Femi Aremu, PharmD, is a professional pharmacist with experience in clinical and community pharmacy. He currently practices in Chicago, Illinois.
Lokelma (sodium zirconium cyclosilicate) is a treatment option for hyperkalemia (high potassium levels in the body) in nonemergency situations. The zirconium cyclosilicate portion of Lokelma isn't absorbed through the gut and into the bloodstream. Instead, this part of Lokelma stays in your gut and trades its sodium and hydrogen for potassium.
By attaching to potassium, zirconium cyclosilicate helps the body get rid of extra potassium through your stool when you have a bowel movement.
Lokelma is a potassium binder. It's a prescription that's available as an oral (by mouth) powder that needs to be mixed with water. The Food and Drug Administration (FDA) hasn't assigned any black box warnings to this medication yet.
Generic Name: Sodium zirconium cyclosilicate
Brand Name(s): Lokelma
Controlled Substance: N/A
Administration Route: Oral (by mouth)
Active Ingredient: Sodium zirconium cyclosilicate
Dosage Form(s): Powder that needs to be mixed with water
Lokelma is used for hyperkalemia (high potassium levels in the body) in nonemergency situations.
It's unknown how common hyperkalemia is, but around 2% to 3% of the general population likely has high potassium levels. In the hospital setting, the estimate may be up to 10%.
Common causes of hyperkalemia include:
Symptoms of high potassium include:
Get medical help right away, however, if you develop the following serious hyperkalemia symptoms:
The following is general information on how to take Lokelma:
When you receive your Lokelma prescription from the pharmacy, store it at room temperature, which is between 59 degrees and 86 degrees Fahrenheit.
If you're going to travel with Lokelma, familiarize yourself with the regulations of your final destination. In general, however, make a copy of your Lokelma prescription. It's also a good idea to keep your medication in its original container or packaging from the pharmacy, with your name on it.
Your potassium levels may lower within about one hour of taking Lokelma. Within three days, your potassium levels are likely to return to normal. People who experience these effects started their Lokelma treatment at 10 grams by mouth three times daily for two days.
The FDA hasn't approved Lokelma for use in life-threatening or emergency hyperkalemia situations. A small 2020 study, however, suggests that using Lokelma with insulin and glucose might help in these situations.
Additionally, sodium polystyrene sulfonate (SPS) without sorbitol is a possible option for severe hyperkalemia when used with other treatments, like Lokelma, that help the body get rid of extra potassium.
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.
A common side effect with of Lokelma is edema, which is swelling from fluid buildup.
Severe side effects are possible with Lokelma. Get medical help right away if you experience the following serious side effects:
Lokelma may continue to cause edema (swelling) with long-term use. The edema can occur anywhere on the body, including the arms, hands, legs, and feet.
Lokelma may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
The following modifications (changes) should be kept in mind when using Lokelma:
Pregnancy and breastfeeding: Lokelma isn't absorbed into the bloodstream. Therefore, negative effects are unlikely for the unborn fetus during your pregnancy or nursing baby while nursing.
Children: There is little safety or effectiveness information about Lokelma in children.
Older adults over the age of 65 years: There are no differences between older and younger adults in regards to Lokelma's effectiveness and safety.
Dialysis: If you're on dialysis, your dosing will be slightly different than for someone who doesn't receive dialysis treatment. Additionally, you'll only take Lokelma on your non-dialysis days.
Acute illness—like an infection: Notify your healthcare provider right away if you're not feeling well. Having an acute (short-term) illness—like an infection—may cause appetite loss. You might also drink less water and experience diarrhea. These symptoms can affect your potassium levels. Therefore, your healthcare provider may need to adjust your Lokelma dose.
People with a high risk of edema: Lokelma might increase your sodium levels, which can cause your body to retain water. This water retention may also result in severe edema (swelling) from fluid buildup. Certain medical conditions—like heart failure or kidney impairment—further raises this risk. As a result, your healthcare provider will closely monitor your potassium levels and adjust your Lokelma dose accordingly.
Potassium levels: Your healthcare provider will regularly monitor your potassium levels and adjust your Lokelma dose accordingly. If you're having low potassium levels, your healthcare provider may stop Lokelma.
If you accidentally forget your Lokelma dose, take it as soon as you remember. If it's already close to your next scheduled dose, however, skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.
Try to find ways to help yourself remember to routinely take your medication. If you miss too many doses, Lokelma might be less effective at ridding your body of the extra potassium.
There is limited information available about Lokelma overdose.
Taking too much Lokelma, however, might increase your risk of serious side effects, such as low potassium levels, severe edema, and worsening of certain medical conditions (e.g., heart failure and kidney impairment).
If you think that you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.
If you think you or someone else may have overdosed on Lokelma, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Lokelma, call 911 immediately.
It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.
This medicine may cause swelling in the different parts of your body. This is more likely if you have heart failure or kidney disease. You may also need to adjust your sodium intake while using this medicine. Talk to your doctor if you have any concerns.
Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests (eg, abdominal or stomach X-ray) may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Lokelma's prescribing information doesn't list any contraindications. Before taking Lokelma, however, talk with your healthcare provider if any of the following applies to you:
Lokelma can briefly affect the acidity of the environment in your stomach. In fact, Lokelma can make your stomach less acidic (more basic).
This change in acidity can affect the absorption of some medications—including human immunodeficiency virus (HIV) medications—but not all medications. Your pharmacist or healthcare provider can help you determine if changes in your stomach environment will affect the absorption of your medications. To be safe, however, you can take all oral medications at least two hours before or after Lokelma.
For more detailed information about medication interactions with Lokelma, talk with your pharmacist or healthcare provider.
Lokelma is a potassium binder, which is a small medication class. Other than Lokelma, this medication class includes just the following two medications:
Lokelma and Veltassa are the newer potassium binders, which are effective alternatives to sodium polystyrene sulfonate (SPS). Compared to SPS, the newer potassium binders have the following advantages:
Additional research might be needed, but Lokelma and Veltassa may also have the following possible pros:
Compared to Veltassa, Lokelma might stand out for the following reasons:
Since all of these medications are potassium binders, they're not typically used together. In reference to the KDIGO (Kidney Disease Improving Global Outcomes Controversies Conference), however, Lokelma might have an off-label use with sodium polystyrene sulfonate (without sorbitol) for severe hyperkalemia.
Lokelma is available as a prescription. You'll likely find it at your local retail pharmacy. If necessary, the pharmacy staff might need to order the product for you.
A generic version of Lokelma isn't available, so it likely is expensive without insurance. If cost is a concern, Lokelma's manufacturer does offer a savings program. For eligibility questions, visit AstraZeneca's website or call 866-494-8080.
Depending on the severity of your high-potassium condition, your healthcare provider may recommend dietary changes. Some changes may include avoiding potassium supplements and limiting potassium-rich foods. Since Lokelma might increase your sodium levels, you may also need to eat foods with less sodium.
Depending on the severity of your high potassium condition, your healthcare provider may recommend some of the following tips to help you stay healthy:
Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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Food and Drug Administration. Lokelma label.
National Kidney Foundation. Facts about high potassium in patients with kidney disease.
National Kidney Foundation. What is hyperkalemia?
Peacock WF, Rafique Z, Vishnevskiy K, et al. Emergency potassium normalization treatment including sodium zirconium cyclosilicate: a phase II, randomized, double-blind, placebo-controlled study. Academic Emergency Medicine. 2020;27(6):475-486. doi: 10.1111/acem.13954
Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. KDIGO Executive Conclusions. 2020;97(1):P41-61. doi: https://doi.org/10.1016/j.kint.2019.09.018
Palmer BF. Potassium binders for hyperkalemia in chronic kidney disease—diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis. Mayo Clinic Proceedings. 2020;95(2):P339-354. doi: https://doi.org/10.1016/j.mayocp.2019.05.019
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National Kidney Foundation. Potassium and your CKD diet.
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