrosis a

Concomitant administration not recommendeda

Thyroxine

Possible decreased absorption of thyroxine a

Sodium Polystyrene Sulfonate Pharmacokinetics

Absorption

Onset

Following administration, effective lowering of serum potassium may take hours to days.a c

Elimination

Elimination Route

Modified resin is excreted in the feces.b

Stability

Storage

Oral or Rectal

Powder for Suspension

25°C (may be exposed to 15–30°C).a

Suspension

Tight container at 15–30°C.b c

Extemporaneous suspensions of the resin should be freshly prepared and should not be stored for >24 hours.a b

Suspension should not be heated because changes in the exchange properties of the resin may occur.a b c

Actions

  • A cation-exchange resin used for the removal of excess potassium.a b c

  • Releases sodium in exchange for other cations (e.g., potassium, calcium, magnesium, iron, organic cations, lipids, steroids, proteins).b

  • Sodium is released from the resin in exchange for potassium primarily in the large intestine, where there is a relatively high concentration of potassium present.a b Each 1 g of the resin has an in vitro exchange capacity of about 3.1 mEq of potassium; an in vivo exchange capacity >1 mEq of potassium per g of resin is not likely.b

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information.a (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Sodium Polystyrene Sulfonate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral or Rectal

Powder, for suspension

Kayexalate

Sanofi-Aventis

Kionex

Paddock

Sodium Polystyrene Sulfonate Powder

Carolina Medical

Suspension

1.25 g/5 mL*

Sodium Polystyrene Sulfonate Suspension (with alcohol, parabens, propylene glycol, and sorbitol solution)

Roxane

SPS (with alcohol, parabens, propylene glycol, and sorbitol solution)

Carolina Medical

Rectal

Suspension

1.25 g/5 mL*

Sodium Polystyrene Sulfonate Suspension Retention Enema (with alcohol, parabens, propylene glycol, and sorbitol solution)

Roxane

SPS (with alcohol, parabens, propylene glycol, and sorbitol solution; with enema kit)

Carolina Medical

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions July 1, 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

100. Lillemoe KD, Romolo JL, Hamilton SR et al. Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Surgery. 1987; 101:267-72. [PubMed 3824154]

101. Wootton FT, Rhodes DF, Lee WM et al. Colonic necrosis with Kayexalate-sorbitol enemas after renal transplantation. Ann Intern Med. 1989; 111:947-9. [IDIS 261438] [PubMed 2817643]

102. Arvanitakis C, Malek G, Uehling D et al. Colonic complications after renal transplantation. Gastroenterology. 1973; 64:533-8. [PubMed 4144776]

103. Burnett RJ. Sodium polystyrene-sorbitol enemas. Ann Intern Med. 1990; 112:311-2. [IDIS 263378] [PubMed 2297214]

104. Shepard KV. Cleansing enemas after sodium polystyrene sulfonate enemas. Ann Intern Med. 1990; 112:711. [IDIS 265446] [PubMed 2334084]

a. Sanofi-Synthelabo. Kayexalate (sodium polystyrene sulfonate) prescribing information. New York, NY: 2003 Sep.

b. AHFS Drug Information 2005. McEvoy, GK, ed. Sodium Polystyrene Sulfonate. Bethesda, MD: American Society of Health-System Pharmacists; 2005: 2550-1.

c. Roxane Laboratories. Sodium polystyrene sulfonate suspension prescribing information. Columbus, OH: 1998 Sep.

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