Sodium Polystyrene Sulfonate
(SOW dee um pol ee STYE reen SUL fon ate)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kalexate: (454 g) [sorbitol free; contains sodium 100 mg (4.1 mEq)/g]
Kayexalate: (453.6 g) [contains sodium 100 mg (4.1 mEq)/g]
Kionex: (454 g) [contains sodium 100 mg (4.1 mEq)/g]
Generic: (15 g, 453.6 g, 454 g)
Kionex: 15 g/60 mL (60 mL, 473 mL) [contains alcohol, usp, methylparaben, propylene glycol, propylparaben, saccharin sodium, sodium 1500 mg (65 mEq)/60 mL, sorbitol; raspberry flavor]
SPS: 15 g/60 mL (60 mL, 120 mL, 473 mL) [contains alcohol, usp, methylparaben, propylene glycol, propylparaben, saccharin sodium, sodium 1500 mg (65 mEq)/60 mL, sorbitol; cherry flavor]
Generic: 15 g/60 mL (60 mL, 480 mL, 500 mL)
Generic: 30 g/120 mL (120 mL); 50 g/200 mL (200 mL)
Brand Names: U.S.
Removes potassium by exchanging sodium ions for potassium ions in the intestine (especially the large intestine) before the resin is passed from the body; exchange capacity is 1 mEq/g in vivo, and in vitro capacity is 3.1 mEq/g, therefore, a wide range of exchange capacity exists such that close monitoring of serum electrolytes is necessary
Completely feces (primarily as potassium polystyrene sulfonate)
Onset of Action
Use: Labeled Indications
Treatment of hyperkalemia
Hypersensitivity to sodium polystyrene sulfonate or any component of the formulation; hypokalemia; obstructive bowel disease; neonates with reduced gut motility; oral administration in neonates; patients with ileus or those at risk for constipation or impaction; any postoperative patient until normal bowel function resumes
Additional contraindications: Sodium polystyrene sulfonate suspension (with sorbitol): Rectal administration in neonates (particularly in premature infants)
Oral: 15 g 1-4 times/day
Rectal: 30-50 g every 6 hours
Refer to adult dosing.
Oral: Children: 1 g/kg/dose every 6 hours
Rectal: Children: 1 g/kg/dose every 2-6 hours (in small children and infants, employ lower doses by using the practical exchange ratio of 1 mEq K+/g of resin as the basis for calculation)
Dosing: Renal Impairment
No dosage adjustment provided in manufacturer’s labeling. Use with caution; risks of gastrointestinal adverse effects are greater in patients with renal insufficiency or failure.
Dosing: Hepatic Impairment
No dosage adjustment provided in manufacturer’s labeling.
Oral: Shake the suspension well prior to administration. Administer orally (or via NG tube) as a suspension. Do not mix in orange juice due to the presence of potassium in orange juice. Chilling the oral mixture will increase palatability. Sodium polystyrene sulfonate suspension may also be added to the patient’s food (with the exception of potassium-containing food such as bananas and orange juice).
Powder for suspension: For each 1 g of the powdered resin, add 3 to 4 mL of water or syrup (amount of fluid usually ranges from 20 to 100 mL). Do not heat the solution to enhance dissolution of the powder as heating impairs the exchange resin properties.
Rectal: Enema route is less effective than oral administration. Administer cleansing enema first. Each dose of the powder for suspension should be suspended in 100 mL of aqueous vehicle, such as water, 25% sorbitol, 1% methylcellulose or 10% dextrose, and administered as a warm emulsion (body temperature). The commercially available suspension should also be warmed to body temperature. During administration, the solution should be agitated gently. Retain the enema in the colon for at least 30 to 60 minutes and for several hours, if possible. Once retention time is complete, irrigate the colon with a nonsodium-containing solution to remove resin.
Do not mix in orange juice or in any fruit juice known to contain potassium. Some products may contain sodium.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Store repackaged product in refrigerator and use within 14 days. Freshly prepared suspensions should be used within 24 hours. Do not heat resin suspension.
Aluminum Hydroxide: Sodium Polystyrene Sulfonate may enhance the adverse/toxic effect of Aluminum Hydroxide. More specifically, concomitant use of these agents may increase the risk for intestinal obstruction. Management: Monitor for signs/symptoms of intestinal obstruction with concomitant use of calcium polystyrene sulfonate and aluminum hydroxide. Adequate fluid intake, laxative use, alternative antacid agents, and/or limiting duration of therapy may help reduce risks. Consider therapy modification
Antacids: May enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis and/or loss of efficacy of the exchange resin. Management: To minimize this interaction, consider: a)separating doses by 2 or more hours; b)rectal administration of the exchange resin; or c)alternatives to antacids. Monitor for metabolic alkalosis and attenuation of SPS effects. Avoid magnesium hydroxide. Exceptions: Sodium Bicarbonate. Consider therapy modification
Digoxin: Sodium Polystyrene Sulfonate may enhance the adverse/toxic effect of Digoxin. Monitor therapy
Laxatives (Magnesium Containing): May enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of sodium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of sodium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Avoid combination
Lithium: Sodium Polystyrene Sulfonate may decrease the serum concentration of Lithium. Management: Consider separating administration of lithium from administration of oral sodium polystyrene sulfonate by at least 6 hours. Consider therapy modification
Meloxicam: May enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of meloxicam oral suspension (which contains sorbitol) may increase the risk for intestinal necrosis. Avoid combination
Sorbitol: May enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of these agents may increase the risk for intestinal necrosis. Avoid combination
Thyroid Products: Sodium Polystyrene Sulfonate may decrease the serum concentration of Thyroid Products. Management: To minimize risk of interaction, separate dosing of oral sodium polystyrene sulfonate and thyroid products (e.g., levothyroxine) or administer sodium polystyrene sulfonate rectally. Monitor for signs/symptoms of hypothyroidism with concomitant use (oral). Consider therapy modification
Frequency not defined.
Endocrine & metabolic: Hypernatremia, hypocalcemia, hypokalemia, hypomagnesemia, sodium retention
Gastrointestinal: Anorexia, constipation, diarrhea, fecal impaction, nausea, vomiting
<1% (Limited to important or life-threatening): Bezoar formation, gastrointestinal hemorrhage, gastrointestinal ulcer, intestinal necrosis, intestinal perforation, ischemic colitis
Concerns related to adverse effects:
• Electrolyte disturbances: In addition to serum potassium-lowering effects, cation-exchange resins may also affect other cation concentrations possibly resulting in decreased serum magnesium and calcium.
• Fecal impaction: Large oral doses may cause fecal impaction (especially in elderly); rectal administration has been associated with fecal impaction in children.
• Hypokalemia: Severe hypokalemia may occur; frequent monitoring of serum potassium is recommended within each 24-hour period; ECG monitoring may be appropriate in select patients.
• Intestinal necrosis: Intestinal necrosis (including fatalities) and other serious gastrointestinal events (eg, bleeding, ischemic colitis, perforation) have been reported, especially when administered with sorbitol. Increased risk may be associated with a history of intestinal disease or surgery, hypovolemia, prematurity, and renal insufficiency or failure. Avoid use in any postoperative patient until normal bowel function resumes or in patients at risk for constipation or impaction; discontinue use if constipation occurs. Oral or rectal administration of sorbitol-containing sodium polystyrene sulfonate suspensions is contraindicated in neonates (particularly with prematurity).
• Cardiovascular disease: Use with caution in patients with severe heart failure and/or hypertension; sodium load may exacerbate condition.
• Edema: Use with caution in patients with edema; sodium load may exacerbate condition.
• Renal impairment: Use with caution in patients with renal impairment.
Concurrent drug therapy issues:
• Antacids/laxative: Concomitant administration of oral sodium polystyrene sulfonate with nonabsorbable cation-donating antacids or laxatives (eg, magnesium hydroxide) may result in systemic alkalosis and may diminish ability to reduce serum potassium concentrations; use with such agents is not recommended. In addition, intestinal obstruction has been reported with concomitant administration of aluminum hydroxide due to concretion formation.
• Sorbitol: Concomitant use of sorbitol is associated with an increased risk of intestinal necrosis and other serious gastrointestinal events (eg, bleeding, ischemic colitis, perforation); use with sorbitol is not recommended. Use caution with sorbitol-containing sodium polystyrene sulfonate suspensions.
• Elderly: Higher doses in elderly patients may result in fecal impaction.
• Pediatric: Oral administration in neonates and use in neonates with reduced gut motility (postoperatively or drug-induced) is contraindicated. Oral or rectal administration of sorbitol-containing sodium polystyrene sulfonate suspensions in neonates (particularly with prematurity) is also contraindicated due to propylene glycol content and risk of intestinal necrosis and digestive hemorrhage. Use sodium polystyrene sulfonate (without sorbitol) with caution in premature or low-birth-weight infants. Use with caution in children when administering rectally; excessive dosage or inadequate dilution may result in fecal impaction.
Dosage form specific issues:
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
• Appropriate use: Effective lowering of serum potassium from sodium polystyrene sulfonate may take hours to days after administration; consider alternative measures (eg, dialysis) or concomitant therapy (eg, IV sodium bicarbonate) in situations where rapid correction of severe hyperkalemia is required.
• Enema vs oral administration: Enema will reduce the serum potassium faster than oral administration, but the oral route will result in a greater reduction over several hours.
Serum electrolytes (potassium, sodium, calcium, magnesium); ECG in select patients
Pregnancy Risk Factor
Animal reproduction studies have not been conducted. There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if benefits outweigh the risks.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience lack of appetite, vomiting, or nausea. Have patient report immediately to prescriber signs of low potassium (muscle pain or weakness, muscle cramps, or an abnormal heartbeat), signs of bowel problems (black, tarry, or bloody stools; fever; mucus in stools; vomiting; vomiting blood; severe abdominal pain; constipation; or diarrhea), mood changes, behavioral changes, confusion, dizziness, bradycardia, tachycardia, seizures, severe diarrhea, or swelling of arms or legs (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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