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Patiromer

Class: Potassium-removing Agents
Brands: Veltassa

Warning(s)

WARNING: BINDING TO OTHER ORAL MEDICATIONS

Patiromer binds to many orally administered medications, which could decrease their absorption and reduce their effectiveness. Administer other oral medications at least 6 hours before or 6 hours after patiromer. Choose patiromer or the other oral medication if adequate dosing separation is not possible.1

Introduction

Patiromer is a potassium-removing agent.

Uses for Patiromer

Patiromer has the following uses:

Patiromer is a potassium binder indicated for the treatment of hyperkalemia.1

Patiromer has the following limitation of use:

Patiromer should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.1

Patiromer Dosage and Administration

General

Patiromer is available in the following dosage form(s) and strength(s):

  • Powder: 8.4, 16.8 and 25.2 grams patiromer packets.1

Dosage

It is essential that the manufacturer's labeling be consulted for more detailed information on dosage and administration of this drug. Dosage summary:

  • The recommended starting dose of patiromer is 8.4 grams administered orally once daily with food.1

  • Adjust dose by 8.4 grams daily as needed at one week intervals to obtain desired serum potassium target range.1

Cautions for Patiromer

Contraindications

  • Known hypersensitivity to patiromer or any of its components.1

Warnings/Precautions

Binding to Other Orally Administered Medications

Patiromer binds many orally administered medications, which could decrease their gastrointestinal absorption and lead to reduced efficacy. Administer other oral medications at least 6 hours before or 6 hours after patiromer. Choose patiromer or the other oral medication if adequate dosing separation is not possible.1

Worsening of Gastrointestinal Motility

Avoid use of patiromer in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders, because patiromer may be ineffective and may worsen gastrointestinal conditions.1

Patients with a history of bowel obstruction or major gastrointestinal surgery, severe gastrointestinal disorders, or swallowing disorders were not included in the clinical studies.1

Hypomagnesemia

Patiromer binds to magnesium in the colon, which can lead to hypomagnesemia. In clinical studies, hypomagnesemia was reported as an adverse reaction in 5.3% of patients treated with patiromer. Monitor serum magnesium. Consider magnesium supplementation in patients who develop low serum magnesium levels on patiromer.1

Specific Populations

Pregnancy

Patiromer is not absorbed systemically following oral administration and maternal use is not expected to result in fetal risk.1

Lactation

Patiromer is not absorbed systemically by the mother, so breastfeeding is not expected to result in risk to the infant.1

Pediatric Use

Safety and efficacy in pediatric patients have not been established.1

Geriatric Use

Of the 666 patients treated with patiromer in clinical studies, 59.8% were age 65 and over, and 19.8% were age 75 and over. No overall differences in effectiveness were observed between these patients and younger patients. Patients age 65 and older reported more gastrointestinal adverse reactions than younger patients.1

Renal Impairment

Of the 666 patients treated with patiromer in clinical studies, 93% had chronic kidney disease (CKD). No special dosing adjustments are needed for patients with renal impairment.1

Common Adverse Effects

  • Most common adverse reactions (incidence ≥ 2%) are constipation, hypomagnesemia, diarrhea, nausea, abdominal discomfort, and flatulence.1

Drug Interactions

Specific Drugs

It is essential that the manufacturer's labeling be consulted for more detailed information on interactions with this drug, including possible dosage adjustments. Interaction highlights:

  • Take other orally administered drugs at least 6 hours before or 6 hours after patiromer.1

Actions

Mechanism of Action

Patiromer is a non-absorbed, cation exchange polymer that contains a calcium-sorbitol counterion.1

Patiromer increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, resulting in a reduction of serum potassium levels. 1

Advice to Patients

Advise the patient to read the FDA-approved patient labeling (Medication Guide).1

Drug Interactions

Advise patients who are taking other oral medication to separate the dosing of patiromer by at least 6 hours (before or after).1

Dosing Recommendations

Inform patients to take patiromer as directed with food and adhere to their prescribed diets. Instruct patients to prepare each dose separately using the preparation instructions provided in the FDA-approved patient labeling (Medication Guide).1

Inform patients that patiromer should not be heated (e.g., microwaved) or added to heated foods or liquids and should not be taken in its dry form.1

Additional Information

AHFS First Release. For additional information until a more detailed monograph is developed and published, the manufacturer's labeling should be consulted. It is essential that the manufacturer's labeling be consulted for more detailed information on usual uses, dosage and administration, cautions, precautions, contraindications, potential drug interactions, laboratory test interferences, and acute toxicity.

Preparations

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

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Patiromer

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Powder, For Suspension

8.4 g

Veltassa

Relypsa Inc.

16.8 g

Veltassa

Relypsa Inc.

25.2 g

Veltassa

Relypsa Inc.

AHFS DI Essentials. © Copyright, 2016, American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

Date modified: October 12, 2016
Last reviewed: September 13, 2016
Date published: September 13, 2016

References

1. Relypsa, Inc. VELTASSA (patiromer) ORAL prescribing information. 2016 May.

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