If you have hyperkalemia (high potassium levels in your blood), your doctor may prescribe Lokelma.

This drug is used in adults, but not in emergency situations. See “What is Lokelma used for?” just below for details.

Lokelma basics

The active ingredient in Lokelma is sodium zirconium cyclosilicate. (The active ingredient is what makes the drug work.) Lokelma comes as a powder that you’ll mix with water and then drink.

Lokelma belongs to a group of drugs called potassium binders. It isn’t currently available in generic form.

In this article, we describe Lokelma’s uses, side effects, and more.

Lokelma is used in adults with hyperkalemia. With this condition, you have too much potassium in your blood. Symptoms can include:

The way Lokelma works is by binding (attaching) to potassium in your stomach and intestines. This leads to potassium being released in your stool, along with the drug. This lowers the potassium level in your blood.*

It’s important to note that Lokelma isn’t used to treat acute (sudden) hyperkalemia in an emergency. The drug doesn’t work quickly enough for this.

* See “How does Lokelma work?” in the “What are some frequently asked questions about Lokelma?” section below for details.

Your doctor will recommend the dosage of Lokelma that’s right for you. Below are commonly used dosages, but always take the dosage that your doctor prescribes.

Form and strengths

Lokelma comes as a powder in foil packets. You’ll mix the powder with water and then drink the liquid solution right away.

The powder comes in strengths of 5 grams (g) and 10 g.

Recommended dosage

When starting Lokelma treatment, you may need to take the drug three times per day for the first 2 days. Your doctor will prescribe the starting dose that’s right for you.

If you continue taking Lokelma, your doctor may lower your dosage to once per day. They will also recommend how long you should continue taking Lokelma.

Your doctor will monitor your blood potassium level and change your dosage as needed. If you need a dosage change, they will keep you on the new dosage for at least a week.

Questions about Lokelma’s dosage

  • What if I miss a dose of Lokelma? If you miss a dose of Lokelma, take it as soon as you remember. If you’re close to your next dose, skip the missed dose and take your next dose as usual. Do not double your dose to make up for a missed dose. This can increase your risk of side effects. If you’re unsure when to take Lokelma because of a missed dose, talk with your doctor or pharmacist.
  • Will I need to take Lokelma long term? It depends on your condition and your blood potassium level. Some people may only need to take Lokelma for 48 hours. Talk with your doctor to find out how long you’ll need to take Lokelma.
  • How long does Lokelma take to work? Studies show that Lokelma can start working 1 hour after the first dose, and it continues to lower potassium levels for 48 hours.

Lokelma and Kayexalate are both treatments for hyperkalemia (high potassium).

Brand-name Kayexalate is no longer available in the United States. But a generic form of Kayexalate is available, which is called sodium polystyrene sulfonate (SPS). A generic drug is a copy of the active ingredient in a branded drug.

SPS may take hours or days to lower potassium. Lokelma can work within 1 hour of taking the first dose. Neither drug is used to treat emergency hyperkalemia.

If you’d like to learn more about how Lokelma compares with SPS, see this detailed breakdown. Be sure to check with your doctor about which medication is recommended for your condition.

Find answers to some common questions about Lokelma.

How does Lokelma work?

Lokelma works by binding (attaching) to potassium in your digestive tract (your stomach and intestines). This is Lokelma’s mechanism of action (the way the drug works in your body).

Your body doesn’t absorb Lokelma’s active ingredient,* sodium zirconium cyclosilicate, through your intestines. This means that once Lokelma binds to potassium, the potassium and the drug are released through your stool. This lowers the level of potassium in your digestive tract and blood.

* A drug’s active ingredient makes the drug work.

Does Lokelma cause diarrhea or constipation?

No, diarrhea and constipation aren’t side effects of Lokelma.

If you have problems with your digestive system, such as severe constipation or a blockage in your intestines, Lokelma can make your symptoms worse.

Having severe diarrhea can cause you to lose electrolytes (minerals), such as potassium. Taking Lokelma and having severe diarrhea can cause your potassium level to become too low. Talk with your doctor if you have diarrhea and you’re taking Lokelma.

Hemodialysis (a treatment that filters waste from your blood) increases your risk of getting sick and having vomiting or diarrhea. If you’re taking Lokelma while you’re having hemodialysis and you have diarrhea or vomiting, you should talk with your doctor.

* See “What should be considered before taking Lokelma?” below for details.

How does Lokelma compare with alternatives such as SPS?

Other drugs used for hyperkalemia (high potassium) besides Lokelma include sodium polystyrene sulfonate (SPS). SPS is the generic form of the brand-name drugs Kalexate and Kionex. A generic drug is a copy of the active ingredient in a branded drug.

Both SPS and Lokelma work quickly, though neither are used for emergency hyperkalemia. And to find out which treatment is best for your condition, talk with your doctor or pharmacist.

Note: Kayexalate was another brand-name form of SPS, but it’s no longer available in the United States. See “What should I know about Lokelma vs. Kayexalate?” above for details about how these drugs compare.

How should I store Lokelma?

You’ll store Lokelma packets at room temperature, which is 59°F to 86°F (15°C to 30°C). Don’t store the drug in a humid area such as the bathroom, or a warm spot such as in a cabinet near the stove.

After mixing Lokelma powder with water, you should drink your full dose right away. Do not mix the powder into water before you plan to drink your dose.

What is Lokelma’s efficacy?

Studies show that Lokelma is effective for lowering potassium levels in the blood. The drug starts working within 1 hour. And with regular use, Lokelma keeps potassium levels in a normal range for as long as it’s taken. Talk with your doctor to find out how long you’ll need to take Lokelma.

For more information about Lokelma’s effectiveness for your condition, talk with your doctor or pharmacist.

Like most drugs, Lokelma may cause mild or serious side effects. The lists below describe some of the more common side effects that Lokelma may cause. These lists don’t include all the possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Lokelma. They can also suggest ways to help reduce side effects.

Mild side effects

Swelling is the only mild side effect that has been reported in studies. For details about swelling, see “Side effect focus” below. And to learn about side effects in studies, you can see Lokelma’s prescribing information.

Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects of Lokelma can occur, but they aren’t common. If you have serious side effects of Lokelma, call your doctor right away. If you think you’re having a medical emergency, call 911 or your local emergency number.

Serious side effects of Lokelma that have been reported include:

* For more information about this side effect, see the “Side effect focus” section below.

Side effect focus

Learn more about some side effects that Lokelma may cause.

Swelling

Swelling, also called edema, can happen with Lokelma. In studies, swelling was usually mild to moderate. It may be more common in people taking higher doses of Lokelma.

Lokelma contains a form of sodium (salt) as its active ingredient (the ingredient that makes the drug work). Too much sodium in your body can cause your body to hold on to more fluid, which can lead to swelling. It isn’t clear how much sodium your body may hold on to while you’re taking Lokelma.

What might help

If you have swelling when taking Lokelma, talk with your doctor. They may recommend that you limit sodium in your diet.

Another way to reduce swelling is to take another medication that releases water from your body. Your doctor may prescribe this type of medication, which is called a diuretic.

If you have certain heart or kidney conditions, or if you currently need to limit how much sodium is in your diet, your doctor might monitor you for swelling during your Lokelma treatment.

Low potassium level

Lokelma is used to treat hyperkalemia (high potassium), and sometimes you can develop hypokalemia (low potassium) as a side effect.

You might only have symptoms of hypokalemia if your potassium levels drop below a certain level. Your doctor can tell you what is considered a low level of potassium.

Symptoms of low potassium may include:

Severe hypokalemia can be life threatening.

If you’re having hemodialysis (a treatment that filters waste from your blood) while you’re taking Lokelma, you’re more likely to have severe hypokalemia. See “What should be considered before taking Lokelma?” below for details.

What might help

Your doctor may change your dosage of Lokelma or have you stop taking it if your potassium level becomes too low. They’ll monitor your potassium level with blood tests during your treatment. Be sure to tell your doctor about any symptoms of low potassium right away.

Allergic reaction

Some people may have an allergic reaction to Lokelma.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Lokelma. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Costs of prescription drugs can vary, depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Lokelma manufacturer’s website to see if they have support options. And you can check out this article to learn more about saving money on prescriptions.

Lokelma (sodium zirconium cyclosilicate) and Veltassa (patiromer) are both treatments for hyperkalemia (high potassium). Like Lokelma, Veltassa isn’t used to treat hyperkalemia in an emergency because it works too slowly.

To learn about the similarities and differences of Lokelma and Veltassa, see this comparison. It provides information about the drugs’ uses, costs, and more.

Also, talk with your doctor about which medication is right for your condition.

Your doctor will explain how you should take Lokelma. Be sure to follow their instructions.

Taking Lokelma

Lokelma comes as a powder that you’ll mix with water. Then you’ll drink the liquid solution. You should drink it right away after mixing it.

To prepare Lokelma, follow the mixing instructions on the packaging. Your doctor or pharmacist can also provide instructions.

Taking Lokelma with other drugs

If you take other medications, take them at least 2 hours before or after Lokelma. Administration of Lokelma with certain medications can affect how well they’re absorbed.

If you’re unsure when to take other medications while you’re taking Lokelma, talk with your doctor or pharmacist.

Questions about taking Lokelma

  • Can Lokelma be chewed, crushed, or split? You can’t chew, crush, or split Lokelma powder. After mixing the powder with water, drink the entire dose. If you’re unsure how to take Lokelma, talk with your doctor or pharmacist.
  • Should I take Lokelma with food? You can take Lokelma with or without food. Lokelma isn’t absorbed into the blood, so taking it with or without food won’t change how well it works.
Questions for your doctor

You may have questions about Lokelma and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Lokelma affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback about your treatment.

Some important things to discuss with your doctor when considering treatment with Lokelma include your overall health and any medical conditions you may have.

Tell your doctor if you’re taking other medications. This is important, since some medications can interfere with Lokelma. Below, learn more about these and other considerations to discuss with your doctor.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking Lokelma, be sure to tell your doctor about all the medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions with Lokelma that these items may cause.

Interactions with drugs or supplements

You’ll need to take Lokelma at least 2 hours before or after other medications. Lokelma can affect how the body absorbs other medications that you take by mouth.

Lokelma can also interact with several types of drugs. These drugs include:

This list does not contain all the types of drugs that may interact with Lokelma. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Lokelma.

Other interactions

Lokelma can affect X-ray images of your belly area. On an X-ray, the drug can look like a dye in your stomach or intestines. If you need to have an X-ray or other medical imaging, let the healthcare professional know that you’re taking Lokelma.

Warnings

Lokelma may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Lokelma. Factors to consider include those in the list below.

  • Digestive system problems. If you have a disorder of your digestive system, Lokelma can worsen symptoms of your condition. These disorders include severe constipation or a blockage in your intestines. And if you have digestive conditions like these, Lokelma may not work to treat your hyperkalemia (high potassium). Talk with your doctor if you have a medical condition related to digestion before taking Lokelma.
  • Allergic reaction. If you’ve had an allergic reaction to Lokelma or any of its ingredients, your doctor will likely recommend that you don’t take Lokelma. Ask them what other medications are better options for you.
  • Sodium restriction. Lokelma contains a form of sodium (salt) as its active ingredient (the ingredient that makes the drug work). Taking the drug can lead to swelling (see “What are Lokelma’s side effects?” above). If you currently limit sodium in your diet, you may be more at risk of swelling with Lokelma. If you have a heart condition, such as heart failure, or problems with your kidney function, talk with your doctor before taking Lokelma. You may need to limit sodium in your diet or take medications to manage your sodium levels.
  • Hemodialysis. If you’re having hemodialysis, you may have a higher risk of very low potassium with Lokelma. This is because hemodialysis can cause diarrhea and vomiting. These side effects can lower your potassium, and Lokelma also works to lower potassium. Taking Lokelma while you’re having diarrhea or vomiting may cause potassium levels to drop too low. If you’re taking Lokelma, you’re having hemodialysis, and you have diarrhea or vomiting, talk with your doctor. They may lower your Lokelma dosage or have you stop taking the drug. Do not stop taking Lokelma without talking with your doctor first.

Lokelma and alcohol

Some medications interact with alcohol. But Lokelma isn’t one of them.

However, drinking alcohol can affect how well your body releases potassium. This can make it harder for Lokelma to lower your potassium.

Ask your doctor if it’s OK to drink alcohol while taking Lokelma. Your doctor may ask how often and how much alcohol you drink.

Pregnancy and breastfeeding

Lokelma is safe to take during pregnancy and breastfeeding because it doesn’t get absorbed into the blood. If you’re pregnant or breastfeeding, taking Lokelma shouldn’t expose your baby to the drug.

Talk with your doctor first about taking Lokelma if you’re pregnant, breastfeeding, or considering either.

Do not take more Lokelma than your doctor prescribes. Taking more than this can lead to serious side effects. If you take too much Lokelma, your doctor may closely monitor you for signs and symptoms of overdose.

What to do in case you take too much Lokelma

Call your doctor if you think you’ve taken too much Lokelma. You can also call 800-222-1222 to reach the American Association of Poison Control Centers, or use its online resource. However, if you have severe symptoms, immediately call 911 or your local emergency number. Or, go to the nearest emergency room.

If you have questions about taking Lokelma, talk with your doctor or pharmacist. Your doctor can tell you about other treatments for your condition. Here’s an article that that you might find helpful: How to Lower Your Potassium Levels

Some questions to ask your doctor about Lokelma may include:

Q:

If I throw up within 1 hour of taking Lokelma, do I need to retake the dose?

Anonymous

A:

The manufacturer of Lokelma hasn’t provided a recommendation about what to do if you throw up within 1 hour of taking the drug. It’s best to talk with your doctor about what to do next. They’ll discuss the risks and benefits of retaking your dose.

In general, throwing up soon after taking a medication could make the drug less effective for you.

Lokelma works by binding (attaching) to potassium in your digestive tract (your stomach and intestines). If you throw up soon after taking Lokelma, the drug may not have had time to reach your digestive tract. This means that Lokelma may not work as well for lowering your potassium.

Amber Watson, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.