Sodium Polystyrene Sulfonate

Pronunciation: SOE-dee-um POL-ee-STYE-reen SUL-foe-nate
Class: Potassium-removing resin

Trade Names

Kayexalate
- Powder for suspension, oral or rectal Sodium polystyrene sulfonate

Kionex
- Powder for suspension, oral or rectal Sodium polystyrene sulfonate
- Suspension, oral or rectal 15 g per 60 mL

SPS
- Suspension, oral or rectal 15 g per 60 mL

Sodium Polystyrene Sulfonate (Canada)

Pharmacology

Resin that exchanges sodium ions for potassium in large intestine.

Slideshow: Fact or Fiction? The Top 15 Osteoarthritis Myths

Pharmacokinetics

Absorption

Sodium polystyrene sulfonate is not absorbed from the GI tract.

Onset

Onset of action is hours to days.

Indications and Usage

Treatment of hyperkalemia.

Contraindications

Hypokalemia; hypersensitivity to polystyrene sulfonate resins; obstructive bowel disease; oral administration in neonates; rectal administration in neonates (suspension only); neonates with reduced gut motility (postoperatively or drug-induced) (powder only); any postoperative patient until normal bowel function resumes (suspension only).

Dosage and Administration

Adults

PO or via nasogastric tube 15 to 60 g/day, preferably given as 15 g one to four times/day.

PR 30 to 50 g every 6 h as a retention enema.

Children

PO Calculate children's dose by exchange ratio of 1 mEq potassium per gram of resin. (1 g/kg every 6 h has been recommended.)

General Advice

  • Shake suspension well before using.
  • Coadministration with sorbitol is not recommended.
  • Each dose of powder should be given as an oral suspension in a small quantity of water or syrup. The amount of fluid usually ranges from 20 to 100 mL, or may be determined by allowing 3 to 4 mL of fluid per gram of resin.
  • When using powder to make a suspension for rectal administration, prepare as a warm (body temperature) emulsion in 100 mL of aqueous vehicle. Agitate emulsion gently during administration.

Storage/Stability

Store between 59° and 86°F. Store repackaged suspension in refrigerator and use within 14 days. Do not store freshly prepared suspensions longer than 24 h. Do not heat, because this may alter exchange of properties of resin.

Drug Interactions

Digoxin

If hypokalemia occurs, likelihood of toxic effects of digoxin may be increased. Close clinical and laboratory monitoring are warranted.

Lithium, thyroid hormones (eg, levothyroxine)

Absorption of these agents may be reduced by sodium polystyrene sulfonate, decreasing their pharmacologic effect. Close clinical and laboratory monitoring is warranted. If an interaction is suspected, adjust therapy as needed.

Nonabsorbable cation-donating antacids and laxatives (eg, aluminum carbonate, magnesium hydroxide)

Systemic alkalosis has occurred. Potassium exchange capability of sodium polystyrene sulfonate may be reduced. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination has occurred. If these agents are used concurrently, separate the administration times by at least several hours. Magnesium hydroxide should not be administered with sodium polystyrene sulfonate.

Sorbitol

Concomitant use has been implicated in cases of intestinal necrosis, which may be fatal. Concurrent use is not recommended.

Adverse Reactions

GI

Anorexia; constipation; diarrhea; fecal impaction; gastric irritation; nausea; vomiting; GI tract ulceration, intestinal necrosis, intestinal obstruction due to GI concretions, ischemic colitis (postmarketing).

Metabolic

Hypocalcemia; hypokalemia; hypomagnesemia; sodium retention.

Respiratory

Acute bronchitis and/or bronchopneumonia associated with inhalation of the particles (postmarketing).

Precautions

Monitor

Frequently monitor serum potassium. Regularly monitor other electrolytes (eg, calcium, magnesium, sodium). Monitor ECG in select patients.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Use with caution in premature or low birth weight infants because of the risk of digestive hemorrhage or intestinal necrosis. Contraindicated for oral administration in neonates. Rectal administration of suspension is contraindicated in neonates; powder for suspension is contraindicated in neonates with reduced gut motility.

Elderly

Large doses in elderly patients may cause fecal impaction.

Renal Function

Use with caution in patients with diabetic ESRD.

Aspiration risk

Position patient carefully when ingesting resin to avoid aspiration, which may lead to bronchopulmonary complications.

Cleansing enema

Take precautions to ensure the use of adequate volumes of sodium-free cleansing enemas after rectal administration.

Constipation

If significant constipation occurs, discontinue treatment until normal bowel motion is resumed.

Electrolyte abnormalities

Serious potassium deficiency can occur. Sodium polystyrene sulfonate is not totally selective for potassium and small amounts of magnesium and calcium can be lost. Use with caution in patients who cannot tolerate even a small increase in sodium load (ie, severe CHF, severe hypertension, marked edema).

Intestinal necrosis

Cases of intestinal necrosis, which may be fatal, and other serious GI adverse reactions (bleeding, ischemic colitis, perforation) have been reported. Most were associated with concomitant use of sorbitol.

Severe hyperkalemia

Treatment with this drug alone may be insufficient to rapidly correct severe hyperkalemia associated with states of rapid tissue breakdown (eg, burns, renal failure) or hyperkalemia so marked as to constitute medical emergency.

Surgery patients

Do not administer following surgery until normal bowel function resumes.

Overdosage

Symptoms

Cardiac arrhythmias, ECG changes, hypocalcemia that may lead to hypocalcemic tetany, hypokalemia and related symptoms (eg, apnea, confusion, delayed thought processes, hyporeflexia that may progress to trunk paralysis, irritability, muscle weakness), hypomagnesemia.

Patient Information

  • Tell patient not to mix medication with fruit juice.
  • Instruct patient to shake suspension well before taking medication.
  • Advise patient to report any water retention or edema.
  • Instruct patient to report the following symptoms to health care provider: anorexia, any changes in bowel function, confusion, nausea, palpitations, severe muscle weakness, trouble thinking, vomiting.

Copyright © 2009 Wolters Kluwer Health.

Hide
(web2)