Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Veltassa: 8.4 g (1 ea, 4 ea, 30 ea); 16.8 g (1 ea, 30 ea); 25.2 g (1 ea, 30 ea)
Pharmacology
Mechanism of Action
Patiromer, a non-absorbed, cation exchange polymer that contains a calcium-sorbitol counterion, increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract, resulting in a reduction of serum potassium levels.
Pharmacokinetics/Pharmacodynamics
Absorption
Not systemically absorbed
Excretion
Feces (unchanged)
Onset of Action
7 hours (Bushinsky 2015)
Duration of Action
24 hours (Bushinsky 2015)
Use: Labeled Indications
Hyperkalemia: Treatment of hyperkalemia
Limitations of use: Patiromer should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
Contraindications
Hypersensitivity to patiromer or any component of the formulation
Dosage and Administration
Dosing: Adult
Hyperkalemia: Oral: Initial: 8.4 g once daily; adjust dose at ≥1-week intervals in increments of 8.4 g (maximum dose: 25.2 g/day)
Dosing: Geriatric
Refer to adult dosing.
Reconstitution
Immediately prior to administration, measure 1/3 cup of water and pour half into an empty glass; empty entire contents of the packet(s) into the glass and stir. Add the remaining water to the mixture; stir thoroughly (powder will not dissolve and the mixture will look cloudy). Add more water as needed for desired consistency.
Administration
Administer without regard to food. Do not administer patiromer in its dry form. Following reconstitution, drink mixture immediately. If powder remains in the glass after drinking, add more water, stir, and drink immediately; repeat as needed to ensure the entire dose is administered. Do not heat patiromer (eg, microwave) or add to heated foods or liquids. Administer other oral medications at least 3 hours before or 3 hours after patiromer.
Storage
Store at 2°C to 8°C (36°F to 46°F). If stored at room temperature (25°C ± 2°C [77°F ± 4°F]), use within 3 months of being taken out of the refrigerator. Avoid exposure to excessive heat above 40°C (104°F).
Drug Interactions
Ciprofloxacin (Systemic): Patiromer may decrease the serum concentration of Ciprofloxacin (Systemic). Management: Administer oral ciprofloxacin at least 3 hours before or 3 hours after patiromer. Consider therapy modification
Levothyroxine: Patiromer may decrease the serum concentration of Levothyroxine. Management: Administer oral levothyroxine at least 3 hours before or 3 hours after patiromer. Consider therapy modification
MetFORMIN: Patiromer may decrease the serum concentration of MetFORMIN. Management: Administer metformin at least 3 hours before or 3 hours after patiromer. Consider therapy modification
Adverse Reactions
1% to 10%:
Endocrine & metabolic: Hypomagnesemia (5% to 9%), hypokalemia (5%)
Gastrointestinal: Constipation (7%; transient), diarrhea (5%), abdominal distress (2%), flatulence (2%), nausea (2%)
<1%, postmarketing, and/or case reports: Hypersensitivity reaction (including lip edema)
Warnings/Precautions
Concerns related to adverse effects:
- GI effects: Avoid use in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders; patiromer may be ineffective and may worsen GI conditions.
- Hypomagnesemia: Patiromer binds to magnesium in the colon, which can lead to hypomagnesemia. Monitor serum magnesium and consider magnesium supplementation if hypomagnesemia develops.
Special populations:
- Elderly: May experience more gastrointestinal adverse reactions.
Monitoring Parameters
Serum potassium and magnesium.
Pregnancy
Pregnancy Considerations
Patiromer is not absorbed systemically following oral administration. Use during pregnancy is not expected to result in significant exposure to the fetus.
Patient Education
What is this drug used for?
- It is used to treat high potassium levels.
Frequently reported side effects of this drug
- Constipation
- Diarrhea
- Nausea
- Abdominal pain
- Passing gas
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
- Low magnesium like mood changes, muscle pain or weakness, muscle cramps or spasms, seizures, tremors, lack of appetite, severe nausea or vomiting, an abnormal heartbeat
- Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
