Patiromer (Monograph)

Brand name: Veltassa
Drug class: Potassium-removing Agents
Chemical name: Hydrolyzed divinylbenzene-Me 2-fluoro-2-propenoate-1,7-octadiene polymer sorbitol complexes calcium
Molecular formula: [[C₃H₂FO₂)₂Ca]_x[C₈H₁₄]_z[C₁₀H₁₀]_y,[C₆H₁₄O₆]_w]_n
CAS number: 1415477-49-4

Medically reviewed by Drugs.com on Nov 2, 2023. Written by ASHP.

Introduction

Nonabsorbed, cation-exchange polymer used for the removal of excess potassium.^{1 3 5 7}

Uses for Patiromer

Hyperkalemia

Treatment of hyperkalemia.^{1 3 5}

Efficacy in decreasing elevated serum potassium concentrations and reducing recurrence of hyperkalemia established in patients with chronic kidney disease receiving drugs that inhibit the renin-angiotensin-aldosterone system.^{1 3} Efficacy maintained during treatment for up to 1 year.^{1 5}

Not used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.¹

Patiromer Dosage and Administration

Administration

Oral Administration

Administer ≥3 hours before or ≥3 hours after other oral drugs.¹ (See Interactions.)

Administer without regard to food.¹

Do not heat (e.g., in microwave) or add to heated foods or liquids.¹

Administer as oral suspension; do not administer in dry form.¹

Preparation of Oral Suspension

Empty entire contents of the packet(s) containing patiromer into glass or cup containing approximately 40 mL of water.¹ Stir, then add additional 40 mL of water. ¹ Stir thoroughly; may add more water to achieve desired consistency.¹ Administer immediately.¹

If powder remains in glass after initial administration, add more water, stir, and administer immediately; repeat, as needed, until the entire dose is administered.¹

Dosage

Available as patiromer sorbitex calcium; dosage expressed in terms of patiromer.¹

Adults

Hyperkalemia

Oral

Initially, 8.4 g once daily.¹ Monitor serum potassium concentration; dosage may be increased (in 8.4-g increments at intervals of ≥1 week, up to 25.2 g daily) or reduced based on serum potassium concentration and desired target range.¹

Prescribing Limits

Adults

Hyperkalemia

Oral

Maximum 25.2 g once daily.¹

Special Populations

Hepatic Impairment

No special dosage recommendations.¹

Renal Impairment

Dosage adjustments not necessary.¹

Geriatric Patients

No special dosage recommendations.¹

Related/similar drugs

sodium bicarbonate, Lokelma, insulin regular, Kayexalate, Humulin R, Veltassa

Cautions for Patiromer

Contraindications

• Known hypersensitivity to patiromer or to any ingredient in the formulation.¹

Warnings/Precautions

Worsening of GI Motility Disorders

Clinical studies excluded patients with history of bowel obstruction or major GI surgery, severe GI disorders, or swallowing disorders.¹

Avoid use in patients with severe constipation, bowel obstruction, or fecal impaction, including abnormal postoperative bowel motility disorders, because the drug may not be effective and may worsen GI conditions.¹

Hypomagnesemia

Binds to magnesium in the colon, which can lead to hypomagnesemia.¹ Monitor serum magnesium concentrations, and consider magnesium supplementation in patients with low serum magnesium concentrations.¹

Specific Populations

Pregnancy

Not expected to cause fetal harm when administered to pregnant women because patiromer is not absorbed systemically following oral administration.¹

Lactation

Breast-feeding not expected to result in risk to infants of patiromer-treated women because the drug is not absorbed systemically following oral administration.¹

Pediatric Use

Safety and efficacy not established in pediatric patients.¹

Geriatric Use

No overall differences in efficacy observed between geriatric patients and younger adults.¹ However, adverse GI effects reported more frequently in those ≥65 years of age.¹

Common Adverse Effects

Constipation,^{1 3} hypomagnesemia,^{1 3} diarrhea,^{1 3} nausea,^{1 3} abdominal discomfort,¹ flatulence.¹

Drug Interactions

Effects on GI Absorption of Drugs

Binds to approximately 50% of the oral drugs tested in vitro; clinical interaction studies indicate that concomitant oral administration with patiromer alters bioavailability of some of these drugs.^{1 10} (See Specific Drugs under Interactions.)

Binding could reduce GI absorption of oral drugs and result in loss of efficacy when administration times are close to those of patiromer.^{1 10} Administer other oral agents ≥3 hours before or ≥3 hours following administration of patiromer.¹

Specific Drugs

Patiromer Pharmacokinetics

Absorption

Bioavailability

Not absorbed systemically after oral administration.^{1 6}

Onset

Onset of lowering of serum potassium observed in 7 hours.^{1 7} Maximum (steady-state) effects attained within 7–14 days with twice-daily dosing.⁸ (See Actions.)

Food

Mean dosage and effects on serum potassium concentration are similar whether patiromer is administered with or without food.¹

Elimination

Elimination Route

Excreted in feces.^{1 6}

Stability

Storage

Oral

Powder for Suspension

2–8°C; if stored at 25°C, use within 3 months.¹ Do not expose to >40°C.¹

Actions

• Patiromer sorbitex calcium consists of patiromer, a nonabsorbed cation-exchange polymer, and a calcium-sorbitol counterion; used for the removal of excess potassium.^{1 3 5 7}

• Increases fecal potassium excretion via binding of potassium in the GI lumen, which decreases the free potassium concentration in the GI lumen and, consequently, reduces serum potassium concentrations.¹

• In patients with chronic kidney disease and hyperkalemia (mean serum potassium concentration of 5.9 mEq/L), patiromer (16.8 g daily in divided doses for 2 days) reduced serum potassium concentrations by 0.2 and 0.8 mEq/L at 7 and 48 hours, respectively; potassium concentrations stable for 24 hours after last dose, then began to increase.^{1 7}

• In healthy individuals, exhibits a dose-dependent increase in fecal potassium excretion and corresponding dose-dependent decrease in urinary potassium excretion, with no change in serum potassium concentrations.¹ Effects on fecal and urinary potassium excretion similar whether administered as single daily dose or in 2 or 3 divided doses daily.¹

Advice to Patients

• Importance of administering other oral drugs ≥3 hours before or ≥3 hours after administration of patiromer.¹

• Importance of adhering to prescribed diet; may take patiromer without regard to food.¹

• Importance of preparing each dose immediately before administration according to manufacturer's instructions.¹ Do not heat (e.g., in microwave) or add to heated foods or liquids; do not administer patiromer in its dry form.¹

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹

• Importance of informing patients of other important precautionary information.¹ (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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