Version May 2024
Hyperkalemia, chronic:
Oral: Initial: 8.4 g once daily; adjust dose by 8.4 g daily at ≥1-week intervals, as needed, based on serum potassium levels; maximum dose: 25.2 g/day.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (no systemic absorption) (Ref).
Hemodialysis, intermittent (thrice weekly): Unlikely to be significantly dialyzed: No supplemental dose or dosage adjustment necessary (no systemic absorption) (Ref).
Peritoneal dialysis: Unlikely to be significantly dialyzed: No dosage adjustment necessary (no systemic absorption) (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Patiromer: Pediatric drug information")
Hyperkalemia, chronic:
Children ≥12 years and Adolescents: Oral: Initial: 4 g once daily; adjust dose at weekly intervals (or longer) in 4 g/day increments based on serum potassium levels; maximum daily dose: 25.2 g/day.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
No dosage adjustment necessary.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults.
1% to 10%:
Endocrine & metabolic: Hypokalemia (5%), hypomagnesemia (5% to 9%)
Gastrointestinal: Abdominal distress (2%), constipation (7%), diarrhea (5%), flatulence (2%), nausea (2%)
<1%: Hypersensitivity: Hypersensitivity reaction
Frequency not defined: Gastrointestinal: Vomiting
Hypersensitivity to patiromer or any component of the formulation.
Canadian labeling: Additional contraindications (not in US labeling): Hereditary condition of fructose intolerance (eg, sorbitol).
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:
• Older adult: May experience more gastrointestinal adverse reactions.
Veltassa 1 g packets: FDA approved October 2023; anticipated availability currently unknown. Veltassa 1 g packets are intended for use in pediatric patients 12 years and older. Consult the prescribing information for additional information.
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)
No
Pack (Veltassa Oral)
8.4 g (per each): $54.77
16.8 g (per each): $40.99
25.2 g (per each): $40.99
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Oral:
Veltassa: 8.4 g (8.4 g); 16.8 g (30 ea)
Oral: 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. Other beverages or soft foods (eg, apple sauce, yogurt, pudding) may be used for preparation and administration instead of water. Do not heat patiromer (eg, microwave) or add to heated foods or liquids. According to the manufacturer, all medications except those that have been identified as not having a clinically important interaction with patiromer should be administered at least 3 hours before or 3 hours after patiromer (consult drug interactions database for more information).
Oral: Administer without regard to food. Do not administer patiromer in its dry form; requires mixing with liquid or soft food and immediate consumption. According to the manufacturer, all medications except those that have been identified as not having a clinically important interaction with patiromer should be administered at least 3 hours before or 3 hours after patiromer (consult drug interactions database for more information). Do not heat patiromer (eg, microwave) or add to heated foods or liquids.
Mixing with liquid: Immediately prior to administration, measure 1/3 cup (~80 mL) of water (or other beverage) and pour half into an empty glass; empty entire contents of the packet(s) into the glass and stir thoroughly (powder will not dissolve and the mixture will look cloudy). Add remaining half of water and mix well; may add more water (or other beverage) to mixture until desired consistency and mix well. 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.
Mixing with soft food (eg, applesauce, yogurt, pudding): A minimum of 45 mL (3 tablespoons) of soft food will be needed to prepare a dose up to 4 g. Immediately prior to administration, place half of desired amount of soft food into a container, add up to 4 g of patiromer from packet(s), and mix well. Add remaining amount of soft food and mix well; may add more soft food until desired consistency and mix well.
Hyperkalemia, chronic: Treatment of hyperkalemia in adults and pediatric patients ≥12 years of age.
Limitations of use: Patiromer should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Bisoprolol: Patiromer may decrease the serum concentration of Bisoprolol. Management: Administer bisoprolol at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Carvedilol: Patiromer may decrease the serum concentration of Carvedilol. Management: Administer carvedilol at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
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. Risk D: 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. Risk D: 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. Risk D: Consider therapy modification
Mycophenolate: Patiromer may decrease the serum concentration of Mycophenolate. Management: Administer mycophenolate at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Nebivolol: Patiromer may decrease the serum concentration of Nebivolol. Management: Administer nebivolol at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
QuiNIDine: Patiromer may decrease the serum concentration of QuiNIDine. Management: Administer quinidine at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Telmisartan: Patiromer may decrease the serum concentration of Telmisartan. Management: Administer telmisartan at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Thiamine: Patiromer may decrease the serum concentration of Thiamine. Management: Administer oral thiamine at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification
Patiromer is not absorbed systemically following oral administration. Use during pregnancy is not expected to result in significant exposure to the fetus.
Patiromer is not absorbed systemically following oral administration. Breastfeeding is not expected to result in significant exposure to a breastfed child.
Consider the potassium content of the liquids or soft food used to prepare the mixture as part of the patient's dietary potassium recommendations.
Serum potassium and magnesium.
Note: Reference ranges may vary depending on the laboratory.
Serum potassium: 3.5 to 5 mEq/L (SI: 3.5 to 5 mmol/L).
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.
Onset of action: 7 hours (Bushinsky 2015)
Duration of action: 24 hours (Bushinsky 2015)
Absorption: Not systemically absorbed
Excretion: Feces (unchanged)
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