Patiromer (Monograph)

Brand name: Veltassa
Drug class: Potassium-removing Agents

Medically reviewed by Drugs.com on Jun 10, 2025. Written by ASHP.

Introduction

Nonabsorbed, cation-exchange polymer used for the removal of excess potassium.

Uses for Patiromer

Hyperkalemia

Treatment of hyperkalemia in adults and pediatric patients ≥12 years of age.

Treatment options for chronic hyperkalemia have traditionally included diuretics (loop or thiazide diuretics), modification or discontinuation of renin-angiotensin-aldosterone system (RAAS) inhibitors, and removal of other hyperkalemia-causing agents. Potassium binders (sodium polystyrene sulfonate, sodium zirconium cyclosilicate, patiromer) may be considered in patients with chronic hyperkalemia despite optimized diuretic therapy and correction of metabolic acidosis.

Patiromer is not used for the emergency treatment of hyperkalemia because of its delayed onset of action, but it may be used to facilitate potassium lowering once emergent treatments have been initiated.

Patiromer Dosage and Administration

General

Patient Monitoring

• Monitor serum potassium concentrations and adjust dosage based on potassium level and desired target range.

• Monitor serum magnesium.

Administration

Oral Administration

Administer as oral suspension without regard to food.

Administer ≥3 hours before or ≥3 hours after other oral drugs, unless the drug has not been shown to have a clinically important interaction.

Do not heat (e.g., in microwave) or add to heated foods or liquids.

Preparation of Oral Suspension

Empty entire contents of the packet(s) containing patiromer into glass or cup containing approximately 40 mL of water. Stir, then add additional 40 mL of water. Stir thoroughly; may add more water to achieve desired consistency. Administer immediately.

If powder remains in glass after initial administration, add more water, stir, and administer immediately; repeat, as needed, until the entire dose is administered.

Can also prepare mixture with other liquids or soft foods (e.g., apple sauce, yogurt, pudding) instead of water. A minimum volume of 45 mL (3 tablespoons) can be used to prepare doses up to and including 4 g of patiromer.

Consider the potassium content of liquids or soft foods used to prepare the mixture as part of the dietary recommendations on potassium intake for each individual patient.

Dosage

Available as patiromer sorbitex calcium; dosage expressed in terms of patiromer.

Pediatric Patients

Hyperkalemia

Oral

Pediatric patients ≥12 years of age: Initially, 4 g once daily. May increase or decrease dosage as necessary based on serum potassium concentrations, in 4-g increments at intervals of ≥1 week, up to a maximum of 25.2 g once daily.

Adults

Hyperkalemia

Oral

Initially, 8.4 g once daily. May increase or decrease dosage as necessary based on serum potassium concentrations, in 8.4-g increments at intervals of ≥1 week, up to a maximum of 25.2 g daily.

Special Populations

Hepatic Impairment

No special dosage recommendations.

Renal Impairment

Dosage adjustments not necessary.

Geriatric Patients

No special dosage recommendations.

Cautions for Patiromer

Contraindications

• Known hypersensitivity to patiromer or to any ingredient in the formulation.

Warnings/Precautions

Worsening of GI Motility Disorders

Clinical studies excluded patients with history of bowel obstruction or major GI surgery, severe GI disorders, or swallowing disorders.

Avoid use in patients with severe constipation, bowel obstruction, or fecal impaction, including abnormal postoperative bowel motility disorders, because the drug may not be effective and may worsen GI conditions.

Hypomagnesemia

Binds to magnesium in the colon, which can lead to hypomagnesemia. Monitor serum magnesium concentrations, and consider magnesium supplementation in patients with low serum magnesium concentrations.

Specific Populations

Pregnancy

Not expected to cause fetal harm when administered to pregnant women because patiromer is not absorbed systemically following oral administration.

Lactation

Breast-feeding not expected to result in risk to infants of patiromer-treated women because the drug is not absorbed systemically following oral administration.

Pediatric Use

Safety and efficacy established in pediatric patients ≥12 years of age. Use in pediatric patients supported by an adequate and well-controlled study in adults as well as pharmacodynamic and safety data from a single-arm, open-label study in pediatric patients 12–17 years of age.

Safety and efficacy not established in pediatric patients <12 years of age. Although some patients 6 to <12 years of age were studied, available data are insufficient to determine a safe and effective dosing regimen for this pediatric age group.

Geriatric Use

No overall differences in efficacy observed between geriatric patients and younger adults. However, adverse GI effects reported more frequently in those ≥65 years of age.

Renal Impairment

In clinical studies, 93% of adults receiving patiromer had chronic kidney disease, and all pediatric patients had chronic kidney disease.

Common Adverse Effects

Most common adverse effects (≥2%): constipation, hypomagnesemia, diarrhea, nausea, abdominal discomfort, flatulence.

Drug Interactions

Effects on GI Absorption of Drugs

Potential to bind some co-administered oral drugs.

Binding could reduce GI absorption of concomitantly administered drug and result in loss of efficacy when administration times are close to those of patiromer. Administer other oral agents ≥3 hours before or ≥3 hours following administration of patiromer, unless the drug has not been shown to have a clinically important interaction as described below.

In vitro binding may result in a clinically important interaction with the following drugs: telmisartan, bisoprolol, carvedilol, nebivolol, ciprofloxacin, levothyroxine, metformin, mycophenolate mofetil, quinidine, and thiamine. Separate administration of these drugs by at least 3 hours from patiromer.

Clinically meaningful in vitro binding has not been observed with the following drugs: benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril, azilsartan, candesartan, irbesartan, losartan, olmesartan, valsartan, metoprolol, furosemide, bumetanide, torsemide, eplerenone, finerenone, spironolactone, sacubitril, canagliflozin, dapagliflozin, empagliflozin, trimethoprim, amoxicillin, cephalexin, warfarin, apixaban, rivaroxaban, cinacalcet, clopidogrel, acetylsalicylic acid, glipizide, amlodipine, verapamil, tacrolimus, lithium, allopurinol, atorvastatin, digoxin, phenytoin, riboflavin, and sevelamer. No separation of dosing is required for these drugs. For other oral drugs not listed, separate administration of patiromer by at least 3 hours as a precautionary measure.

Patiromer Pharmacokinetics

Absorption

Bioavailability

Not absorbed systemically after oral administration.

Onset

Onset of lowering of serum potassium observed in 7 hours. Maximum (steady-state) effects attained within 7–14 days with twice-daily dosing.

Food

Mean dosage and effects on serum potassium concentration are similar whether patiromer is administered with or without food.

Elimination

Elimination Route

Excreted in feces.

Stability

Storage

Oral

Powder for Suspension

2–8°C; if stored at 25°C, use within 3 months. Do not expose to >40°C.

Actions

• Consists of a nonabsorbed cation-exchange polymer and a calcium-sorbitol counterion; used for the removal of excess potassium.

• Increases fecal potassium excretion via binding of potassium in the GI lumen, which decreases the free potassium concentration in the GI lumen and, consequently, reduces serum potassium concentrations.

• In patients with chronic kidney disease and hyperkalemia (mean serum potassium concentration of 5.9 mEq/L), patiromer (16.8 g daily in divided doses for 2 days) reduced serum potassium concentrations by 0.2 and 0.8 mEq/L at 7 and 48 hours, respectively; potassium concentrations stable for 24 hours after last dose, then began to increase.

• In healthy individuals, exhibits a dose-dependent increase in fecal potassium excretion and corresponding dose-dependent decrease in urinary potassium excretion, with no change in serum potassium concentrations. Effects on fecal and urinary potassium excretion similar whether administered as single daily dose or in 2 or 3 divided doses daily.

Advice to Patients

• Advise patients to administer other oral drugs ≥3 hours before or ≥3 hours after administration of patiromer, unless the drug has not been shown to have a clinically important interaction.

• Advise patients to adhere to prescribed diet; may take patiromer without regard to food.

• Advise patients to prepare each dose immediately before administration according to manufacturer's instructions. Do not heat (e.g., in microwave) or add to heated foods or liquids; do not administer patiromer in its dry form.

• Advise patients to inform their clinicians if they are or plan to become pregnant or plan to breast-feed.

• Advise patients to inform their clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

• Inform patients of other important precautionary information.

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

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.

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