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Sodium polystyrene sulfonate Side Effects

For the Consumer

Applies to sodium polystyrene sulfonate: oral powder for suspension, oral suspension

Other dosage forms:

As well as its needed effects, sodium polystyrene sulfonate may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking sodium polystyrene sulfonate, check with your doctor immediately:

  • Bloody vomit
  • chest pain
  • cough
  • cough producing mucus
  • difficulty with breathing
  • fever or chills
  • severe stomach pain
  • shortness of breath
  • sneezing
  • sore throat
  • tightness in the chest
  • troubled breathing
  • wheezing
Incidence not known
  • Abdominal or stomach cramps or pain
  • confusion
  • constipation
  • convulsions
  • decrease in the amount of urine
  • diarrhea
  • dry mouth
  • increased thirst
  • irregular heartbeats
  • loss of appetite
  • muscle cramps in the hands, arms, feet, legs, or face
  • nausea or vomiting
  • noisy, rattling breathing
  • numbness and tingling around the mouth, fingertips, or feet
  • severe constipation
  • swelling of the fingers, hands, feet, or lower legs
  • tremor
  • troubled breathing at rest
  • unusual tiredness or weakness
  • weight gain
  • weight loss

If any of the following symptoms of overdose occur while taking sodium polystyrene sulfonate, get emergency help immediately:

Symptoms of overdose
  • Dizziness
  • drowsiness
  • fainting
  • fast, slow, or irregular heartbeat
  • lightheadedness
  • muscle cramps
  • muscle spasms (tetany) or twitching
  • pounding or rapid pulse
  • seizures
  • trembling

For Healthcare Professionals

Applies to sodium polystyrene sulfonate: oral suspension, oral and rectal powder, oral and rectal suspension, rectal enema


Gastrointestinal side effects have included anorexia, nausea, vomiting, constipation, and fecal impaction. Occasionally, diarrhea may develop. Fatal intestinal necrosis has been associated rarely with rectal administration of sodium polystyrene sulfonate in sorbitol.[Ref]

Large oral doses may lead to fecal impaction. Sorbitol given orally with the resin may help to decrease the frequency of constipation. Magnesium-containing laxatives should not be used.

Fatal intestinal necrosis has occurred primarily in patients with severe renal dysfunction receiving rectal administration. Intestinal necrosis occurred rapidly (usually within 1 to 2 days) and presented as abdominal pain and distention, ileus, fever, hypotension, and/or metabolic acidosis. The manufacturer recommends a sodium-free cleansing enema after the administration of rectal sorbitol to help prevent this complication. Alternatively, an aqueous vehicle (i.e., 1% methylcellulose or 10% dextrose) may be used instead of sorbitol. Sorbitol is not necessary for effective rectal use of sodium polystyrene sulfonate.[Ref]


Metabolic side effects have included hypokalemia. Patients should be monitored closely to help prevent this effect. ECG, muscle weakness and mental status changes should be evaluated. Sodium retention, hypocalcemia, and hypomagnesemia may also occur. Metabolic alkalosis has been reported with the combined use of sodium polystyrene sulfonate and aluminum carbonate or magnesium hydroxide in renal failure patients.[Ref]

Nervous system

Nervous system side effects have been reported rarely. These have included a case report of a grand mal seizure in a patient with chronic hypocalcemia of renal failure who was administered sodium polystyrene sulfonate and magnesium hydroxide. The magnesium was being used as a laxative.[Ref]


1. Gales MA, Gales BJ, Dyer ME, Orr SR "Rectally administered sodium polystyrene sulfonate." Am J Health Syst Pharm 52 (1995): 2813-5

2. Gerstman BB, Platt R "Use of sodium polystyrene sulfonate in sorbitol in the United States, 1985-1989." Am J Kidney Dis 18 (1991): 619-20

3. "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals, New York, NY.

4. Gerstman BB, Kirkman R, Platt R "Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol." Am J Kidney Dis 20 (1992): 159-61

5. Shepard KV "Cleansing enemas after sodium polystyrene sulfonate enemas." Ann Intern Med 112 (1990): 711

6. Scott TR, Graham SM, Schweitzer EJ, Bartlett ST "Colonic necrosis following sodium polystyrene sulfonate (Kayexalate)- sorbitol enema in a renal transplant patient. Report of a case and review of the literature." Dis Colon Rectum 36 (1993): 607-9

7. Bennett LN, Myers TF, Lambert GH "Cecal perforation associated with sodium polystyrene sulfonate- sorbitol enemas in a 650 gram infant with hyperkalemia." Am J Perinatol 13 (1996): 167-70

8. Wootton FT, Rhodes DF, Lee WM, Fitts CT "Colonic necrosis with Kayexalate-sorbitol enemas after renal transplantation." Ann Intern Med 111 (1989): 947-9

9. Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM "Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis." Surgery 101 (1987): 267-72

10. Meyer I "Sodium polystyrene sulfonate: a cation exchange resin used in treating hyperkalemia." ANNA J 20 (1993): 93-5

It is possible that some side effects of sodium polystyrene sulfonate may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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