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Sodium Zirconium Cyclosilicate

Medically reviewed by Last updated on Oct 2, 2020.


(SOW dee um zir KOE nee um SYE kloe SIL i kate)

Index Terms

  • Zirconium cyclosilicate
  • ZS-9

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Packet, Oral:

Lokelma: 5 g (1 ea, 11 ea, 30 ea); 10 g (1 ea, 11 ea, 30 ea)

Brand Names: U.S.

  • Lokelma

Pharmacologic Category

  • Antidote
  • Potassium Binder


Sodium zirconium cyclosilicate is a potassium binder that preferentially exchanges potassium for hydrogen and sodium. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, lowering serum potassium levels.


Not systemically absorbed





Onset of Action

1 hour

Use: Labeled Indications

Hyperkalemia: Treatment of hyperkalemia in adults.

Limitations of use: Should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.


There are no contraindications listed in the US manufacturer's labeling.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to sodium zirconium cyclosilicate or any component of the formulation.

Dosing: Adult

Hyperkalemia: Oral: Initial: 10 g 3 times daily for up to 48 hours; adjust dose by 5 g daily at 1-week intervals as needed based on serum potassium; maintenance: 10 g once daily (range: 5 g every other day to 15 g once daily); maximum maintenance dose: 15 g/day.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Adjustment for Toxicity

Serum potassium below desired target range or for clinically significant hypokalemia: Decrease dose or discontinue therapy.


Oral: Empty entire contents of the packet(s) into a glass with ≥3 tablespoons (45 mL) of water. Stir well and drink immediately; if powder remains in the glass, add water, stir and drink immediately; repeat until no powder remains. Administer other oral medications ≥2 hours before or 2 hours after dose.


Store at 15°C to 30°C (59°F to 86°F).

Drug Interactions

Clopidogrel: Sodium Zirconium Cyclosilicate may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Separate the administration of sodium zirconium cyclosilicate and clopidogrel by at least 2 hours. Consider therapy modification

Dabigatran Etexilate: Sodium Zirconium Cyclosilicate may decrease the serum concentration of Dabigatran Etexilate. Management: Separate the administration of sodium zirconium cyclosilicate and dabigatran by at least 2 hours. Consider therapy modification

Warfarin: Sodium Zirconium Cyclosilicate may increase the serum concentration of Warfarin. Management: Separate the administration of sodium zirconium cyclosilicate and warfarin by at least 2 hours. If simultaneous administration is required, monitor for signs and symptoms of warfarin toxicity (eg, elevated INR, bleeding). Consider therapy modification

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Cardiovascular: Edema (4% to 16%)

1% to 10%: Endocrine & metabolic: Hypokalemia (3% to 4%)


Concerns related to adverse effects:

• Edema: Mild to moderate edema has been reported and was more common in patients not on dialysis or treated with higher doses. Monitor for signs of edema, especially in patients on sodium-restricted diet or who are prone to fluid overload (eg, heart failure, renal disease).

Disease-related concerns:

• GI motility disorders: Avoid use in patients with severe constipation, bowel obstruction or impaction, including abnormal postoperative bowel motility disorders (may be ineffective and may worsen GI conditions).

Special populations:

• Hemodialysis patients: May be at increased risk of hypokalemia due to associated conditions (eg, diarrhea, decreased oral intake); monitor serum potassium and adjust dose accordingly.

Dosage form specific issues:

• Sodium: Each 5 g dose contains ~400 mg sodium. Adjust dietary sodium intake as needed.

Monitoring Parameters

Serum potassium; signs/symptoms of edema

Pregnancy Considerations

Sodium zirconium cyclosilicate is not systemically absorbed, therefore, exposure to the fetus would not be expected.

Patient Education

What is this drug used for?

• It is used to treat high potassium levels.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Swelling

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.