Table 2:

Pharmacokinetic and pharmacodynamic properties of novel potassium binders.

Characteristic	Patiromer	Sodium zirconium cyclosilicate (SZC)
Starting dose (adults)	8.4 g once daily	10 g three times per day for up to 48 h, followed by 10 g once daily
Maximum dose (adults)	25.2 g per day	15 g daily
Mechanism of action	Nonabsorbable cation exchange polymer that exchanges calcium for potassium ions and contains sorbitol as a laxative, increasing stool potassium excretion	Nonabsorbable non-polymer that selectively entraps potassium and ammonium ions in exchange for sodium and hydrogen ions, increasing stool potassium excretion
Primary site of action	Colon	Throughout the gastrointestinal tract, as early as the duodenum
Time to onset	Initial response: 7 h, peak response: 48 h	Initial response: 1 h
Duration	24 h	48 h in patients treated with SZC 10 g three times daily for up to 48 h
Adverse effects and tolerability	Gastrointestinal discomfort, constipation, diarrhea, flatulence, nausea	Peripheral edema, vomiting, constipation
Effect on magnesium	Can cause hypomagnesemia in 5.3%–9%	Negligible
Additional effects		Increased serum bicarbonate level (within the normal range) due to SZC binding ammonium