Hyperkalemia, chronic:
Oral: Initial: 8.4 g once daily; adjust dose by 8.4 g daily at ≥1-week intervals, as needed, based on serum potassium levels; maximum dose: 25.2 g/day.
No dosage adjustment necessary.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Veltassa: 8.4 g (1 ea, 4 ea, 30 ea); 16.8 g (1 ea, 30 ea); 25.2 g (1 ea, 30 ea)
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Veltassa: 8.4 g (8.4 g); 16.8 g (30 ea)
Oral: Administer without regard to food. Do not administer patiromer in its dry form. Following reconstitution, drink mixture immediately. If powder remains in the glass after drinking, add more water, stir, and drink immediately; repeat as needed to ensure the entire dose is administered. Other beverages or soft foods (eg, apple sauce, yogurt, pudding) may be used for preparation and administration instead of water. Do not heat patiromer (eg, microwave) or add to heated foods or liquids. Administer other oral medications at least 3 hours before or 3 hours after patiromer.
Hyperkalemia, chronic: Treatment of hyperkalemia.
Limitations of use: Patiromer should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Endocrine & metabolic: Hypomagnesemia (5% to 9%), hypokalemia (5%)
Gastrointestinal: Constipation (7%; transient), diarrhea (5%), abdominal distress (2%), flatulence (2%), nausea (2%)
<1%, postmarketing, and/or case reports: Hypersensitivity reaction (including lip edema)
Hypersensitivity to patiromer or any component of the formulation.
Canadian labeling: Additional contraindications (not in US labeling): Hereditary condition of fructose intolerance (eg, sorbitol).
Concerns related to adverse effects:
• GI effects: Avoid use in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders; patiromer may be ineffective and may worsen GI conditions.
• Hypomagnesemia: Patiromer binds to magnesium in the colon, which can lead to hypomagnesemia. Monitor serum magnesium and consider magnesium supplementation if hypomagnesemia develops.
Special populations:
• Older adult: May experience more gastrointestinal adverse reactions.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Ciprofloxacin (Systemic): Patiromer may decrease the serum concentration of Ciprofloxacin (Systemic). Management: Administer oral ciprofloxacin at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Levothyroxine: Patiromer may decrease the serum concentration of Levothyroxine. Management: Administer oral levothyroxine at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
MetFORMIN: Patiromer may decrease the serum concentration of MetFORMIN. Management: Administer metformin at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Patiromer is not absorbed systemically following oral administration. Use during pregnancy is not expected to result in significant exposure to the fetus.
Patiromer is not absorbed systemically following oral administration. Breastfeeding is not expected to result in significant exposure to a breastfed child.
Consider the potassium content of the liquids or soft food used to prepare the mixture as part of the patient's dietary potassium recommendations.
Serum potassium and magnesium.
Note: Reference ranges may vary depending on the laboratory.
Serum potassium: 3.5 to 5.2 mEq/L
Patiromer, a non-absorbed, cation exchange polymer that contains a calcium-sorbitol counterion, increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract, resulting in a reduction of serum potassium levels.
Onset of action: 7 hours (Bushinsky 2015)
Duration of action: 24 hours (Bushinsky 2015)
Absorption: Not systemically absorbed
Excretion: Feces (unchanged)
Pack (Veltassa Oral)
8.4 g (per each): $51.63
16.8 g (per each): $38.64
25.2 g (per each): $38.64
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