sodium polystyrene sulfonate (Kalexate, Kayexalate, Kionex, SP)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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What is sodium polystyrene sulfonate-powder, and how does it work (mechanism of action)?

Sodium polystyrene sulfonate is a cation-exchange resin taken orally that is used to reduce high levels of potassium in the blood (hyperkalemia). Sodium polystyrene sulfonate removes potassium by exchanging sodium ions for potassium ions in the intestine. The majority of this cation exchange seems to take place in the large intestine where potassium ions are excreted in greater amounts.

In-vitro studies have shown that each gram of resin removes roughly 3 mEq of potassium. However, actual removal of potassium in patients is closer to 1 mEq per gram of medication. Sodium polystyrene sulfonate starts working over a period of several hours and therefore should not be used to treat life-threatening episodes of acute hyperkalemia.

Sodium polystyrene sulfonate was initially approved by the US FDA in 1958.

What brand names are available for sodium polystyrene sulfonate-powder?

Kalexate, Kayexalate, Kionex, SP

Is sodium polystyrene sulfonate-powder available as a generic drug?

Yes

Do I need a prescription for sodium polystyrene sulfonate-powder?

Yes

What are the side effects of sodium polystyrene sulfonate-powder?

The most common side effects associated with sodium polystyrene sulfonate treatment are gastrointestinal (affecting the stomach and intestines).

Other side effects include:

Large oral doses have been reported to cause fecal impaction in the elderly, while large rectal doses have caused fecal impaction in children.

Colonic necrosis is one of the most serious side effects reported with rectal administration of sodium polystyrene sulfonate.

Rare but serious side effects are:

What is the dosage for sodium polystyrene sulfonate-powder?

  • Oral dosage Adults: The usual recommended dose is 15 g administered 1 to 4 times per day.
  • Oral dosage Pediatrics: The usual recommended dose is 1 g/kg administered by mouth every 6 hours as needed.
  • Rectal dosage Adults: The usual recommended dose is 30 to 50 g administered rectally every 1-2 hours initially, followed by repeat doses every 6 hours if needed.
  • Rectal dosage Pediatrics: The usual recommended dose is 1 g/kg administered rectally every 6 hours as needed.

Which drugs or supplements interact with sodium polystyrene sulfonate-powder?

Cation-donating antacids or laxatives may reduce the effectiveness of sodium polystyrene sulfonate when given concomitantly. Examples of cation-donating antacids and laxatives include:

Sodium polystyrene sulfonate should be used cautiously with digoxin (Lanoxin) since sodium polystyrene sulfonate-induced hypokalemia (low blood potassium levels) may increase the risk of cardiac toxicity (heart rhythm abnormalities) associated with digoxin.

Concomitant use of sorbitol (Ora-Blend, Ora-Blend SF, Numoisyn Lozenges, Saliva Substitute) with sodium polystyrene sulfonate may cause colonic necrosis. Therefore, use of this combination treatment is not recommended.

Sodium polystyrene sulfonate may decrease the absorption of lithium (Eskalith, Lithobid).

Sodium polystyrene sulfonate may decrease the absorption of thyroxine or levothyroxine (Synthroid). Therefore, the administration of thyroid hormones and sodium polystyrene sulfonate should be separated by at least 4 hours.

Is sodium polystyrene sulfonate-powder safe to take if I'm pregnant or breastfeeding?

Sodium polystyrene sulfonate is classified asFDA pregnancy risk category C. Use of sodium polystyrene sulfonate during pregnancy has not be adequately studied. Due to the lack of conclusive safety data, sodium polystyrene sulfonate should only be used during pregnancy if the benefits of treatment outweigh the potential risk to the fetus.

It is not known if sodium polystyrene sulfonate is excreted in human milk. Due to the lack of safety data, this medication should be used cautiously in females who are breastfeeding.

What else should I know about sodium polystyrene sulfonate-powder?

What preparations of sodium polystyrene sulfonate-powder are available?

  • Oral suspension: 15 g/60 ml
  • Oral powder for suspension: 454 g
  • Rectal suspension: 15 g/60 ml

How should I keep sodium polystyrene sulfonate-powder stored?

This medication should be stored at room temperature, between 15 C to 30 C (59 F to 86 F).

Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCE:

FDA Prescribing Information.

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Reviewed on 5/16/2017
References
Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCE:

FDA Prescribing Information.

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