Indications

Hyperkalemia is treated with this medication. (Acute or chronic kidney disease is the most common cause of hyperkalemia. Other reasons include liver failure, adrenal insufficiency, and the use of certain medications such as ARBs, ACE inhibitors, beta blockers, or excessive potassium supplementation.)

Pharmacology

Sodium Polystyrene Sulfonate is a cation exchange polymer with a sodium counterion that is not absorbed. Sodium Polystyrene Sulfonate enhances fecal potassium excretion by binding potassium in the gastrointestinal tract lumen. Potassium binding decreases the concentration of free potassium in the gastrointestinal lumen, resulting in lower serum potassium levels. 1 mEq K per 1 gram of resin is the realistic exchange ratio.

The sodium ions are partially released and replaced by potassium ions as the resin travels through the gut or is held in the colon following enema delivery. This process takes place largely in the large intestine, which excretes potassium ions more than the small intestine. This process's efficiency is restricted and unexpectedly changeable.

Dosage

Adults (including the elderly)-

Oral Dose: The average daily oral dose for adult is 15 gm to 60 gm (1 Sachet 1-4 times daily).
Rectal dose: In patients who are unable to intake this medicine orally, rectal administration is possible (as enema). 30 gm to 50 gm of resin is given once or twice daily (at intervals of 6 hours). Each dose is administered as a warm emulsion (at body temperature) in 150 ml to 200 ml of aqueous vehicle (such as plain water, 10% dextrose in water or equal parts of water and 2% Methylcellulose suspension). The emulsion should be agitated gently during administration. The enema should be retained for as long as possible and should be followed by a cleansing enema.

Children-

Oral dose: In smaller children and infants correspondingly lower doses should be employed. An appropriate initial dose is 1 gm/kg body weight daily in divided doses in acute hyperkalemia. For maintenance therapy, dosage may be reduced to 0.5 gm/kg body weight daily.
Rectal dose: When refused by mouth, the resin may be given rectally using a dose at least as much as that which would have been given orally. The resin should be suspended in a proportional amount of 10% Dextrose in water. Following retention of the enema, the colon should be irrigated to ensure adequate removal of the resin.

Neonates-

Rectal dose: Since it is advised that the oral route should not be employed, only rectal administration should be considered. With rectal administration, the minimum effective dosage within the range of 0.5 to 1 gm/kg of resin should be employed. The resultant suspension should be diluted as for adults. Following administration of the resin, the colon should be adequately irrigated to ensure recovery of the resin.

Administration

Mixing procedure: Each dose should be given as a suspension in a small quantity of water or, for greater palatability, in sweetened liquid or syrup (but not with orange or other fruit juices which contain potassium). The amount of fluid usually ranges from 20 ml to 100 ml, depending on the dose. It may be simply determined by allowing 3 ml to 4 ml per gram of drug. The prepared suspension should be administered by placing and maintaining the patient in an upright position. The resin may be introduced into the stomach through a plastic tube. If desired, it may be mixed with a diet appropriate for a patient in renal failure.The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia. Sodium Polystyrene Sulfonate should not be heated because it may alter the exchange properties of the resin.

Suspension of this drug should be freshly prepared and not to be stored beyond 24 hours.

Interaction

Drug interactions with Sodium Polystyrene Sulfonate include antacids, nonabsorbable cation-donating antacids and laxatives, digitalis, sorbitol, lithium, and thyroxine.

Contraindications

People with hypokalemia, patients with a history of hypersensitivity to polystyrene sulfonate resins, obstructive bowel illness, newborns with decreased gut motility (postoperatively or medication induced), and oral administration in neonates are all contraindicated.

Side Effects

The medication may cause mild stomach discomfort. Anorexia, nausea, vomiting, and constipation are all possible side effects, especially at high dosages. Hypokalemia, hypocalcemia, and substantial sodium retention, as well as associated clinical symptoms, are also possible. Diarrhea can occur on rare occasions. Large dosages in the elderly may result in fecal impaction. There have been a few reports of colonic necrosis. When used in conjunction with such resin, it has been observed that concretions of aluminum hydroxide cause intestinal blockage.

Pregnancy & Lactation

Pregnancy Type C. Sodium Polystyrene Sulfonate has not been studied in animal reproduction. It is also unknown if it can harm a pregnant woman's fetus or alter her reproductive ability if given to her. It should only be administered to a pregnant woman if absolutely necessary.

Mothers who are nursing: It is unknown if this medication is excreted in human milk. Because many medications are excreted in human milk, care should be taken while administering this product to a breastfeeding woman.

Precautions & Warnings

Caution is suggested when administering this medication to patients who cannot handle even a minor increase in salt burdens (i.e., severe congestive heart failure, severe hypertension, or marked edema). In such cases, compensating sodium limitation from other sources may be advised. In the event of clinically significant constipation, this medication should be stopped until regular bowel motion is restored. Laxatives containing magnesium or sorbitol should not be utilized.

Therapeutic Class

Calcium Receptor

Storage Conditions

Store at temperatures below 30°C. Keep out of children's reach. This drug's suspension should be produced fresh and not kept for more than 24 hours.