sodium polystyrene sulfonate (Rx)

Brand and Other Names:SPS, Kayexalate, more...Kionex, Kalexate
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for oral suspension

  • 454g

oral suspension

  • 15g/60mL

rectal suspension

  • 15g/60mL

Hyperkalemia

PO: 15 g once daily or q6-12hr

Rectal: 30-50 g q6hr

Lithium Overdose (Off-label)

30 g in sorbitol q4hr; monitor for hypokalemia

Dosage Forms & Strengths

powder for oral suspension

  • 454g

oral suspension

  • 15g/60mL

rectal suspension

  • 15g/60mL

Hyperkalemia

PO: 1 g/kg q6hr PRN; alternatively, use exchange ratio of 1 mEq K+ to 1 g of resin for lower dose (oral use not recommended in patients < 1 month old)  

Rectal: 1 g/kg q2-6hr PRN; alternatively, use exchange ratio of 1 mEq K+ to 1 g of resin for lower dose

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Interactions

Interaction Checker

and sodium polystyrene sulfonate

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • meloxicam

              meloxicam increases toxicity of sodium polystyrene sulfonate by Other (see comment). Contraindicated. Comment: Cases of intestinal necrosis (possibly fatal) described with concomitant sorbitol and sodium polystyrene sulfonate; due to sorbitol in meloxicam oral suspension, coadministration is not recommended.

            Serious - Use Alternative (1)

            • sorbitol

              sodium polystyrene sulfonate, sorbitol. Mechanism: unknown. Avoid or Use Alternate Drug. Combination implicated in cases of colonic necrosis.

            Monitor Closely (5)

            • deflazacort

              sodium polystyrene sulfonate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • magnesium sulfate

              sodium polystyrene sulfonate increases levels of magnesium sulfate by decreasing renal clearance. Use Caution/Monitor. Risk of seizure.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of sodium polystyrene sulfonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of sodium polystyrene sulfonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              sodium polystyrene sulfonate and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            Minor (11)

            • calcium acetate

              sodium polystyrene sulfonate increases levels of calcium acetate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • calcium carbonate

              sodium polystyrene sulfonate increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • calcium chloride

              sodium polystyrene sulfonate increases levels of calcium chloride by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • calcium citrate

              sodium polystyrene sulfonate increases levels of calcium citrate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • calcium gluconate

              sodium polystyrene sulfonate increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • levothyroxine

              sodium polystyrene sulfonate decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • lithium

              sodium polystyrene sulfonate decreases levels of lithium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • magnesium chloride

              sodium polystyrene sulfonate increases levels of magnesium chloride by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • magnesium citrate

              sodium polystyrene sulfonate increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • magnesium hydroxide

              sodium polystyrene sulfonate increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • magnesium oxide

              sodium polystyrene sulfonate increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

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            Adverse Effects

            1-10%

            GI disturbance

            Constipation

            Hypokalemia

            Hypocalcemia

            Hypomagnesemia

            Sodium retention

            Nausea

            Vomiting

            Frequency Not Defined

            GI concretions (bezoars) after oral use

            GI tract ulceration or necrosis, which could lead to perforation

            Fecal impaction after rectal administration (especially in children)

            Acute bronchitis or bronchopneumonia associated with inhalation of polystyrene particles (rare)

            Postmarketing Reports

            Intestinal necrosis

            Aspiration

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            Warnings

            Contraindications

            Hypersensitivity to polystyrene sulfonate resins

            Hypokalemia

            Obstructive bowel disease

            Neonates with reduced gut motility (postoperative or drug-induced), oral administration

            Rectal administration of suspension with sorbitol in neonates, particularly in premature infants

            Cautions

            Use caution in congestive heart failure, severe hypertension, marked edema (due to sodium content; 1 g contains 100 mg of sodium, 1/3 of which is delivered to body)

            Best when used in non-life-threatening hyperkalemia

            Monitor electrolytes

            Large doses may result in fecal impaction, especially in the elderly

            Hypokalemia may occur monitor serum potassium frequently within each 24 hr period; ECG monitoring may be appropriate in some patients; cation exchange resins may also affect concentrations of other cations, including calcium and magnesium

            In severe hyperkalemia, consider more immediate treatment modalities (eg, dialysis, IV calcium, bicarbonate, glucose, and insulin)

            Products can contain as much as 20 g of sorbitol per 15 g of sodium polystyrene

            Use caution with dosage forms containing propylene glycol; large amounts are potentially toxic; associated with hyperosmolality, seizures, lactic acidosis, and respiratory depression

            Do not use in patients who do not have normal bowel function, including postoperative patients who have not had a bowel movement since operation' avoid use in postoperative patients at risk of constipation or impaction until normal bowel function resumes; discontinue use if constipation occurs

            Do not mix PO dose with banana or orange juice (potassium-rich)

            If there is clinically significant constipation, discontinue until normal bowel motion; do not use magnesium-containing laxatives or sorbitol

            In children and neonates rectal administration, excessive dosage or inadequate dilution could result in impaction of resin

            Premature and low-birth-weight infants: Risk of digestive hemorrhage or colonic necrosis

            Enema may reduce serum concentrations faster than oral administration but oral route will achieve greater reduction over several hours

            Risk of colonic necrosis and other serious GI adverse events (eg, bleeding, ischemic colitis, perforation), most frequently with concomitant use of sorbitol

            Concomitant administration of sorbitol is not recommended

            Risk factors for GI adverse events include prematurity, history of intestinal disease or surgery, hypovolemia, and renal insufficiency or failure

            Cases of acute bronchitis or bronchopneumonia caused by inhalation of sodium polystyrene sulfonate particles reported; patients with impaired gag reflex, altered level of consciousness, or patients prone to regurgitation may be at increased risk; administer product with patient in upright position

            May bind orally administered medications, which could decrease their gastrointestinal absorption and lead to reduced efficacy; administer other oral medications at least 3 hours before or 3 hours after therapy; patients with gastroparesis may require a 6 hour separation

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            Pregnancy & Lactation

            Pregnancy

            Not absorbed systemically following oral or rectal administration and maternal use is not expected to result in fetal risk

            Lactation

            Not absorbed systemically by the mother, so breastfeeding is not expected to result in risk to the infant

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Cation exchange resin, sodium ions partially released from polystyrene and replaced by potassium

            Absorption

            Bioavailability: Nonabsorbable ion-exchange resin

            Onset: 2-24 hr

            Duration: 4-6 hr

            Elimination

            Excretion: Feces

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            Administration

            Oral Preparation

            For each gram of powdered resin add 3-4 mL of water or syrup

            Do not heat solution to improve dissolution; heat impairs resin exchange

            Rectal Preparation

            Suspend dose in 100 mL of aqueous liquid (eg, water, sorbitol 25%, methylcellulose 1%, dextrose 10%)

            Oral Administration

            Shake suspension well before administering

            Administer PO or via NG tube with patient in upright position

            Do not take other oral medications within 3 hr of dosing (6 hr for patients with gastroparesis or other conditions) because of potential GI binding

            Do not mix with potassium containing liquids or food (eg, orange juice, bananas)

            Suspension may be chilled to improve palatability

            Rectal Administration

            Administer cleansing enema beforehand

            Administer sodium polystyrene sulfonate as warm emulsion (body temperature)

            Gently agitate suspension during administration

            Retain in colon for at least 30-60 min (several hours if possible)

            After completing retention, use nonsodium colonic irrigant to remove remaining resin

            Storage

            Resin powder: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)

            Freshly prepared suspension should be used within 24 hr

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            Patient Handout

            Patient Education
            sodium polystyrene sulfonate oral

            SODIUM POLYSTYRENE SULFONATE SUSPENSION - ORAL, RECTAL

            (SOE-dee-um POL-ee-STYE-reen SUL-foe-nate)

            COMMON BRAND NAME(S): SPS

            USES: This medication is used to treat a high level of potassium in your blood. Too much potassium in your blood can sometimes cause heart rhythm problems. Sodium polystyrene sulfonate works by helping your body get rid of extra potassium.

            HOW TO USE: Shake the bottle well before using.Do not heat this medication because it may not work as well.Take this medication by mouth, or use it rectally as directed by your doctor.If you are taking this medication by mouth, take it usually 1 to 4 times a day as directed by your doctor. Carefully measure the dose using a special measuring device/spoon, or use the prescribed number of pre-measured bottles of suspension. Do not use a household spoon because you may not get the correct dose. Stay upright (sitting, standing, or walking) and do not lie down for at least an hour after your dose. Consult your doctor for details.Sodium polystyrene sulfonate may decrease your absorption of other medications. Take your other medications as directed by your doctor, usually at least 3 hours before or 3 hours after sodium polystyrene sulfonate. Ask your doctor or pharmacist for more information or if you have any questions.To give this medication rectally as an enema, use the prescribed dose usually every 6 hours as needed or as directed by your doctor. Consult your doctor or pharmacist for directions on how to prepare the dose and how to use the enema. Follow instructions for the use of a cleansing enema both before and after your dose of sodium polystyrene sulfonate. The cleansing enema after each rectal dose of this medication should be a non-sodium-containing enema.The dosage and length of treatment are based on your medical condition and response to treatment. Follow your doctor's instructions carefully. Do not use more of this medication or use it for longer than directed because your potassium blood level may drop too low.Keep all laboratory and medical appointments so your doctor can check your potassium blood level.

            SIDE EFFECTS: Loss of appetite, nausea, vomiting, or constipation may occur. Diarrhea may occur less frequently. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: muscle weakness/spasms, fast/irregular heartbeat, mental/mood changes (such as irritability, confusion, slowed thinking), swelling hands/ankles/feet.This medication may cause serious (rarely fatal) intestinal problems (such as bleeding, blockage). Get medical help right away if any of these very serious side effects occur: severe constipation, bloating/swelling/pain in the stomach/abdomen, black/bloody stools, vomit that looks like coffee grounds.Get medical help right away if you have any very serious side effects, including: inability to move your muscles (paralysis), seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using sodium polystyrene sulfonate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication contains a large amount of salt (sodium). Do not use salt substitutes that contain potassium without asking your doctor first. If you have any of these conditions, follow your doctor's instructions for limiting the amount of sodium in your diet: kidney problems, heart failure, high blood pressure, swelling hands/ankles/feet.Before using this medication, tell your doctor or pharmacist your medical history, especially of: stomach/intestine/bowel problems (such as inflammatory bowel disease, bowel obstruction, chronic constipation, fecal impaction), low level of potassium in the blood.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be at greater risk for severe constipation.This medication must not be given by mouth to newborns, especially premature infants. Also, newborns with slow gut function must not use this drug. Caution is advised when using this medication rectally in newborns and children. They may be more sensitive to the side effects of this drug, especially severe constipation and intestinal problems.Tell your doctor if you are pregnant before using this medication.This medication does not pass into breast milk and is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: antacids/laxatives that contain aluminum/calcium/magnesium (such as aluminum carbonate, aluminum hydroxide, calcium carbonate, magnesium hydroxide).Do not use any laxatives that contain sorbitol with this medication. Doing so may increase your risk of intestinal problems. See also Side Effects section.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: mental/mood changes, muscle weakness, fast/irregular heartbeat, slowed breathing, paralysis.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood levels of potassium and other minerals, EKG) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store tightly closed according to the directions on the product package, away from light and moisture. Some brands must be refrigerated, and others may be stored at room temperature. Ask your pharmacist for more details about the brand you are using and when it should be discarded. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.