Lokelma (Sodium Zirconium Cyclosilicate) – Oral

What Is Lokelma?

Lokelma (sodium zirconium cyclosilicate) is a treatment option for hyperkalemia (high potassium levels in the body) in nonemergency situations. The zirconium cyclosilicate portion of Lokelma isn't absorbed through the gut and into the bloodstream. Instead, this part of Lokelma stays in your gut and trades its sodium and hydrogen for potassium.

By attaching to potassium, zirconium cyclosilicate helps the body get rid of extra potassium through your stool when you have a bowel movement.

Lokelma is a potassium binder. It's a prescription that's available as an oral (by mouth) powder that needs to be mixed with water. The Food and Drug Administration (FDA) hasn't assigned any black box warnings to this medication yet.

Drug Facts

Generic Name: Sodium zirconium cyclosilicate

Brand Name(s): Lokelma

Drug Availability: Prescription

Therapeutic Classification: Potassium binder

Available Generically: No

Controlled Substance: N/A

Administration Route: Oral (by mouth)

Active Ingredient: Sodium zirconium cyclosilicate

Dosage Form(s): Powder that needs to be mixed with water

What Is Lokelma Used For?

Lokelma is used for hyperkalemia (high potassium levels in the body) in nonemergency situations.

It's unknown how common hyperkalemia is, but around 2% to 3% of the general population likely has high potassium levels. In the hospital setting, the estimate may be up to 10%.

Common causes of hyperkalemia include:

  • Kidney problems
  • High-potassium diet
  • Medication side effects

Symptoms of high potassium include:

  • Muscle weakness
  • Nausea
  • Numbness or tingling sensation

Get medical help right away, however, if you develop the following serious hyperkalemia symptoms:

  • Abnormal heartbeat or heart rhythm
  • Breathing difficulties
  • Chest pain
  • Nausea or vomiting

How to Take Lokelma

The following is general information on how to take Lokelma:

  • Fill your cup with at least 3 tablespoons (45 milliliters) of water before emptying the entire contents of the Lokelma packet into the cup. Stir well and drink the mixture.
  • If you still see powder in your cup after taking the mixture, add more water into the cup and drink the remaining powder mixture. Keep repeating this step until there's no more powder in your cup.
  • Remember to take other oral medications at least two hours before or after drinking the Lokelma mixture.
  • If you're not on dialysis, you'll likely start out with 10 grams of Lokelma by mouth three times daily for two days. Afterward, your usual dose can vary from 5 grams every other day to 15 grams daily—depending on your potassium levels. If you're experiencing hypokalemia (low potassium levels in your body), your healthcare provider may stop Lokelma.
  • If you're on dialysis, take Lokelma on non-dialysis days. You'll usually start out at 5 grams to 10 grams of Lokelma on non-dialysis days. Depending on your potassium levels, your typical dose may vary from five grams to 15 grams on non-dialysis days. If your potassium is lower than the normal range, your healthcare provider may stop Lokelma.

Storage

When you receive your Lokelma prescription from the pharmacy, store it at room temperature, which is between 59 degrees and 86 degrees Fahrenheit.

If you're going to travel with Lokelma, familiarize yourself with the regulations of your final destination. In general, however, make a copy of your Lokelma prescription. It's also a good idea to keep your medication in its original container or packaging from the pharmacy, with your name on it.

How Long Does Lokelma Take to Work?

Your potassium levels may lower within about one hour of taking Lokelma. Within three days, your potassium levels are likely to return to normal. People who experience these effects started their Lokelma treatment at 10 grams by mouth three times daily for two days.

Off-Label Uses

The FDA hasn't approved Lokelma for use in life-threatening or emergency hyperkalemia situations. A small 2020 study, however, suggests that using Lokelma with insulin and glucose might help in these situations.

Additionally, sodium polystyrene sulfonate (SPS) without sorbitol is a possible option for severe hyperkalemia when used with other treatments, like Lokelma, that help the body get rid of extra potassium.

What Are the Side Effects of Lokelma?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

A common side effect with of Lokelma is edema, which is swelling from fluid buildup.

Severe Side Effects

Severe side effects are possible with Lokelma. Get medical help right away if you experience the following serious side effects:

  • Worsening digestive tract (gut) conditions: Lokelma might raise your risk of an intestinal blockage. If you're having a blockage in your intestines, you may notice symptoms of severe constipation, bloating, stomach swelling, and severe stomach pain.
  • Worsening of certain medical conditions: Lokelma might increase your sodium levels, which can cause fluid buildup in your body. This fluid buildup may worsen your other medical conditions—like heart disease, causing heart failure. If you suspect that you're having severe edema, immediately notify your healthcare provider. Symptoms of worsening heart failure include breathing difficulties or abnormal mood and behavioral changes.
  • Low potassium levels: Lokelma might lower your potassium levels too much. If you're having hypokalemia (low potassium), you might experience symptoms of muscle weakness or cramps, abnormal heartbeat or heart rhythm, and numb or tingling sensations.

Long-Term Side Effects

Lokelma may continue to cause edema (swelling) with long-term use. The edema can occur anywhere on the body, including the arms, hands, legs, and feet.

Report Side Effects

Lokelma may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Lokelma Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (powder for suspension):
    • For treatment of hyperkalemia:
      • Adults—At first, 10 grams (g) 3 times a day for up to 48 hours. For patients receiving dialysis, the dose is usually 5 g once a day taken on non-dialysis days. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Lokelma:

Pregnancy and breastfeeding: Lokelma isn't absorbed into the bloodstream. Therefore, negative effects are unlikely for the unborn fetus during your pregnancy or nursing baby while nursing.

Children: There is little safety or effectiveness information about Lokelma in children.

Older adults over the age of 65 years: There are no differences between older and younger adults in regards to Lokelma's effectiveness and safety.

Dialysis: If you're on dialysis, your dosing will be slightly different than for someone who doesn't receive dialysis treatment. Additionally, you'll only take Lokelma on your non-dialysis days.

Acute illness—like an infection: Notify your healthcare provider right away if you're not feeling well. Having an acute (short-term) illness—like an infection—may cause appetite loss. You might also drink less water and experience diarrhea. These symptoms can affect your potassium levels. Therefore, your healthcare provider may need to adjust your Lokelma dose.

People with a high risk of edema: Lokelma might increase your sodium levels, which can cause your body to retain water. This water retention may also result in severe edema (swelling) from fluid buildup. Certain medical conditions—like heart failure or kidney impairment—further raises this risk. As a result, your healthcare provider will closely monitor your potassium levels and adjust your Lokelma dose accordingly.

Potassium levels: Your healthcare provider will regularly monitor your potassium levels and adjust your Lokelma dose accordingly. If you're having low potassium levels, your healthcare provider may stop Lokelma.

Missed Dose

If you accidentally forget your Lokelma dose, take it as soon as you remember. If it's already close to your next scheduled dose, however, skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Try to find ways to help yourself remember to routinely take your medication. If you miss too many doses, Lokelma might be less effective at ridding your body of the extra potassium.

Overdose: What Happens If I Take Too Much Lokelma?

There is limited information available about Lokelma overdose.

Taking too much Lokelma, however, might increase your risk of serious side effects, such as low potassium levels, severe edema, and worsening of certain medical conditions (e.g., heart failure and kidney impairment).

If you think that you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Lokelma?

If you think you or someone else may have overdosed on Lokelma, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Lokelma, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

This medicine may cause swelling in the different parts of your body. This is more likely if you have heart failure or kidney disease. You may also need to adjust your sodium intake while using this medicine. Talk to your doctor if you have any concerns.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests (eg, abdominal or stomach X-ray) may be affected by this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Lokelma?

Lokelma's prescribing information doesn't list any contraindications. Before taking Lokelma, however, talk with your healthcare provider if any of the following applies to you:

  • Severe or emergency hyperkalemia (high potassium levels in the body): Lokelma might not work quickly enough for severe or life-threatening hyperkalemia. Therefore, Lokelma isn't recommended for these situations.
  • Digestive tract (gut) conditions: Lokelma hasn't been studied in people with certain medical conditions of the gut, like severe constipation or intestinal blockage. If you have these medical conditions, avoid Lokelma. Lokelma might not work or may worsen your condition.
  • Stomach-area X-ray: Lokelma might affect X-ray procedures because it may look like an imaging agent (what you may take before an X-ray or other imaging test). Before your X-ray appointment, notify your healthcare provider that you're taking Lokelma.
  • Pregnancy and breastfeeding: Lokelma isn't absorbed into the bloodstream. As a result, negative effects are unlikely for the unborn fetus or nursing baby. If you have any questions or concerns, talk with your healthcare provider.
  • Children: We don't know enough about the safety and effectiveness information about Lokelma in children yet.
  • Adults over 65 years of age: Lokelma has no safety and effectiveness differences between older and younger adults, so differences in dosage for older adults are unlikely.

What Other Medications Interact With Lokelma?

Lokelma can briefly affect the acidity of the environment in your stomach. In fact, Lokelma can make your stomach less acidic (more basic).

This change in acidity can affect the absorption of some medications—including human immunodeficiency virus (HIV) medications—but not all medications. Your pharmacist or healthcare provider can help you determine if changes in your stomach environment will affect the absorption of your medications. To be safe, however, you can take all oral medications at least two hours before or after Lokelma.

For more detailed information about medication interactions with Lokelma, talk with your pharmacist or healthcare provider.

What Medications Are Similar?

Lokelma is a potassium binder, which is a small medication class. Other than Lokelma, this medication class includes just the following two medications:

  • Kayexalate (sodium polystyrene sulfonate)
  • Veltassa (patiromer)

Lokelma and Veltassa are the newer potassium binders, which are effective alternatives to sodium polystyrene sulfonate (SPS). Compared to SPS, the newer potassium binders have the following advantages:

  • Better taste, texture, and appearance
  • Better specific binding to potassium
  • Fewer side effects

Additional research might be needed, but Lokelma and Veltassa may also have the following possible pros:

  • No limitations to using renin-angiotensin-aldosterone system inhibiting (RAASi) medications that may raise potassium levels: Many of the RAASi medications are used for heart-related conditions. Examples include angiotensin-converting enzyme (ACE) inhibitors, like Prinvil or Zestril (lisinopril); angiotensin receptor blockers (ARBs), like Diovan or Entresto (valsartan), which relax your blood vessels and lowers your blood pressure; and mineralocorticoid receptor antagonists (diuretics that help your body avoid absorbing too much salt and keep your potassium levels stable), like Aldactone (spironolactone).
  • Ability to slow decreased potassium levels due to dialysis: Having this effect might lower the risk of abnormal heart rhythm and sudden cardiac (heart) death during dialysis.

Compared to Veltassa, Lokelma might stand out for the following reasons:

  • Lokelma starts working within one hour, but Valtessa requires seven hours.
  • The Lokelma powder requires less water to mix.
  • Lokelma can be stored at room temperature, while Veltassa should be stored in the refrigerator. If Veltassa is stored at room temperature, it will expire in three months.
  • Oral medications need to be taken two hours before or after Lokelma—but three hours before or after Veltassa.

Since all of these medications are potassium binders, they're not typically used together. In reference to the KDIGO (Kidney Disease Improving Global Outcomes Controversies Conference), however, Lokelma might have an off-label use with sodium polystyrene sulfonate (without sorbitol) for severe hyperkalemia.

Frequently Asked Questions

  • Where is Lokelma available?

    Lokelma is available as a prescription. You'll likely find it at your local retail pharmacy. If necessary, the pharmacy staff might need to order the product for you.

  • How much does Lokelma cost?

    A generic version of Lokelma isn't available, so it likely is expensive without insurance. If cost is a concern, Lokelma's manufacturer does offer a savings program. For eligibility questions, visit AstraZeneca's website or call 866-494-8080.

  • Do I need to change my diet while taking Lokelma?

    Depending on the severity of your high-potassium condition, your healthcare provider may recommend dietary changes. Some changes may include avoiding potassium supplements and limiting potassium-rich foods. Since Lokelma might increase your sodium levels, you may also need to eat foods with less sodium.

How Can I Stay Healthy While Taking Lokelma?

Depending on the severity of your high potassium condition, your healthcare provider may recommend some of the following tips to help you stay healthy:

  • Keep up with your potassium lab appointments to help your healthcare provider make any needed adjustments to your Lokelma dose and other medications.
  • Consider bringing a notebook to office visits with your healthcare provider. If your healthcare provider makes any changes to your medications, write the changes in your notebook to prevent medication errors.
  • If you're on dialysis, keep up with your dialysis appointments.
  • Don't eat large amounts of potassium-rich foods, such as avocados, bananas, and potatoes.
  • Since Lokelma may raise sodium levels, you may need to limit your sodium intake, as well.
  • Consider working with a registered dietitian (RD) or registered dietitian nutritionist (RDN) specializing in kidney care (renal dietitian) to help you with any dietary changes.
  • Don't take potassium supplements unless recommended by your healthcare provider.
  • Notify your healthcare provider if you suspect that you're experiencing severe edema (swelling).

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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