Generic Name

Sodium Zirconium Cyclosilicate

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Classification

FDA Approved Indications

• Treatment of hyperkalemia in adults

Mechanism of Action

Sodium zirconium cyclosilicate is an oral, activated zirconium silicate that exchanges potassium ions for sodium and hydrogen ions in the gastrointestinal tract, selectively removing potassium from the body.

Dosage and Administration

Adult: Initial dose: 10 g three times daily for up to 48 hours, then 10 g once daily or three times weekly as needed to maintain normal potassium levels.

Pediatric: Not established; use in pediatric patients is not recommended due to lack of safety and efficacy data.

Geriatric: Adjust dose based on renal function and response, caution in elderly due to potential for increased adverse effects.

Renal Impairment: Dose adjustment may be necessary; use caution and monitor potassium levels.

Hepatic Impairment: No specific adjustments required.

Pharmacokinetics

Absorption: Minimal systemic absorption; acts locally in GI tract.

Distribution: N/A

Metabolism: Not metabolized systemically.

Excretion: Excreted in feces; minimal renal excretion.

Half Life: Not applicable due to local action.

Contraindications

• Hypokalemia
• Obstructive bowel disease
• Gastrointestinal perforation or fistula

Precautions

• Monitor potassium levels closely, especially during dose adjustments.
• Use with caution in patients with heart failure or edema, as sodium load may contribute to volume overload.
• Assess for gastrointestinal symptoms; discontinuation may be necessary if severe GI side effects occur.

Adverse Reactions - Common

• Edema (Common)
• Constipation (Common)
• Hypokalemia (Uncommon)

Adverse Reactions - Serious

• Gastrointestinal perforation or ischemia (Rare)
• Serious gastrointestinal adverse events leading to hospitalization or death (Rare)

Drug-Drug Interactions

• Other agents that affect electrolyte balance, such as diuretics, ACE inhibitors, ARBs, or other potassium-lowering agents.

Drug-Food Interactions

• Limit sodium intake as high sodium load may counteract the drug’s efficacy.

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take as directed, with or without food.
• Report symptoms of hypokalemia or gastrointestinal discomfort.
• Avoid excess sodium intake during therapy.

Special Considerations

Black Box Warnings:

• Potential for gastrointestinal adverse events, including perforation, ischemia, or necrosis, particularly in patients with gastrointestinal conditions.

Genetic Factors: None currently known.

Lab Test Interference: May alter serum electrolyte levels; interpret labs with clinical context.

Overdose Management

Signs/Symptoms: Symptoms of hypokalemia, such as muscle weakness, arrhythmias, or gastrointestinal symptoms.

Treatment: Discontinue medication; provide supportive therapy; correct electrolyte imbalances as needed.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable for the shelf life indicated by the manufacturer.