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K+ binders are not all the same

Physical and chemical properties of K+ binders1,2
 VELTASSA (patiromer)Kayexalate® (sodium polystyrene sulfonate)Lokelma® (sodium zirconium cyclosilicate)
CounterionCalcium (Ca++)Sodium (Na+)Sodium (Na+) Hydrogen (H+)
Na+ per dose1,500–6,000 mg40‍0–800 mg
Dosage packaging1 g, 8.4 g, and 16.8 g packets454 g jar5 g and 10 g packets
DescriptionSpherical, free-flowing beadsPowdered form of resinInsoluble white powder
Chemical structurePolymerResinCrystal
Microscopic viewVELTASSA (patiromer)VELTASSA (patiromer)Kayexalate (sodium polystyrene sulfonate)Kayexalate (sodium polystyrene sulfonate)Lokelma (sodium zirconium cyclosilicate)Lokelma (sodium zirconium cyclosilicate)
IndicationVELTASSA is indicated for the treatment of hyperkalemia in adult and pediatric patients 12 to 17 years of ageKayexalate® is indicated for the treatment of hyperkalemiaLokelma® is indicated for the treatment of hyperkalemia in adults

Kayexalate was a registered trademark of Concordia Pharmaceuticals, Inc. Lokelma is a registered trademark of the AstraZeneca group of companies.

Due to their delayed onset of action, these K+ binders should not be used as monotherapy for the emergency treatment of life-threatening hyperkalemia.

No head-to-head clinical trials have been conducted between sodium polystyrene sulfonate, sodium zirconium cyclosilicate, and patiromer; therefore, no safety or efficacy comparisons can be made.

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INDICATION

VELTASSA is indicated for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older.

Limitation of Use: VELTASSA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

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INDICATION & Important Safety Information

Important Safety Information

VELTASSA is indicated for the treatment of hyperkalemia.

Limitation of Use: VELTASSA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

CONTRAINDICATIONS

VELTASSA is contraindicated in patients with a history of a hypersensitivity reaction to VELTASSA or any of its components.

INDICATION

VELTASSA is indicated for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older.

Limitation of Use: VELTASSA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

VELTASSA is contraindicated in patients with a history of a hypersensitivity reaction to VELTASSA or any of its components.

WARNINGS AND PRECAUTIONS

Worsening of Gastrointestinal Motility: Avoid use of VELTASSA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders, because VELTASSA may be ineffective and may worsen gastrointestinal conditions. Patients with a history of bowel obstruction or major gastrointestinal surgery, severe gastrointestinal disorders, or swallowing disorders were not included in clinical studies.

Hypomagnesemia: VELTASSA 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 adult patients treated with VELTASSA. Approximately 9% of adult patients in clinical trials developed hypomagnesemia with a serum magnesium value < 1.4 mg/dL. Monitor serum magnesium. Consider magnesium supplementation in patients who develop low serum magnesium levels.

MOST COMMON ADVERSE REACTIONS

The most common adverse reactions (incidence ≥  2%) in adult patients treated with VELTASSA were constipation (7.2%), hypomagnesemia (5.3%), diarrhea (4.8%), nausea (2.3%), abdominal discomfort (2.0%) and flatulence (2.0%). Mild to moderate hypersensitivity reactions were reported in 0.3% of adult patients treated with VELTASSA and included edema of the lips.The safety profile of VELTASSA in a study of 14 pediatric patients ages 12 to 17 years was generally similar to that observed in adult patients.

  1. References:
  2. Kayexalate®. Product information. Sanofi Aventis US LLC; 2017. 
  3. Lokelma®. Package insert. AstraZeneca Pharmaceuticals LP; 2024.