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. 2016 Jan;41(1):43–50.

Table 1.

Potassium-Binding Agents for Treatment of Patients With Hyperkalemia

Sodium Polystyrene Sulfonate Sodium Zirconium Cyclosilicilate (ZS-9) Patiromer (Valtessa)
FDA approval 1958 Pending 2015
Mechanism of action Nonspecific sodium-cation exchange resin20 Selective potassium cation trapping agent55 Calcium-potassium cation exchange resin45,48
Formulation

  • Oral suspension

  • Powder for reconstitution

  • Rectal enema21,22

  • Oral suspension

  • Dissolvable tablet35

  • Oral suspension45
Onset of action 1 to 2 hours27 1 hour42 7 hours45,48
Dosing

  • 15–60 g/day orally (1–4 times daily)

  • 30–50 g/day rectally (up to 4 times daily)21,22

  • 5–10 g once daily pending FDA approval35

  • 8.4–25.2 g once daily45
Common adverse events

  • GI disturbances (e.g., constipation, diarrhea, nausea, vomiting, gastric irritation)

  • Electrolyte disorders (e.g., hypokalemia, hypomagnesemia, hypocalcemia)32

  • Systemic alkalosis21,22

  • GI disturbances (e.g., constipation, diarrhea, nausea, vomiting)

  • Hypokalemia35–37

  • GI disturbances (e.g., constipation, diarrhea, nausea, vomiting, flatulence)

  • Hypokalemia48,49

  • Possible calcium load39

  • Hypomagnesemia48,49,54
Serious adverse events Colonic necrosis20,32 None35–37 None48,49,54